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Frontiers in Psychology 2024Health has effects on children's academic performance. Qi deficiency is generally used to assess an individual's health in the Chinese traditional medicine theory. This...
BACKGROUND
Health has effects on children's academic performance. Qi deficiency is generally used to assess an individual's health in the Chinese traditional medicine theory. This study explores the effects of qi deficiency on children's academic performance and examines whether mental fatigue mediates these effects.
METHODS
A total of 550 students aged 10-13 in fifth-grade were surveyed in a big primary school in Sichuan Province in November 2023 using paper-pencil-based questionnaires. Qi deficiency and mental fatigue were assessed, and exam scores in Chinese and Mathematics were recorded. Pearson's correlation and linear regression analyses were used to test the mediation model and hypotheses.
RESULTS
The fifth-grade students had mild qi deficiency (M = 2.09) and a mild state of mental fatigue (M = 2.38) on a five-point Likert scale. The average exam scores in Mathematics and Chinese were 70.07 and 74.44 points out of 100, respectively. Qi deficiency was associated with Mathematics scores ( = -0.37, < 0.01) and Chinese scores ( = -0.30, < 0.01), and mental fatigue ( = 0.47, < 0.01). Furthermore, mental fatigue was associated with Mathematics scores ( = -0.46, < 0.01) and Chinese scores ( = -0.34, < 0.01). Linear regression analyses showed that qi deficiency significantly predicted Mathematics scores ( = -0.26, < 0.01), Chinese scores ( = -0.19, < 0.01), and mental fatigue ( = 0.41, < 0.01). When qi deficiency was controlled for, mental fatigue significantly predicted Mathematics scores ( = -0.28, < 0.01) and Chinese scores ( = -0.17, < 0.01).
CONCLUSION
The mediation model and hypotheses were well supported, indicating that mental fatigue mediated the influence of qi deficiency on academic performance of fifth-grade students. Furthermore, the mediation effect of mental fatigue on Mathematics scores was a little stronger than that on Chinese scores.
PubMed: 38873520
DOI: 10.3389/fpsyg.2024.1369611 -
JAMA Network Open Jun 2024Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed.
OBJECTIVES
To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response.
DESIGN, SETTING, AND PARTICIPANTS
This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain.
INTERVENTIONS
Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions.
MAIN OUTCOMES AND MEASURES
The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants.
RESULTS
Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT.
CONCLUSIONS AND RELEVANCE
The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03918642.
Topics: Humans; Male; Chronic Pain; Veterans; Aged; Cognitive Behavioral Therapy; Female; Middle Aged; Aged, 80 and over; Stress Disorders, Post-Traumatic; Depression; Emotions; Treatment Outcome; Awareness; Anxiety; Pain Measurement
PubMed: 38869899
DOI: 10.1001/jamanetworkopen.2024.15842 -
Heliyon Jun 2024This pilot study evaluated the impact of using a 3D printed model of the patient's bronchovascular lung anatomy on the mental workload and fatigue of surgeons during...
OBJECTIVE
This pilot study evaluated the impact of using a 3D printed model of the patient's bronchovascular lung anatomy on the mental workload and fatigue of surgeons during full thoracoscopic segmentectomy.
DESIGN
We performed a feasibility pilot study of a prospective randomized controlled trial with 2 parallel arms. All included patients underwent digital 3D visual reconstruction of their bronchovascular anatomy and were randomized into the following two groups: Digital arm (only a virtual 3D model was available) and Digital + Object arm (both virtual and printed 3D models were available). The primary end-point was the surgeons' mental workload measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score.
SETTING
Between October 28, 2020 and October 05, 2021, we successively investigated all anatomic segmentectomies performed via thoracoscopy in the Thoracic Department of the Montsouris Mutualiste Institute, except for S6 segmentectomies and S4+5 left bi-segmentectomies.
PARTICIPANTS
We assessed 102 patients for anatomical segmentectomy. Among the, 40 were randomly assigned, and 34 were deemed analysable, with 17 patients included in each arm.
