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1.
Rehabilitation (Stuttg) ; 58(5): 339-350, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31645080

RESUMO

Multiple sclerosis is the most common cause of non-traumatic disability in young adults. The following article addresses special features of multiple sclerosis in the context of neurological rehabilitation. The rehabilitative and symptomatic therapy of frequent symptoms and functional deficits are presented independently of the course of the disease. Rehabilitation in MS focuses on functional deficits in mobility, paresis, spasticity, ataxia, bladder dysfunction, fatigue, cognitive symptoms, depression and pain. The multimodal inpatient rehabilitation comprises aerobic training in MS-specific groups and interventions targeting individual deficits. Neuropsychological training, individual and group session on coping and adherence to therapy as well as advice on social issues and the evaluation of the work place situation complement the therapy options. The early age of onset of the disease often causes an early restriction of participation in working life. The restoration and maintenance of work ability is therefore an essential goal of neurological rehabilitation, as well as the organization of aftercare and the introduction of vocational rehabilitation services.


Assuntos
Fadiga/complicações , Esclerose Múltipla/psicologia , Esclerose Múltipla/reabilitação , Reabilitação Neurológica/métodos , Atividades Cotidianas , Depressão/reabilitação , Alemanha , Humanos , Qualidade de Vida , Centros de Reabilitação , Resultado do Tratamento
2.
Expert Opin Pharmacother ; 20(11): 1309-1320, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237780

RESUMO

Introduction: Multiple sclerosis (MS) is a demyelinating disease, causing axonal damage and disability. Dalfampridine (DAL) is an extended-release formulation of 4-aminopyridine (4AP) and broad-spectrum voltage-dependent potassium channel blocker that is reported to improve motor, visual and cognitive functions. Furthermore, it is presently the only approved drug for walking impairment in MS. Areas covered: Herein, the authors evaluate DAL as a relapsing-remitting MS treatment, reporting and commenting on all aspects of the drug including its chemistry, safety, pharmacokinetics, and cost-effectiveness. A bibliographic search was performed on PubMed using the terms 'dalfampridine OR fampridine OR 4-aminopyridine'. Expert opinion: Evidence from post-marketing studies suggests that DAL, consistent with the effects of 4AP, may not only improve walking speed, but also arm function, fatigue, mood and cognition through restored nerve conduction in central nervous system demyelinated areas. Long-term safety data confirm that the approved dose of 10 mg twice daily is generally well tolerated. However, despite the reported efficacy, the extent of the benefits is limited in real life activities, although significant improvements have been demonstrated in the clinical setting. Patients often complain of side effects (such as cramps and painful paraesthesia) or lack of efficacy. Also, its considerably higher pricing in comparison to 4AP represents an important limitation.


Assuntos
4-Aminopiridina/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Bloqueadores dos Canais de Potássio/uso terapêutico , 4-Aminopiridina/efeitos adversos , 4-Aminopiridina/química , 4-Aminopiridina/farmacocinética , Ensaios Clínicos como Assunto , Disfunção Cognitiva/complicações , Análise Custo-Benefício , Bases de Dados Factuais , Fadiga/complicações , Meia-Vida , Humanos , Esclerose Múltipla Recidivante-Remitente/economia , Bloqueadores dos Canais de Potássio/efeitos adversos , Bloqueadores dos Canais de Potássio/química , Bloqueadores dos Canais de Potássio/farmacocinética , Convulsões/etiologia , Resultado do Tratamento
3.
BMC Infect Dis ; 19(1): 439, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109292

RESUMO

BACKGROUND: Brucellosis has extensive clinical spectrum, clinicians have insufficient understanding of the disease, and the misdiagnosis rate is still high. By collecting and analyzing the clinical characteristics of patients with brucellosis in Heilongjiang Province to provide guidance and reference for clinicians to make timely diagnosis and treatment. METHODS: The demographic and epidemiological characteristics, clinical features, complications, laboratory findings were retrospectively evaluated in 850 brucellosis patients admitted in the Department of Infectious Diseases of the First Affiliated Hospital of Harbin Medical University and the Second Hospital of Daqing from 2012 to 2017. RESULTS: Of the 850 patients, the most common clinical manifestations were fever (93.3%), joint pain (69.8%), sweating (45.2%), fatigue (38.6%), and splenomegaly (34.0%). Peripheral arthritis, spondylitis and epididymal-orchitis were the common complications. Of the 398 patients who were followed up and completed treatment, 22 (5.5%) had relapse. CONCLUSIONS: Brucellosis is a multisystem disease with diverse clinical manifestations. In areas where brucellosis is endemic, the possibility of the disease should be considered in patients with unexplained fever and joints pain. In addition, the high rate of relapse is mainly due to the misdiagnosis of complications, so local CT or MRI examination is necessary for patients with joint pain and low back pain. Timely diagnosis, early detection of complications are essential to improve the prognosis and reduce relapse.


