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BMJ Military Health Jun 2024Antarctic expeditions present exceptional physiological and mental challenges. Research data are lacking on psychological aspects of such endeavours. The aim of our...
INTRODUCTION
Antarctic expeditions present exceptional physiological and mental challenges. Research data are lacking on psychological aspects of such endeavours. The aim of our study is to provide data on changes in mood, well-being, personality traits and personal experiences during an Antarctica crossing.
METHODS
This is a study of a 33-year-old female British Army officer (height 175 cm; weight 75 kg; body mass index 24.49 kg/m; VO 49 mL/kg/min) who completed the longest, solo, unsupported, one-way polar ski expedition. The expedition started at Hercules Inlet and finished at Ross Ice Shelf, lasting 70 days and 16 hours covering 1484.53 km, with temperatures estimating from -12°C to -50°C and wind speeds of up to 60 miles per hour. The adventurer pulled all equipment and nutrition in a pulk (sled), weighing approximately 120 kg. Five psychometric questionnaires were completed pre post and during the expedition, including the International Personality Item Pool - Neuroticism, Extraversion and Openness-60, Brief Assessment of Mood, Positive and Negative Affective Schedule, Profile of Mood States, Wellness questionnaire, as well as an unstructured open questionnaire.
RESULTS
Mood generally deteriorated, particularly positive affective mood. Scores for fatigue and muscle soreness increased, with a reduction in sleep times. Personality traits of openness, agreeableness, and conscientiousness remained stable throughout the expedition, with some reduction in extraversion and an increase in neuroticism. Personal accounts give a unique insight into the increasing demands on the mental and physical impact of the expedition.
CONCLUSIONS
Meticulous preparation and planning may have led to a successful expedition, including physical preparation, prior on-field experience, and psychological preparedness and resiliance. Some of these strategies may be applicable to a range of settings, including future Antarctic expeditions, expeditions in extreme environments, or missions within a military context.
PubMed: 38897641
DOI: 10.1136/military-2023-002647 -
Psychology of Sport and Exercise Jun 2024Mental fatigue has been highly cited as having a negative impact on endurance performance. Few, however, have investigated whether different types of mental fatigue,...
Mental fatigue has been highly cited as having a negative impact on endurance performance. Few, however, have investigated whether different types of mental fatigue, namely active and passive fatigue, might affect endurance performance differently. This study used a repeated-measures design where 11 participants completed a 3 km run after three 32-min conditions: an actively fatiguing task (Task-load Dual-back; TloadDback); a passively fatiguing task (Mackworth Clock); and a control task (Documentary). Subjective ratings and performance on a second task (Flanker task) were taken before and after the 32-min tasks, while ratings of perceived effort, motivation and workload were taken during the 3 km run. Results showed that both fatigue conditions were mentally fatiguing, with the TloadDback rated as more demanding and the Mackworth Clock more boring and less motivating. Performance on subsequent tasks showed different effects: the TloadDback condition had the slowest responses on the post-test Flanker task, while the Mackworth Clock condition had the slowest completion time on the 3 km run, though this difference in completion times was non-significant. These results suggest that different cognitive tasks lead to different types of mental fatigue, which can lead to different outcomes on subsequent cognitive tasks but non-significant differences on subsequent physical tasks. This study highlights that to understand the influence of mental fatigue on physical performance, it is important to understand the cognitive tasks used and how different cognitive and physical tasks interact. Future work should examine whether performance outcomes in other areas commonly affected by mental fatigue, like technical and tactical sporting skills, are affected differently by active and passive fatigue.
PubMed: 38897333
DOI: 10.1016/j.psychsport.2024.102687 -
Sleep Jun 2024Mindfulness-based interventions (MBI) have been shown to improve psychosocial functioning in medical populations but have not been studied in narcolepsy. This study...
STUDY OBJECTIVES
Mindfulness-based interventions (MBI) have been shown to improve psychosocial functioning in medical populations but have not been studied in narcolepsy. This study examined the feasibility and acceptability of an MBI that was adapted for narcolepsy, including three variations in program length.
METHODS
Adults with narcolepsy (N = 60) were randomized to MBI groups of varying durations: brief (4 weeks), standard (8 weeks), or extended (12 weeks). Participants completed assessments at baseline, 4 weeks, 8 weeks, and 12 weeks. To assess feasibility and acceptability, primary outcomes included attendance, meditation practice, and data completeness. Additionally, participants completed measures of mindfulness, self-compassion, mood, sleep, psychosocial functioning, and cognition. An effect size of Cohen's d ≥ 0.5 was used as the pre-specified benchmark for a minimal clinically important difference (MCID).