RESULTS
Comparison of the two groups, each comprising 17 patients, revealed no statistically significant difference in primary or secondary end-points. The consultation of the visual digital model was significantly less frequent when a 3D printed model was available (6 versus 54 consultations, p = 0.001). Notably, both arms exhibited high NASA-TLX scores, particularly in terms of mental demand, temporal demand, and effort scores.
CONCLUSION
In our pilot study, 3D printed models and digital 3D reconstructions for pre-operative planning had an equivalent effect on thoracoscopic anatomic segmentectomy for experienced surgeons. The originality of this study lies in its focus on the impact of 3D printing of bronchovascular anatomy on surgeons, rather than solely on the surgical procedure.
PubMed: 38867971
DOI: 10.1016/j.heliyon.2024.e31842 -
Journal of Occupational Health Jun 2024Although vaccines have promoted the socioeconomic normalization of the new coronavirus disease 2019 (COVID-19), adverse effects on work performance due to the...
OBJECTIVE
Although vaccines have promoted the socioeconomic normalization of the new coronavirus disease 2019 (COVID-19), adverse effects on work performance due to the post-vaccination side effects have been reported. Thus, we examined the relationship between the status of going to work the day following vaccination as a post-vaccination employment consideration and work performance among the Japanese workers in the manufacturing industry.
METHODS
Overall, 1,273 employees who received the COVID-19 vaccine in a Japanese manufacturing district were surveyed using a self-administered web-based questionnaire that included fever, fatigue, workplace attendance the day after vaccination, work performance one week after vaccination, and the demographic and occupational characteristics (age, gender, work style, and psychological distress [K6 scale]). The effects of fatigue and attendance on declining work performance were estimated using a linear mixed model, with individuals as random effects and the rest as fixed effects.
RESULTS
After adjusting for the demographic and occupational characteristics, the third-order interaction of fever, fatigue, and attendance on the day following vaccination was significant. The non-attendance group had a significantly higher work performance than the attendance group in those without fever and long-term fatigue [F(1, 1559)=4.9, p=0.026] and with fever and short-term fatigue [F(1, 1559)=5.9, p=0.015]. Fever and workplace attendance the following day were not directly related to a decrease in work performance after vaccination.
CONCLUSIONS
Our findings suggest that non-attendance at the workplace is associated with work performance due to the side effects after COVID-19 vaccination.
PubMed: 38865583
DOI: 10.1093/joccuh/uiae030 -
Scientific Reports Jun 2024Post-COVID Syndrome has emerged as a significant public health concern worldwide with increasing evidence to suggest that individuals who have had an acute COVID-19...
Post-COVID Syndrome has emerged as a significant public health concern worldwide with increasing evidence to suggest that individuals who have had an acute COVID-19 infection report lingering memory and attention difficulties, even in individuals who have fully recovered and no longer experiencing symptoms of COVID-19. The present study sought to investigate the profile of objective and subjective cognitive difficulties in people who have Post-COVID Syndrome, people who have fully recovered from an acute COVID infection and people who have never had COVID-19. We further sought to explore the extent to which self-reported fatigue and stress are related to subjective and objective cognitive difficulties. 162 participants including 50 people living with Post-COVID Syndrome, 59 people who have had COVID-19 but have fully recovered and 53 people who have never experienced symptoms of COVID-19 and had never tested positive for COVID-19 were recruited from Academic Prolific to complete a series of online questionnaires and neurocognitive tasks. Subjective cognitive function was measured using the Cognitive Failures Questionnaire and objective cognitive function was measured using the Cognitron cognitive test battery. We found that objective and subjective measures of cognitive function were not significantly related, suggesting that self-reports of "brain fog" are not reflecting objectively measured cognitive dysfunction. A MANOVA revealed that subjective cognitive deficits were driven by heightened perceived stress and fatigue and not significantly related to COVID-19 status. Objective cognitive function, however, was significantly related to perceived stress and COVID status whereby we observed significant objective cognitive deficits in people who have been exposed to an acute COVID-19 infection regardless of whether they had Post-COVID Syndrome or had fully recovered, as compared to people who had never had COVID-19. This suggests that an acute infection can have long term effects on cognitive function, even without persistent COVID-19 symptoms. Encouragingly, objective cognitive function was significantly associated with time since initial infection showing that cognitive deficits improved over time for people who had recovered from COVID-19. However, we did not observe the same improvement in individuals with Post-COVID Syndrome and observed that cognitive dysfunction was significantly related to the number of neurological symptoms presently experienced. These results add to the accumulating literature that COVID-19 is associated with significant cognitive difficulties following a COVID-19 infection, which appear to improve over time for those who have recovered from COVID-19 yet persist in people living with Post-COVID Syndrome.