Assuntos
Brucelose/diagnóstico , Adolescente , Adulto , Idoso , Artralgia/complicações , Brucelose/complicações , Brucelose/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Fadiga/complicações , Feminino , Febre/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Esplenomegalia/complicações , Adulto Jovem
4.
Medicine (Baltimore) ; 98(14): e14853, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946312

RESUMO

BACKGROUND: Zao Ren An Shen (ZRAS), a Chinese Herbal Medicine product, has been proposed as an alternative to recommended treatments for chronic insomnia. There is a lack of strong evidence supporting this proposition. AIMS: To assess the efficacy and safety of ZRAS capsule for chronic insomnia compared to placebo. METHODS: A parallel-group, double-blind, randomized-controlled trial will be performed in Western Sydney University, Australia. After a 1-week placebo run-in, adults with chronic insomnia (n = 90) will be randomized in a 1:1 ratio to receive either ZRAS capsule or placebo for 4 weeks. Insomnia severity (Insomnia Severity Scale score), sleep parameters (measured with the Consensus Sleep Diary and actigraphy), fatigue levels (Fatigue Severity Scale score), psychological status (Depression Anxiety Stress Scale score), quality of life (Assessment of Quality of Life score), and adverse events will be assessed at baseline, mid-treatment, post-treatment and at a 1-month follow-up. EXPECTED OUTCOMES: We hypothesize that ZRAS capsule will improve insomnia severity, sleep parameters, fatigue levels, psychological status, and quality of life better than placebo at mid-treatment, post-treatment, and follow-up. We also hypothesize that the number of adverse events provoked by ZRAS capsule will be similar to placebo at these time-points. TRIAL REGISTRATION: Australia New-Zealand Clinical Trial Registry (Registration number ACTRN12619000140156).


Assuntos
Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Adulto , Austrália/epidemiologia , Doença Crônica , Medicamentos de Ervas Chinesas/administração & dosagem , Fadiga/complicações , Humanos , Qualidade de Vida , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/psicologia , Resultado do Tratamento
5.
Front Neural Circuits ; 13: 12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30853901

RESUMO

Prolonged performance of a demanding cognitive task induces cognitive fatigue. We examined the behavioral and neural responses to fatigue-induced cognitive impairments in young and older adults. Particular emphasis was placed on whether the brain exhibited compensatory neural activity in response to cognitive fatigue. High-density EEG was recorded from a young (n = 16; 18-33 years of age) and an older (n = 18; 60-87 years of age) cohort who performed a Stroop task continuously for ∼2 h with no breaks. In the young cohort, behavioral performance declined as the experiment progressed, reflecting the deleterious effects of cognitive fatigue. Neurophysiologically, in addition to declining neural activity as cognitive fatigue developed, there is also evidence of region- and time-specific increase in neural activity, suggesting neural compensation. The compensatory activities followed patterns paralleling that of posterior-anterior shift in aging (PASA) and early to late shift in aging (ELSA) observed in cognitive aging and helped to moderate fatigue-induced behavioral deterioration. In the older cohort, behavioral performance did not decline as the experiment progressed, and neural activity either declined or stayed unchanged, showing no evidence of neural compensation, in contrast to the young. These results suggest that young and older adults coped with cognitive fatigue differently by exhibiting differential responses as a function of time-on-task at both the behavioral level and the neural level.


Assuntos
Envelhecimento/fisiologia , Mapeamento Encefálico , Ondas Encefálicas/fisiologia , Transtornos Cognitivos/patologia , Fadiga/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/complicações , Sinais (Psicologia) , Eletroencefalografia , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação/fisiologia , Teste de Stroop , Adulto Jovem
6.
Anaesthesia ; 74(8): 992-1000, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30883682

RESUMO

The incidence of an anaesthetic drug error can be directly observed in large trials. In an alternative approach, we developed a probabilistic mathematical model in which the anaesthetist is modelled as a 'fallible entity' who makes repeated drug administration choices during an operation. This fallibility was factored in the model as an initial 'intrinsic error rate'. The choices faced included: dose; timing of administration; and the routes available for injection (e.g. venous, arterial, epidural, etc.). Additionally, we modelled the effect of fatigue as a factor that magnifies the cumulative error rate. For an initial intrinsic error rate of 1 in 1000 (which from first principles we consider a reasonable estimate), our model predicted a cumulative probability of error over a ~12 h operation of ~10%; that is, 1 in 10 operations this long results in some drug error. This is similar to the rate reported by large observational trials. Serious errors constitute a small fraction of all errors; our model predicts a Poisson distribution for the uncommon serious errors, also consistent with independent observations. Even modest assumptions for the development of fatigue had a dramatic and adverse impact on the cumulative error rate. The practice implications of our modelling include: exercising caution or avoiding starting work if under par; added vigilance in unfamiliar environments; keeping anaesthetic recipes simple; and recognising that operation durations > 5-6 h constitute a time of exaggerated risk. These implications are testable predictions in observational trials. If validated, our model could serve as a potential research tool to investigate the impact of safety interventions on the rate of intrinsic error using simulation.