RESULTS
The attendance, meditation, and data completeness benchmarks were met by 71.7%, 61.7%, and 78.3% of participants, respectively. Higher proportions of the brief and extended groups met these benchmarks compared to the standard group. All groups met the MCID for mindfulness, self-compassion, self-efficacy for managing emotions, positive psychosocial impact, global mental health, and fatigue. Standard and extended groups met the MCID for anxiety and depression, and extended group met the MCID for additional measures including social and cognitive functioning, daytime sleepiness, hypersomnia symptoms, and hypersomnia-related functioning.
CONCLUSION
Results suggest that the remote delivery and data collection methods are feasible to employ in future clinical trials, and it appears that the extended MBI provides the most favorable clinical impact while maintaining attendance and engagement in meditation practice.
PubMed: 38895897
DOI: 10.1093/sleep/zsae137 -
Journal of Clinical Medicine May 2024The most common post-acute consequences of SARS-CoV-2 include lung dysfunction, the impairment of cognitive functions and mental health, as well as the impairment of...
The most common post-acute consequences of SARS-CoV-2 include lung dysfunction, the impairment of cognitive functions and mental health, as well as the impairment of the musculoskeletal system in the form of fatigue and muscle weakness. Post-COVID-19 patients often experience impaired balance and reduced physical capacity. It is important to implement a rehabilitation program that eliminates the side effects of COVID-19 and allows for significant improvement in the patient's functionality. The aim of our study was to assess patient functionality after a 6-week rehabilitation program on balance, foot pressure distribution, and physical capacity in post-COVID-19 patients. The clinical study group consisted of 53 people 3 months after COVID-19 infection, confirmed by a positive PCR test. Exclusion from the study included people with comorbidities that impaired balance and gait. The patients underwent a posturographic assessment-Romberg test, a baropodometric assessment-static and dynamic, and a performance assessment-a 6 min walk test determining shortness of breath on the mMRC scale, blood pressure, heart rate, and saturation. Patients participated in rehabilitation until the sixth week, after which they were assessed again. Comparisons were made using IBM SPSS Statistics 27.0 software using the Wilcoxon pairwise order test, at a significance level of < 0.05. The result of the postural control assessment showed an improvement in the ability to maintain the centre of gravity in terms of the foot support area-statistical decreases were observed in the ellipse area, from 745.28 mm to 453.52 mm ( = 0.009), as well as maximum (from 3133.5 gr/cm to 2994.2 gr/cm; = 0.065) and average load on the left foot (from 1010.1 gr/cm to 969.38 gr/cm; = 0.028). In the 6 min walk test before and after exercise, the heart rate decreased after the therapy (shortness of breath on the mMRC scale also decreased from 79.12 to 74.95). This means that patients achieved better physical fitness and efficiency. Rehabilitation significantly improved balance, as measured by a decrease in ellipse area during the Romberg test
PubMed: 38892974
DOI: 10.3390/jcm13113257 -
Journal of Clinical Medicine May 2024Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystemic disease characterized by a complex, incompletely understood etiology. To...
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystemic disease characterized by a complex, incompletely understood etiology. To facilitate future clinical and translational research, a multicenter German ME/CFS registry (MECFS-R) was established to collect comprehensive, longitudinal, clinical, epidemiological, and laboratory data from adults, adolescents, and children in a web-based multilayer-secured database. Here, we present the research protocol and first results of a pilot cohort of 174 ME/CFS patients diagnosed at two specialized tertiary fatigue centers, including 130 (74.7%) adults (mean age 38.4; SD 12.6) and 43 (25.3%) pediatric patients (mean age 15.5; SD 4.2). A viral trigger was identified in 160/174 (92.0%) cases, with SARS-CoV-2 in almost half of them. Patients exhibited severe functional and social impairment, as reflected by a median Bell Score of 30.0 (IQR 30.0 to 40.0) and a poor health-related quality of life assessed with the Short Form-36 health survey, resulting in a mean score of 40.4 (SD 20.6) for physical function and 59.1 (SD 18.8) for mental health. The MECFS-R provides important clinical information on ME/CFS to research and healthcare institutions. Paired with a multicenter biobank, it facilitates research on pathogenesis, diagnostic markers, and treatment options. Trial registration: ClinicalTrials.gov NCT05778006.
PubMed: 38892879
DOI: 10.3390/jcm13113168 -
Journal of Clinical Medicine May 2024Permanent tracheostomy because of total laryngectomy surgery entails significant consequences for patients regarding respiratory physiopathology, such as the loss of...