Topics: Humans; COVID-19; Male; Female; Middle Aged; Adult; Post-Acute COVID-19 Syndrome; Cognition; SARS-CoV-2; Fatigue; Neuropsychological Tests; Surveys and Questionnaires; Stress, Psychological; Cognitive Dysfunction; Aged; Self Report
PubMed: 38862569
DOI: 10.1038/s41598-024-62050-x -
Trials Jun 2024Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line... (Comparative Study)
Comparative Study
BACKGROUND
Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined.
METHODS
This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment).
DISCUSSION
The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I.
TRIAL REGISTRATION
Trial registration number in the German Clinical Trials Register: DRKS00028153 ( https://drks.de/search/de/trial/DRKS00028153 ). Registered on 16th May 2023.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy; Treatment Outcome; Internet-Based Intervention; Equivalence Trials as Topic; Quality of Life; Germany; Multicenter Studies as Topic; Internet; Cost-Benefit Analysis; Time Factors; Severity of Illness Index
PubMed: 38858707
DOI: 10.1186/s13063-024-08214-6 -
Medicine Jun 2024Mindfulness-Based Cancer Recovery (MBCR) program is a group course training for cancer patients that combines cancer knowledge and psychological knowledge, emphasizing...
Effects of Mindfulness-Based Cancer Recovery training on anxiety, depression, post-traumatic stress disorder, and cancer-related fatigue in breast neoplasm patients undergoing chemotherapy.
RATIONALE
Mindfulness-Based Cancer Recovery (MBCR) program is a group course training for cancer patients that combines cancer knowledge and psychological knowledge, emphasizing focusing on the psychosomatic symptoms of cancer patients. Currently, the application value of Mindfulness-Based Cancer Recovery in improving psychosomatic health of cancer patients has been confirmed, however, its intervention effect on breast neoplasm patients has not yet been widely studied in China.
PATIENT CONCERNS AND DIAGNOSES
This study introduced the Mindfulness-Based Cancer Recovery protocol into the rehabilitation process of breast cancer patients, aiming to elucidate the effects of Mindfulness-Based Cancer Recovery on anxiety, depression, post-traumatic stress disorder, and cancer-related fatigue in breast neoplasm patients, to provide a practical basis for improving the physical and mental health of breast cancer patients.
INTERVENTION
In this study, 80 patients with chemotherapy-stage breast neoplasm attending the oncology department of a tertiary-level hospital from January 2022 to December 2022 were selected, 40 patients attending from January 2022 to June 2022 were included in the study group, and 40 patients attending from July 2022 to December 2022 were included in the control group. The control group was administered conventional care, and the study group was administered Mindfulness-Based Cancer Recovery based on conventional care in the control group for 8 weeks. After the intervention, hospital anxiety and depression scale, impact of event scale-revised, and cancer fatigue scale were used for evaluation.
OUTCOMES
After the intervention, hospital anxiety and depression scale scores decreased in both groups compared with pre-intervention, with the study group scoring lower than the control group (P < .05). After the intervention, the impact of event scale-revised scores of the 2 groups decreased from the preintervention period, with the study group scoring lower than the control group (P < .05). After the intervention, cancer fatigue scale scores decreased in the 2 groups compared with the preintervention period, with the study group scoring lower than the control group (P < .05).