Assuntos
Anestesia/efeitos adversos , Anestésicos/administração & dosagem , Fadiga/complicações , Erros de Medicação , Humanos , Injeções , Modelos Teóricos , Duração da Cirurgia , Risco
7.
Teach Learn Med ; 31(2): 136-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30596293

RESUMO

Phenomenon: Fatigue is a significant risk factor for deterioration in performance, which may lead to medical errors and reduced well-being in resident physicians (residents). Sleep deprivation, which has been studied extensively, is only one contributor to fatigue. Given the complexity of fatigue and its relationship with resident performance, the National Steering Committee on Resident Duty Hours in Canada recommends that all residency education programs develop a fatigue risk management plan (FRMP) for their residents. The purpose of this study was to explore the impact of residents' experiences of fatigue and the strategies they use to manage it. Approach: This single-site study investigated the perceptions of resident physicians. Residents were recruited through purposive sampling to ensure representation from a variety of programs, postgraduate year level, and gender. Recruitment was managed with support from the residency programs; however, data collection and analysis were conducted by the Office of Postgraduate Medical Education to ensure participant anonymity. Program directors and administrators assisted in relaying the information about the study to the residents; however, they were not made aware if their residents participated in the study. Interview and focus group data were collected all at once, then transcribed, and then subsequent thematic analysis of these data was conducted using a quasi-constant comparison approach until thematic saturation was reached. Two researchers coded the data using thematic content analysis. Findings: Fifty-seven residents participated in a focus group or interview. There was representation from more than half of the 58 residency programs and from 15 of 16 departments. Overall, there was consensus that fatigue impacts residents' physical, cognitive, and emotional states. These impacts were reported as influencing resident performance including those related to patient care. Residents reported that fatigue led them to be less productive in their personal and professional lives. Three major themes were identified for which strategies could be developed for fatigue risk management: self, program, and system. Together with self-, program-, and system-level strategies that complement and enhance each other, specific targeted FRMPs could be developed. Insights: Fatigue is a multifaceted phenomenon experienced by residents that requires management beyond extended duty hours and adequate amounts of sleep. FRMPs that encompass strategies used by the resident, the residency-training program, and the healthcare system in which they work could assist with managing fatigue in residents and support enhanced resident well-being and patient care.


Assuntos
Fadiga/complicações , Internato e Residência , Gestão de Riscos , Canadá , Feminino , Grupos Focais , Humanos , Internato e Residência/organização & administração , Entrevistas como Assunto , Masculino , Segurança do Paciente , Admissão e Escalonamento de Pessoal , Pesquisa Qualitativa
8.
AIDS Behav ; 23(3): 602-608, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30659425

RESUMO

Fatigue among adolescents living with HIV is poorly understood. In this study, we examined the relationships between fatigue and demographic and psychosocial variables to further the understanding of the symptom experience and associated factors. We recruited consecutive attenders at ART clinics in the Western Cape, South Africa (N = 134, age 11-18 years). Participants completed a battery of questionnaires including measures of fatigue, insomnia and mood disturbance. Just under a quarter (24.6%) of adolescents reported elevated levels of fatigue that affected their functioning. The linear combination of age, depression, and insomnia explained 40.6% of the variance in fatigue. Amongst adolescents with HIV, fatigue seems a problematic symptom associated with poor sleep and mood disturbance. Timely identification and management of these potentially disabling symptoms are needed to attain better health outcomes and retention in care in this group. Interventions aimed at ameliorating these symptoms are needed.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Terapia Antirretroviral de Alta Atividade , Depressão/psicologia , Fadiga/complicações , Infecções por HIV/tratamento farmacológico , Adolescente , Afeto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Criança , Depressão/epidemiologia , Fadiga/epidemiologia , Fadiga/psicologia , Fadiga/virologia , Feminino , HIV , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Masculino , Distúrbios do Início e da Manutenção do Sono/complicações , África do Sul/epidemiologia , Estresse Psicológico/complicações , Inquéritos e Questionários
9.
Med Hypotheses ; 123: 60-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30696594