Permanent tracheostomy because of total laryngectomy surgery entails significant consequences for patients regarding respiratory physiopathology, such as the loss of the filtering, humidifying, and heating of air by the nose. The use of special stomal filters can provide adequate protection of the tracheal-bronchopulmonary system with a reduction in respiratory pathologies. In fact, in most cases, laryngectomy patients are first cigarette smokers who for this reason also already have respiratory diseases such as chronic obstructive pulmonary disease (COPD). Despite the availability of tracheal filters, as reported in the literature, patients often tend to limit their use due to reported breathing difficulties, especially in conditions of intense breathing. The objective of this clinical study was to evaluate the most suitable stomal filter for laryngectomy patients during physical activity. The filters studied were an INHEALTH device (Blom-Singer SpeakFree HME); two ATOS devices (Provox Life™ Energy HME and Provox Life™ Home HME); and an FAHL device (Laryvox HME Sport). : For this purpose, the performances of 31 laryngectomy patients, subjected to medium-high physical effort, were analyzed through a standardized pneumological test, the Six Minute Walking Test (6MWT), which involves a sustained walk lasting six minutes, with an evaluation of heart rate, oxygen saturation, and meters traveled every 60 s; furthermore, we examined two subjective indices, namely, the basal and final dyspnea index and the initial and final muscular fatigue index. The multidisciplinary approach of the laryngectomee patient must also take pulmonary rehabilitation into consideration. It is the task of the medical team and speech therapy support to help the patient in the correct choice of HME filters taking into account daily needs.
PubMed: 38892850
DOI: 10.3390/jcm13113137 -
Foods (Basel, Switzerland) May 2024Long-term hepatic damage is associated with human morbidity and mortality owing to numerous pathogenic factors. A variety of studies have focused on improving liver...
Long-term hepatic damage is associated with human morbidity and mortality owing to numerous pathogenic factors. A variety of studies have focused on improving liver health using natural products and herbal medicines. We aimed to investigate the effect of enzyme-treated ethanol extract (ETZL), which increases the content of tricin via enzymatic hydrolysis, for 8 weeks on liver-related outcomes, lipid metabolism, antioxidant activity, and fatigue compared to a placebo. Healthy Korean adult males aged 19-60 years were randomized into ETZL treatment and placebo groups, and alcohol consumption was 24.96 and 28.64 units/week, respectively. Alanine transaminase, a blood marker associated with liver cell injury, significantly decreased after 8 weeks compared to the baseline in the ETZL treatment group ( = 0.004). After 8 weeks, the treatment group showed significant changes in the levels of high-density lipoprotein and hepatic steatosis index compared to the baseline ( = 0.028 and = 0.004, respectively). ETZL treatment tended to reduce antioxidant-activity-related factors, total antioxidant status, and malondialdehyde, but there was no significant difference. In the multidimensional fatigue scale, ETZL treatment showed a significant reduction in general fatigue and total-fatigue-related values after 8 weeks compared to the baseline ( = 0.012 and = 0.032, respectively). Taken together, the 8-week treatment of enzyme-treated ethanol extract demonstrated positive effects on liver-related outcomes, lipid metabolism, and mental fatigue without adverse effects on safety-related parameters.
PubMed: 38890953
DOI: 10.3390/foods13111725 -
Journal of the American Geriatrics... Jun 2024Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard treatment for insomnia disorder in adults. Compared to young adults, older adults have increased...
BACKGROUND
Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard treatment for insomnia disorder in adults. Compared to young adults, older adults have increased risk for the development of conditions associated with chronic pain, which may impact the efficacy of CBT-I in improving insomnia symptoms in older adults. This study evaluated the effect of participant-rated pain on sleep-related outcomes of a supervised, non-clinician administered CBT-I program in older adult patients with chronic insomnia disorder.
METHODS
Secondary analysis was conducted using data from a randomized controlled trial among 106 community-dwelling older adult veterans (N = 106; mean age 72.1 years, 96% male, 78.3% White, 6.6% Hispanic, 5.7% African American) with chronic (≥3 months) insomnia disorder. Participants engaged in five sessions of manual-based CBT-I in individual or group format within one Department of Veterans Affairs healthcare system, provided by non-clinician "sleep coaches" who had weekly telephone supervision by behavioral sleep medicine specialists. Insomnia symptoms (Insomnia Severity Index), perceived sleep quality (Pittsburgh Sleep Quality Index), fatigue (Flinder's Fatigue Scale), daytime sleepiness (Epworth Sleepiness Scale), and perceived pain severity (items from the Geriatric Pain Measure) were assessed at 4 time points: baseline, one-week posttreatment, 6-month follow-up, and 12-month follow-up. Mixed effects models with time invariant and time varying predictors were employed for analyses.