LESSONS
Mindfulness-Based Cancer Recovery can effectively reduce the levels of anxiety, depression and post-traumatic stress disorder in breast neoplasm patients undergoing chemotherapy, reduce the levels of cancer-related fatigue, and promote the physical and mental health of patients.
Topics: Humans; Mindfulness; Female; Breast Neoplasms; Middle Aged; Fatigue; Stress Disorders, Post-Traumatic; Anxiety; Depression; Adult; China; Antineoplastic Agents
PubMed: 38847730
DOI: 10.1097/MD.0000000000038460 -
Sleep Science (Sao Paulo, Brazil) Jun 2024To compare the effects of strength training with load progression after 4 weeks on sleep parameters and mental health in college students. A total of 17...
To compare the effects of strength training with load progression after 4 weeks on sleep parameters and mental health in college students. A total of 17 university students (11 women, 6 men), ranging from 18 to 21 years old, were randomized into a strength training group (STG) and a control group (CG). The Pittsburgh sleep quality index (PSQI), insomnia severity questionnaire, hospital anxiety and depression (HAD) scale, profile of mood states (POMS), and chronotype were used to evaluate the main outcomes. Training consisted of 60 minute·d (2 times/week, for 4-weeks), with 3 sets of 10 to 12 repetitions, and a 1-minute rest interval between sets and exercises. Baseline and postintervention differences were analyzed using generalized estimating equations (GEE). After 4 weeks of ST, a significant time effect on the chronotype (β: 1.33; < 0.05) was observed in the STG. Additionally, there was a significant time and group effect in the reduction of tension (β: 5.00; < 0.05), depression (β: 15.41; < 0.05), anger (β: 8.00; < 0.05), and confusion (β: 6.50; < 0.05). For fatigue (β: 2.66; < 0.05), there was a significant time effect difference in its reduction. Vigor was meaningfully increased in the STG group (β: -1.75; < 0.05). Furthermore, a significant positive relationship was observed between sleep quality and anxiety (r = 0.54; = 0.03). Finally, insomnia was positively related with an increase in confusion (r = 0.70; = 0.04) and anxiety (r = 0.52; = 0.04), as well as with a decrease in vigor (r = -0.71; = 0.03). Short-term strength training for 4 weeks was effective for improving mental health, helping achieve characteristics of a positive mood profile, that is, low values for negative factors and a high value for the positive factor.
PubMed: 38846591
DOI: 10.1055/s-0043-1777781 -
PloS One 2024The association between SARS-CoV-2 humoral immunity and post-acute sequelae of COVID-19 (long COVID) remains uncertain. The objective of this population-based cohort...
The association between SARS-CoV-2 humoral immunity and post-acute sequelae of COVID-19 (long COVID) remains uncertain. The objective of this population-based cohort study was to assess the association between SARS-CoV-2 seropositivity and symptoms consistent with long COVID. English and Spanish-speaking members ≥ 18 years old with SARS-CoV-2 serologic testing conducted prior to August 2021 were recruited from Kaiser Permanente Southern California and Kaiser Permanente Colorado. Between November 2021 and April 2022, participants completed a survey assessing symptoms, physical health, mental health, and cognitive function consistent with long COVID. Survey results were linked to SARS-CoV-2 antibody (Ab) and viral (RNA) lab results in electronic health records. Weighted descriptive analyses were generated for five mutually exclusive patient groups: (1) +Ab/+RNA; (2) +Ab/- or missing RNA; (3) -Ab/+RNA; (4a) -Ab/-RNA reporting no prior infection; and (4b) -Ab/-RNA reporting prior infection. The proportions reporting symptoms between the +Ab/+RNA and -Ab/+RNA groups were compared, adjusted for covariates. Among 3,946 participants, the mean age was 52.1 years old (SD 15.6), 68.3% were female, 28.4% were Hispanic, and the serologic testing occurred a median of 15 months prior (IQR = 12-18). Three quarters (74.5%) reported having had COVID-19. Among people with laboratory-confirmed COVID-19, there was no association between antibody positivity (+Ab/+RNA vs. -Ab/+RNA) and any symptoms, physical health, mental health, or cognitive function. As expected, physical health, cognitive function, and fatigue were worse, and palpitations and headaches limiting the ability to work were more prevalent among people with laboratory-confirmed prior infection and positive serology (+Ab/+RNA) compared to those without reported or confirmed prior infection and negative serology (-Ab/-RNA/no reported COVID-19). Among people with laboratory-confirmed COVID-19, SARS-CoV-2 serology from practice settings were not associated with long COVID symptoms and health status suggesting limited utility of serology testing for long COVID.