RESUMO

This study researches the cause of tumor, cancer related fatigue (CRF) and cancer cachexia (CC), and the relationship among tumor and CRF and CC. Carcinogenesis is consequence of failure of tissue development. Tumor originates from tissue regeneration. The tumor cell is normal incomplete differentiated cell that stop in different phases of differentiation. Tumor promoter stimulates stem cell to proliferate. Carcinogen obstructs stem cell to differentiate. With tumor promoter and carcinogen, the tissue stem cells proliferate but cannot differentiate into mature cell, and form tumors. The disorder of biological signals cell proliferation and differentiation facilitates tumor development. CRF and CC are consequence of endocrine hypofunction and failure caused by persistent stress. Nature factors and psychological factors stimulate organic stress. The significant change of stress is the activation of endocrine system. The persistent stress exhausts the capacity of endocrine glands or hormone receptors of target cells, and leads to endocrine hypofunction even failure. CRF and CC are clinical manifestation of endocrine hypofunction and failure. Cancer is a local lesion, also is a systemic disease. As a local lesion, carcinogen obstructed stem cell to differentiate, developmental failure of local tissue forms tumor. As a systemic disease, cancer is related to natural physical, chemical, and biological factors, as well as negative spiritual factors. The material and spiritual factors induce persistent stress which eventually leads to endocrine hypofunction even failure and unbalance of homeostasis. The disorder of biological signals of cell proliferation and differentiation facilitates tumor development. CRF and CC, as clinical manifestation of endocrine hypofunction and failure, have nothing to do with tumor size and type, but facilitate tumor development. CRF and CC are through all the course of systemic cancerous disease, and commonly precede tumorigenesis. Many patients have been found tumors because of symptoms of CRF and CC. Even if no tumor be found at that time, various tumors would be found in the follow-up. For systemic cancerous disease, cachexia is the cause of death. Most cancer patients do not die of tumor, but of cancer cachexia. Eradicating tumor cell cannot cure systemic cancerous disease; on the contrary, the poisonous side effect of therapies usually speeds up the progress of CC and death. It is important for curing cancer cachexia and restoring the patient's constitution to prevent systemic cancer and improve the quality of life and prolong the survival.


Assuntos
Caquexia/patologia , Sistema Endócrino/fisiopatologia , Fadiga/patologia , Neoplasias/patologia , Estresse Psicológico , Caquexia/complicações , Caquexia/psicologia , Carcinogênese , Diferenciação Celular , Proliferação de Células , Sistema Endócrino/efeitos dos fármacos , Fadiga/complicações , Fadiga/psicologia , Humanos , Inflamação , Neoplasias/complicações , Neoplasias/psicologia , Qualidade de Vida , Regeneração , Transdução de Sinais/efeitos dos fármacos , Células-Tronco/citologia , Células-Tronco/metabolismo
10.
Accid Anal Prev ; 122: 25-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30300796

RESUMO

Intercity bus crashes often involve driver fatigue, which itself is usually the result of sleep deprivation, long driving hours, a maladjusted circadian rhythm, or some combination of the above. And driver scheduling has long been suspected as the root cause affecting sleepiness and fatigue. As such, a fundamental question for intercity bus carriers is how to reduce crashes associated with driver schedules, while maintaining a nonstop service? This research seeks to develop a paradigm to minimize overall fleet crash risk by rescheduling. In this study, we first identified those driving schedules associated with the highest crash risks, and a rescheduling scheme is then proposed to reduce fleet crashes overall. A case-study approach was employed to identify driver scheduling associated with higher crash risk, and a mathematical program was then formulated to minimize fleet crash risk. Our results showed that several types of driver schedules would lead to higher crash risk; for example: (1) working in the afternoon or early hours in the morning for two consecutive days; and (2) commencing a driving shift in the mornings, the afternoon or the early hours of the morning after being off-duty for more than 24 h. To meet the challenge of maintaining a nonstop service while simultaneously minimizing the crash risk associated with these risk patterns, a mathematical program was developed, and it was found that rescheduling based on our algorithm could reduce the incidence of crashes by approximately 30 percent.


Assuntos
Acidentes de Trabalho/prevenção & controle , Acidentes de Trânsito/prevenção & controle , Condução de Veículo , Admissão e Escalonamento de Pessoal , Carga de Trabalho/estatística & dados numéricos , Acidentes de Trabalho/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Algoritmos , Estudos de Casos e Controles , Fadiga/complicações , Fadiga/prevenção & controle , Humanos , Modelos Lineares , Fatores de Risco , Sonolência
11.
Lung Cancer ; 126: 125-132, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527176

RESUMO

INTRODUCTION: Little is known about the optimal amount and timing of exercise strain in concern of the operation wound and with regard improvement of physical function and quality of life (QOL) after surgery for lung cancer. On this background, we decided to investigate the effect of early vs. late initiated postoperative rehabilitation in patients with operable lung cancer on exercise capacity, functional capacity, muscle strength, and QOL. METHODS: The study was designed as a two-armed randomized controlled trial with randomization to either early initiated postoperative rehabilitation (14 days after surgery (ERG)) or a control arm with late initiated postoperative rehabilitation (14 weeks after surgery (LRG)). The primary endpoint was a change in maximum oxygen consumption (VO2peak) from baseline to post intervention 26 weeks following lung resection. Fatigue was measured with EORTC QLQ C30 LC13. RESULTS: From April 2013 to June 2016, 582 patients with operable NSCLC were screened for eligibility. With 119 patients randomized in the early rehabilitation group (ERG) and 116 randomized to late rehabilitation group (LRG). There was no significant difference from baseline to 26 weeks between ERG and LRG (p = 0.926). There was a significant difference from baseline to 14 weeks between groups (p = 0.0018). There was a significant difference from 14 weeks to 26 weeks between the two groups (p < 0.001). We found no significant differences in QOL but we found a significant difference between ERG and LRG from baseline to 14 weeks in fatigue level in favour of ERG. CONCLUSION: This is the first randomized controlled trial to investigate the effects of early vs. late initiated postoperative rehabilitation in patients with lung cancer. There is no difference in the commencement (early vs. late) of a postoperative exercise program for patients with lung cancer on exercise capacity. But to reduce fatigue patients should be recommended to initiate early exercise programs.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/reabilitação , Fadiga/prevenção & controle , Neoplasias Pulmonares/reabilitação , Cuidados Pós-Operatórios/métodos , Idoso , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Exercício , Terapia por Exercício/métodos , Fadiga/complicações , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Testes de Função Respiratória , Fatores de Tempo
12.
Rev. neurol. (Ed. impr.) ; 67(10): 387-393, 16 nov., 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-175272