RESULTS
CBT-I improved insomnia symptoms, perceived sleep quality, fatigue, and daytime sleepiness among older veterans with chronic insomnia. Participant-reported pain was associated with greater improvements in insomnia symptoms following CBT-I. Pain did not affect improvements in other sleep-related outcomes (-0.38 ≤ b ≤ 0.07, p > 0.05). Between-subjects differences in pain, but not within-subject changes in pain over time, appeared to play a central role in insomnia symptom improvement at posttreatment, with individuals with higher-than-average pain showing greater insomnia symptom improvement (ISI score reduction; -0.32 ≤ b ≤ -0.28, p ≤ 0.005).
CONCLUSIONS
Pain did not meaningfully hinder the effects of CBT-I on sleep outcomes. Among older veterans with chronic insomnia disorder, individuals with higher pain exhibited slightly greater improvement in insomnia than those with lower levels of pain. These findings suggest that experiencing pain does not impair treatment response and should not preclude older adults with insomnia from being offered CBT-I.
PubMed: 38888493
DOI: 10.1111/jgs.18910 -
International Journal of MS Care May 2024Although the COVID-19 quarantine required everyone to make lifestyle changes, it may have had especially profound implications for individuals who experience multiple...
BACKGROUND
Although the COVID-19 quarantine required everyone to make lifestyle changes, it may have had especially profound implications for individuals who experience multiple sclerosis (MS)-related fatigue. Individuals with MS who suffer from fatigue are at risk of worsening symptoms and already predisposed to inactivity and social isolation. The objective of this study was to examine the impact of the COVID-19 national quarantine and related restrictions on mental, emotional, and physical fatigue in persons with MS in the United States.
METHODS
We conducted a survey open to all adults (>18 years) with MS within the United States. The survey gathered demographic information and asked how the COVID-19 pandemic impacted their physical, mental, and emotional fatigue.
RESULTS
The survey was completed by 600 individuals, 478 with relapsing MS and 122 with progressive MS. There was a significant 2-way interaction of time by fatigue type; both physical and emotional fatigue significantly increased during the pandemic ( <.01) and remained significantly higher after the pandemic than prior to the pandemic ( <.01). Mental fatigue increased significantly during the pandemic ( <.01) and although it remained higher, on average, after the pandemic, it was not significantly different from the level before the pandemic.
CONCLUSIONS
Individuals with MS experienced increases in physical, mental, and emotional fatigue over the course of the COVID-19 quarantine. Even after the lifting of quarantine restrictions, these levels have not returned to baseline. To adequately address fatigue, it is critical that health care professionals inquire about all types of fatigue in persons with MS.
PubMed: 38887278
DOI: 10.7224/1537-2073.2023-031 -
Frontiers in Oncology 2024Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The...
BACKGROUND
Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression.
METHODS
Patients seen at GSTT RDC between June 2019 and January 2023 completed the General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-8) questionnaires, at baseline. We used logistic regression (LR) and 2 machine learning (ML) algorithms (random forest (RF), support vector machine (SVM)) to predict risk of severe anxiety and severe depression. The models were constructed using a set of sociodemographic and clinical variables.
RESULTS
A total of 1734 patients completed GAD-7 and PHQ-8 questionnaires. Of these, the mean age was 59 years (Standard Deviation: 15.5), and 61.5% (n:1067) were female. Prevalence of severe anxiety (GAD-7 score ≥15) was 13.8% and severe depression (PHQ-8 score≥20) was 9.3%. LR showed that a combination of previous mental health condition (PMH, Adjusted Odds Rario (AOR) 3.28; 95% confidence interval (CI) 2.36-4.56), symptom duration >6 months (AOR 2.20; 95%CI 1.28-3.77), weight loss (AOR 1.88; 95% CI 1.36-2.61), progressive pain (AOR 1.71; 95%CI 1.26-2.32), and fatigue (AOR 1.36; 95%CI 1.01-1.84), was positively associated with severe anxiety. Likewise, a combination PMH condition (AOR 3.95; 95%CI 2.17-5.75), fatigue (AOR 2.11; 95%CI 1.47-3.01), symptom duration >6 months (AOR 1.98; 95%CI 1.06-3.68), weight loss (AOR 1.66; 95%CI 1.13-2.44), and progressive pain (AOR 1.50; 95%CI 1.04-2.16), was positively associated with severe depression. LR and SVM had highest accuracy levels for severe anxiety (LR: 86%, SVM: 85%) and severe depression (SVM: 89%, LR: 86%).
CONCLUSION
High prevalence of severe anxiety and severe depression was found. PMH, fatigue, weight loss, progressive pain, and symptoms >6 months emerged as combined risk factors for both these psychological comorbidities. RDCs offer an opportunity to alleviate distress in patients with concerning symptoms by expediting diagnostic evaluations.
PubMed: 38887232
DOI: 10.3389/fonc.2024.1358888