Topics: Humans; Female; Male; COVID-19; Middle Aged; Antibodies, Viral; SARS-CoV-2; Adult; Aged; Post-Acute COVID-19 Syndrome; Colorado; Cohort Studies; RNA, Viral; California; Immunity, Humoral
PubMed: 38843198
DOI: 10.1371/journal.pone.0304262 -
Journal of Neuroengineering and... Jun 2024Many individuals with neurodegenerative (NDD) and immune-mediated inflammatory disorders (IMID) experience debilitating fatigue. Currently, assessments of fatigue rely...
Evaluation of walking activity and gait to identify physical and mental fatigue in neurodegenerative and immune disorders: preliminary insights from the IDEA-FAST feasibility study.
BACKGROUND
Many individuals with neurodegenerative (NDD) and immune-mediated inflammatory disorders (IMID) experience debilitating fatigue. Currently, assessments of fatigue rely on patient reported outcomes (PROs), which are subjective and prone to recall biases. Wearable devices, however, provide objective and reliable estimates of gait, an essential component of health, and may present objective evidence of fatigue. This study explored the relationships between gait characteristics derived from an inertial measurement unit (IMU) and patient-reported fatigue in the IDEA-FAST feasibility study.
METHODS
Participants with IMIDs and NDDs (Parkinson's disease (PD), Huntington's disease (HD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjogren's syndrome (PSS), and inflammatory bowel disease (IBD)) wore a lower-back IMU continuously for up to 10 days at home. Concurrently, participants completed PROs (physical fatigue (PF) and mental fatigue (MF)) up to four times a day. Macro (volume, variability, pattern, and acceleration vector magnitude) and micro (pace, rhythm, variability, asymmetry, and postural control) gait characteristics were extracted from the accelerometer data. The associations of these measures with the PROs were evaluated using a generalised linear mixed-effects model (GLMM) and binary classification with machine learning.
RESULTS
Data were recorded from 72 participants: PD = 13, HD = 9, RA = 12, SLE = 9, PSS = 14, IBD = 15. For the GLMM, the variability of the non-walking bouts length (in seconds) with PF returned the highest conditional R2, 0.165, and with MF the highest marginal R2, 0.0018. For the machine learning classifiers, the highest accuracy of the current analysis was returned by the micro gait characteristics with an intrasubject cross validation method and MF as 56.90% (precision = 43.9%, recall = 51.4%). Overall, the acceleration vector magnitude, bout length variation, postural control, and gait rhythm were the most interesting characteristics for future analysis.
CONCLUSIONS
Counterintuitively, the outcomes indicate that there is a weak relationship between typical gait measures and abnormal fatigue. However, factors such as the COVID-19 pandemic may have impacted gait behaviours. Therefore, further investigations with a larger cohort are required to fully understand the relationship between gait and abnormal fatigue.
Topics: Humans; Feasibility Studies; Male; Female; Middle Aged; Fatigue; Walking; Aged; Mental Fatigue; Neurodegenerative Diseases; Gait; Wearable Electronic Devices; Immune System Diseases; Adult; Accelerometry
PubMed: 38840208
DOI: 10.1186/s12984-024-01390-1