RESUMO

La esclerosis múltiple es una enfermedad inflamatoria que hasta el día de hoy afecta a la población del hemisferio norte, generando una gran carga socioeconómica. Uno de los síntomas menos favorables en este fenómeno patológico crónico es la fatiga. En esta revisión, sustentamos y favorecemos una alteración principal en el complejo del eje hipotálamo-hipófiso-adrenal y sus consecuencias fisiopatológicas, relacionadas mayormente con el glutamato y los niveles de cortisol. Trataremos de sustentar nuestra hipótesis en lo que se ha notificado hasta el momento, corroborando que las células inflamatorias liberan mayormente glutamato, una sustancia neurotóxica que conlleva un efecto desmielinizante y como resultado principal fatiga como síntoma. Cuando esta hipótesis se demuestre, podríamos trazar dianas terapéuticas para detener la liberación de glutamato en estas células inmunológicas, de manera que podamos evitar la fatiga en la esclerosis múltiple


Multiple sclerosis is an inflammatory disease, which still today affects the Northern-hemisphere population, generating a socioeconomically burden. One of the most unfavorable symptoms in this chronic disorder is fatigue. In this review, we favor and sustain a main alteration of the hypothalamus-pituitary-axis complex and its physiopathologic consequences, mostly related to glutamate and corticoid levels. We try to sustain our hypothesis in what is already reported, corroborating that the inflammatory cells release mainly glutamate, a neuro-toxic substance which leads to a demyelinating effect and as a main result fatigue as a symptom. When this hypothesis is demonstrated, we could trace therapeutic targets to stop the release of glutamate of these immunologic cells, in order to avoid fatigue in multiple sclerosis patients


Assuntos
Humanos , Ácido Glutâmico/uso terapêutico , Fadiga/complicações , Fadiga/etiologia , Esclerose Múltipla/diagnóstico por imagem , Imagem por Ressonância Magnética , Microglia
13.
Medicine (Baltimore) ; 97(40): e12659, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30290646

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide with a substantial and increasing social and economic burden. Liuzijue Qigong is a kind of traditional Chinese Qigong exercises that Traditional Chinese Medicine practitioners prescribe to individuals with COPD to strengthen the internal organs' function. Liuzijue Qigong was recommended for use in COPD rehabilitation, and some clinical trials indicate that Liuzijue Qigong would produce better functional capacity and quality of life of individuals with COPD. The objective of this study is to conduct a systematic review of the existing studies to assess effectiveness and safety of Liuzijue Qigong for the prevention or treatment of COPD in patients. METHODS: We will perform the comprehensive literature search in English and Chinese electronic database. The publication period will be from inception to the search date. In addition, the clinical trial registries, dissertations, informal publication, grey literature, reference lists of studies, systematic reviews, and conference abstracts will also be collected. Two reviewers will identify relevant studies, extract data information, and then assess the methodical quality by the Cochrane risk of bias assessment tool. Only randomized controlled trials comparing Liuzijue Qigong against other intervention or nonintervention will be included. Data will be synthesized by either fixed-effect or random-effect model regarding to a heterogeneity test. The routine lung function, arterial blood gas tensions, partial pressure of carbon dioxide, functional capacity, 30 seconds sit-to-stand test, respiratory function, maximal inspiration pressure, maximal expiratory pressure, airway resistance, and specific airway conductance will be assessed as primary outcomes. The secondary outcomes involved dyspnea, and fatigue levels, respiratory muscle strength, upper and lower limb muscle strength, handgrip strength test, and health-related quality of life and safety. Meta-analysis will be performed by using Cochrane's Review Manager software (version 5.3.5). RESULTS: This systematic review and meta-analysis will provide a high-quality synthesis and evaluate the efficacy and safety based on current relevant literature evidence of Liuzijue Qigong intervention for COPD patient. CONCLUSION: Our systematic review will provide evidence to determine whether Liuzijue Qigong is an effective and safe approach to prevention and treatment of COPD patients.


Assuntos
Força Muscular/fisiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qigong/métodos , Músculos Respiratórios/fisiopatologia , Atividades Cotidianas , Resistência das Vias Respiratórias/fisiologia , Gasometria , Dispneia/complicações , Teste de Esforço , Fadiga/complicações , Força da Mão , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida , Projetos de Pesquisa , Testes de Função Respiratória , Revisão Sistemática como Assunto
14.
Aerosp Med Hum Perform ; 89(8): 708-716, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30020055

RESUMO

BACKGROUND: Flight crew fatigue is an important factor in aviation, leading organizations to implement fatigue risk management programs to reduce risk. The U.S. Air Force Air Mobility Command (AMC) has implemented the Aviation Operational Risk Management (AvORM) program to aid mission schedulers and flight crews in mitigating flight risks and identifying appropriate levels of risk. The AvORM program uses a scheduling tool and underpinning biomathematical fatigue model. This study examined self-reported fatigue-related incidents within AMC, which provides some indirect and anecdotal evidence as to the effectiveness of the scheduling tool. METHODS: Archival data from the AMC Aviation Safety Action Program (ASAP) Safety Reporting System was examined. Report content themes were created through an inductive approach in terms of fatigue prevalence, antecedents, and consequences. RESULTS: Fatigue was estimated as a factor in 4% of the reports. The two most commonly referenced fatigue antecedents were associated with mission/duty length and mission scheduling/planning factors. Factors associated with aircraft operation violations were the most cited consequences of fatigue. Fatigue was almost twice as likely to be reported as a secondary rather than primary contributing factor. Aircrew reported both positive and negative aspects of AvORM resources in mission planning and fatigue mitigation. DISCUSSION: Examination of ASAP reports suggests that fatigue is a contributing factor to safety incidents. Although the AvORM program highlights potential flight risks by utilizing a scheduling tool built upon an underlying biomathematical fatigue model, human fatigue continues to impact safety, suggesting an ongoing need for improved fatigue risk management and mitigation.Morris MB, Wiedbusch MD, Gunzelmann G. Fatigue incident antecedents, consequences, and aviation operational risk management resources. Aerosp Med Hum Perform. 2018; 89(8):708-716.


Assuntos
Acidentes Aeronáuticos/prevenção & controle , Fadiga/complicações , Militares , Gestão de Riscos/métodos , Acidentes Aeronáuticos/estatística & dados numéricos , Humanos , Modelos Estatísticos , Admissão e Escalonamento de Pessoal , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Autorrelato , Estados Unidos/epidemiologia
15.
Mult Scler Relat Disord ; 22: 161-165, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29775851

RESUMO

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are associated with reduced Health Related Quality of Life (HRQOL). To the best of our knowledge, change of HRQOL in patients with NMOSD has not been yet measure in Iran. The objective of this study was to assess HRQOL in NMOSD and MS patients and identify related factors METHODS: A cross sectional study of 41 patients with NMOSD and 136 age and sex-match MS patients was performed. A series of questionnaires including Persian validated questionnaires on HRQOL (SF-36), fatigue (MFIS), depression (BDI-II), anxiety (HAM-A) and sleep quality (PSQI) were record. All demographic variables, socioeconomic status and clinical data were also obtained. Student's T test and Mann-Whitney U test used to compare variables between groups and multivariate regression analysis applied to assay predictor factors. RESULTS: The mean scores of mental (MCS) and physical (PCS) components of QOL were statistically lower in patients with NMOSD compare with MS patients (ß = -4.49, P = 0.004; ß = -3.52, P = 0.015). Multivariate analysis indicated fatigue, depression and anxiety were independent, significant predictor of MCS (ß = -0.229, P = 0.002; ß = -0.229, P = 0.002; ß = -0.258, P = 0.020 respectively). However, PCS was significantly predicted by fatigue (ß = -0.258 P < 0.001), solely. CONCLUSION: These findings indicate NMOSD patients have lower HRQOL in compare to patients with MS. Also, screening and treatment of fatigue as the most important predictor for HRQOL is necessary.


Assuntos
Depressão , Fadiga , Esclerose Múltipla/psicologia , Neuromielite Óptica/psicologia , Qualidade de Vida , Adulto , Ansiedade/complicações , Estudos Transversais , Depressão/complicações , Fadiga/complicações , Feminino , Humanos , Irã (Geográfico) , Masculino , Esclerose Múltipla/complicações , Análise Multivariada , Neuromielite Óptica/complicações , Fatores Sexuais , Transtornos do Sono-Vigília/complicações , Inquéritos e Questionários
16.
J Athl Train ; 53(5): 503-509, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29771139

RESUMO

CONTEXT: National Basketball Association (NBA) athletes experience a high rate of injuries. Injury prevention requires identifying observable and controllable risk factors. OBJECTIVE: To examine the relationship among game load, fatigue, and injuries in NBA athletes. DESIGN: Cross-sectional study. SETTING: Game statistics and injury reports over 3 NBA seasons (2012-2015). PATIENTS OR OTHER PARTICIPANTS: Data represented 627 players (height = 200.7 ± 8.9 cm, mass = 100.6 ± 12.1 kg, NBA experience = 4.8 ± 4.2 years, pre-NBA experience = 3.2 ± 1.9 years), 73 209 games, and 1663 injury events. MAIN OUTCOME MEASURE(S): An injury event was defined as a player missing or leaving a game due to injury. Logistic multilevel regression was used to predict injuries from time-lagged fatigue and game load with between-subjects differences explained by demographic variables. RESULTS: The odds of injury increased by 2.87% ( P < .001) for each 96 minutes played and decreased by 15.96% ( P < .001) for each day of rest. Increases in game load increased injury odds by 8.23% ( P < .001) for every additional 3 rebounds and 9.87% ( P < .001) for every additional 3 field-goal attempts. When fatigue and game load were held constant, injury odds increased by 3.03% ( P = .04) for each year of NBA experience and 10.59% ( P = .02) for a 6-cm decrease in height. I observed variability in the intercepts ( P < .001) and the slopes for minutes, rest, field-goal attempts, and rebounds (all P < .001). CONCLUSIONS: Injuries were associated with greater fatigue and game load, more years of NBA experience, and being shorter than average. Both baseline injury risk and the magnitude of the load-injury and fatigue-injury associations varied across individuals. Researchers should explore the nature of these relationships.


Assuntos
Basquetebol/lesões , Comportamento Competitivo/fisiologia , Fadiga/complicações , Carga de Trabalho , Adulto , Estudos Transversais , Humanos , Incidência , Modelos Logísticos , Masculino , Fatores de Risco , Estados Unidos/epidemiologia
17.
Dan Med J ; 65(4)2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29619936

RESUMO

Iron deficiency and anaemia in the puerperium are associated with several important clinical consequences, most prominently physical fatigue. Current treatment practice with oral iron supplementation is associated with gastrointestinal side-effects and subsequent poor compliance. Red blood cell transfusion is also widely used to treat severe postpartum anaemia, though accumulating evidence questions its risk-benefit ratio. Intravenous iron has in previous studies been associated with fast improvement of haemoglobin and iron biochemical markers in the treatment of postpartum anaemia, but there is a lack of studies on patient reported outcomes.
 The thesis is based on three studies of intravenous iron (Monofer, iron isomaltoside) as an alternative to current treatment practice in postpartum iron deficiency and anaemia.
The first study is a randomised controlled trial comparing a high single-dose iron infusion with oral iron in women after postpartum haemorrhage without severe anaemia. The primary outcome was the aggregated change in physical fatigue within 12 weeks postpartum. We found a difference that was statistically significant, but less than the consensus-based and predefined minimal clinically relevant level. Across visits, particularly in the first weeks postpartum, we found statistically significant differences in fatigue and depression scores, all in favour of intravenous iron. We confirmed previous findings of a fast haematopoietic response and prompt replenishment of iron stores that persisted throughout the 12 weeks of follow-up. 
The second study, a randomised controlled pilot study, tested feasibility and exploratory outcomes of a high single-dose iron infusion compared with red blood cell transfusion for the treatment of severe postpartum anaemia. We found that randomisation could be feasible with some adjustments for a future study design. The difference in biochemical markers was larger than the patient-reported outcomes in the first week. A larger trial is needed to determine whether a high single-dose iron infusion is non-inferior to red blood cell transfusion in severe postpartum anaemia. 
The third study compared iron concentration in breast milk in a randomised sample of women receiving high single-dose iron infusion or oral iron. A high single-dose iron infusion lead to a transient increase in the iron concentration in breast milk, which remained within the normal range. 
In conclusion, iron isomaltoside seems to be associated with improved patient-reported outcomes compared to oral iron treatment, and in severe postpartum anaemia intravenous iron seems promising as an alternative to red blood cell transfusion.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Ferro/administração & dosagem , Anemia Ferropriva/sangue , Biomarcadores/sangue , Dinamarca , Depressão/complicações , Relação Dose-Resposta a Droga , Transfusão de Eritrócitos , Fadiga/complicações , Estudos de Viabilidade , Feminino , Humanos , Infusões Intravenosas , Ferro/sangue , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Hemorragia Pós-Parto/terapia , Período Pós-Parto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença
18.
J Neurol ; 265(6): 1328-1333, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29574556

RESUMO

BACKGROUND: Few studies have evaluated the impact of physical activity (PA) on cognition and fatigue, and none have considered the effects of PA on the relationship between cognition and fatigue. OBJECTIVES: We evaluated the effect of PA in people with multiple sclerosis (pwMS) in a 6-month-long single-blind randomized controlled trial. We focused on the impact of exercise on cognition, fatigue, and the relationship between cognition and fatigue. METHODS: We recruited pwMS, who were then randomly assigned 1:1 to either a PA protocol group or a control group (CG). All patients underwent assessments using the Brief International Cognitive Assessment for Multiple Sclerosis including symbol digit modality test (SDMT), Berg Balance Scale (BBS), gait analysis, 6-Minute Walk Test, Timed Up and Go (TUG) test, and the Modified Fatigue Impact Scale (MFIS) at the beginning of the study (T0), at the end of the study (EOS) 24 weeks after T0, and at 24 weeks following the EOS (FU). RESULTS: A Wilcoxon test revealed a significant effect of exercise in the PA group, but not in the CG. Significant differences between T0 and EOS were found in the spatiotemporal parameters of gait, and performance on the SDMT, TUG, BBS, and MFIS. These differences were also present during the FU period. A regression model revealed that the baseline MFIS score predicted processing speed improvement (R2 = 0.65, p < 0.01), as the SDMT T score increased by 0.3 for each one-unit increase in the MFIS score at T0. CONCLUSION: PA affects multiple aspects of the pathology in pwMS. Patients with greater fatigue must not be discouraged from exercise, as they may greatly benefit from PA. Specifically, PA was shown to improve information processing speed.


Assuntos
Terapia por Exercício , Fadiga/psicologia , Fadiga/terapia , Processos Mentais , Esclerose Múltipla Recidivante-Remitente/psicologia , Esclerose Múltipla Recidivante-Remitente/terapia , Adulto , Exercício/psicologia , Teste de Esforço , Fadiga/complicações , Fadiga/fisiopatologia , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Testes Neuropsicológicos , Equilíbrio Postural , Prognóstico , Índice de Gravidade de Doença , Método Simples-Cego , Adulto Jovem
19.
PLoS One ; 13(3): e0193728, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29505598

RESUMO

INTRODUCTION: The aim of this study was to evaluate the proportion of patients with Systemic Lupus Erythematosus (SLE) who did not met the WHO recommendations for physical activity and to evaluate the amount of time spent in sedentary behavior. METHODS: SLE patients were consecutively enrolled in a cross sectional study. The type and the time spent in physical activity and sedentary behavior were evaluated using the IPAQ short form questionnaire. The adequate physical activity was defined according to the 2010 WHO recommendations for health and the sedentary behavior according to the 2017 SBRN consensus. We also assessed quality of life using SF-36, mood disorders using BDI and HAM-H, fatigue using Facit-Fatigue and sleep disorders using PSQI scores. RESULTS: Physical activity was not sufficient to meet WHO recommendations in 56 of 93 SLE patients (60%). SLE patients spent a median (95% range) of 180 (0-600) minutes everyday in sedentary activities. The length of daily sedentary time was more than 6 hours in 25% of SLE patients. In multivariable analysis, the factors associated to the probability of not meeting WHO criteria was only the time of exposure to antimalarials (OR 0.88, p 0.03) and the factors related to the probability of being in the upper tertile of sedentary time (more than 270 minutes) were age (OR 1.04, p 0.02), disease activity expressed by SELENA-SLEDAI score (OR 1.2, p 0.01) and Facit-fatigue score (OR 0.94, p 0.04). CONCLUSION: A relevant proportion of SLE patients were inadequately physically active. It is essential to improve the awareness of the importance of increase physical activity and reduce sedentary time. A better control of disease activity and fatigue and a prolonged use of antimalarials could help to reach this notable goal.


Assuntos
Exercício , Lúpus Eritematoso Sistêmico/fisiopatologia , Comportamento Sedentário , Adulto , Afeto , Estudos Transversais , Fadiga/complicações , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/psicologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sono , Inquéritos e Questionários
20.
J Neurol ; 265(5): 1016-1025, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29464379

RESUMO

OBJECTIVE: To assess the effects of PR-fampridine on cognitive functioning, fatigue and depression in patients with multiple sclerosis (PwMS). METHODS: Thirty-two PwMS were included in this trial. Cognitive performance was assessed in an open-label and randomized double-blind, placebo-controlled study design using a comprehensive neuropsychological test battery as well as questionnaires examining depression and fatigue. RESULTS: We found significant improvements in cognitive measures assessing alertness (tonic alertness, p = 0.0244 and phasic alertness, p = 0.0428), psychomotor speed (p = 0.0140) as well as verbal fluency (p = 0.0002) during open-label treatment with PR-fampridine. These effects of performance were paralleled by patients' perception of reduced fatigue (physical, p = 0.0131; cognitive, p = 0.0225; total, p = 0.0126). Fampridine-induced improvements in phasic alertness (p = 0.0010) and measures of fatigue (physical, p = 0.0014; cognitive, p = 0.0003; total, p = 0.0005) were confirmed during randomized, double-blind, placebo-controlled assessment in the second year. In addition, we found positive effects of PR-fampridine on depressive symptoms (p = 0.0049). We demonstrated persisting beneficial effects of PR-fampridine on fatigue in PwMS over a period of more than 2 years. Drug responsiveness regarding cognitive performance and fatigue was not limited to walking responders. CONCLUSIONS: Our data demonstrate significant positive effects of treatment with PR-fampridine over 2 years on different cognitive domains as well as fatigue and depression in a cohort of PwMS. These findings imply that PR-fampridine should be considered as symptomatic treatment improving aspects of cognition, fatigue and depression in PwMS.


Assuntos
4-Aminopiridina/uso terapêutico , Cognição/efeitos dos fármacos , Depressão/tratamento farmacológico , Fadiga/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Psicotrópicos/uso terapêutico , Preparações de Ação Retardada , Depressão/complicações , Método Duplo-Cego , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Testes Neuropsicológicos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada
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