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In the wake of the COVID-19 pandemic, millions worldwide are still struggling with persistent or recurring symptoms known as long COVID. Fatigue is one of the most prevalent symptoms associated with long COVID, and for many it can be debilitating. Understanding the potential pathological processes that link fatigue to long COVID is critical to better guide treatment. Challenges with diagnosis and treatment are reviewed, recognizing that post-COVID fatigue does not always present with corroborating clinical evidence, a situation that is frustrating for both patients and healthcare providers. Firefighters are a group of public safety workers who are particularly impacted by long COVID-related fatigue. Firefighters must be able to engage in strenuous physical activity and deal with demanding psychological situations, both of which may be difficult for those suffering from fatigue. Disruption in public safety worker health can potentially impact community welfare. This review creates a framework to explain the clinical-pathological features of fatigue resulting from long COVID, addresses diagnosis and treatment challenges, and explores the unique impact fatigue may pose for public safety workers and their organizations.

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BACKGROUND: In the context of rheumatoid arthritis and its systemic inflammatory implications, there is an increasing interest in investigating the role of prolactin in the clinical and metabolic aspects of the disease. This study aimed to explore the potential links between serum prolactin levels, serum glucose levels, and the clinical manifestations of arthritis. METHODS: This exploratory, cross-sectional, observational study focused on women diagnosed with rheumatoid arthritis. The research involved assessing prolactin and blood glucose concentrations, alongside specific clinical traits such as disease-related inflammation, morning stiffness, and fatigue intensity. The presence of changes in serum prolactin (PRL) was initially compared among the groups based on disease activity intensity. Using a multinomial regression analysis, the study analyzed the impact of predetermined clinical and metabolic factors on various categories of prolactin concentration. RESULTS: Out of the 72 participants included in the study, hyperprolactinemia was detected in 9.1% of the sample. No differences in serum PRL were identified among the evaluated groups based on disease activity. Following multivariate analysis, no statistically significant differences were identified for the outcomes of inflammatory activity and morning stiffness within each PRL category when compared to the reference category for PRL. There was no increased likelihood of encountering blood glucose levels below 100 mg/dl among individuals with higher prolactin concentrations compared to those in the lowest prolactin category (OR 5.43, 95% CI 0.51-58.28). The presence of clinically significant fatigue revealed a higher likelihood of encountering this outcome among patients with intermediate PRL values (prolactin categories 7.76-10.35 with OR 5.18, 95% CI 1.01-26.38 and 10.36-15.29 with OR 6.25, 95% CI 1.2-32.51) when compared to the reference category. CONCLUSIONS: The study found no discernible correlation between prolactin concentrations and worse scores for inflammatory activity of the disease, nor between prolactin concentrations and serum glucose levels. The findings regarding fatigue should be approached with caution given the exploratory nature of this study.

Assuntos

Artrite Reumatoide , Glicemia , Hiperprolactinemia , Prolactina , Humanos , Prolactina/sangue , Artrite Reumatoide/sangue , Feminino , Estudos Transversais , Glicemia/análise , Pessoa de Meia-Idade , Hiperprolactinemia/sangue , Adulto , Índice de Gravidade de Doença , Fadiga/sangue , Fadiga/etiologia

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Introduction: Therapeutic exercise has an important role in the population living with cancer as it improves function and quality of life and reduces the symptoms of cancer treatment. There is little clinical evidence on the effects of hypopressive exercise in women with gynecological cancer. Objective: Evaluate the effects of 4 weeks of hypopressive exercise associated with muscle strength training and aerobic exercises on fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecological cancer compared to a group that will perform conventional training. Methods: This randomized, single-blinded clinical trial study is set in the Clinical Research Laboratory, Department of Kinesiotherapy, at a Chilean University. Patients will be randomly assigned to an experimental group of hypopressive exercises associated with muscle strength training and aerobic exercises or a control group of muscle strength training and aerobic exercises. Twelve tele-rehabilitation sessions will be performed. Women over 18 years of age with gynecologic cancer who have been prescribed radiotherapy or chemotherapy will participate. Fatigue, quality of life, urinary incontinence symptoms, and sexual function will be assessed before and after the intervention. Expected results: The results of this clinical trial have important implications for specific treatment for the cancer population and generate new techniques in the practice of oncology-specialized kinesiologists. Hypopressive exercise is expected to reduce incontinence symptoms due to neuromuscular activation of the pelvic floor muscles. However, more studies are needed to confirm the beneficial effects of hypopressive exercises in face-to-face or remote rehabilitation.

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Introducción: El ejercicio terapéutico juega un rol importante en la población con cáncer, ya que mejora la función, la calidad de vida y reduce los síntomas del tratamiento contra el cáncer. Hay poca evidencia clínica sobre los efectos del ejercicio hipopresivo en mujeres con cáncer ginecológico. Objetivo: Evaluar los efectos de cuatro semanas de ejercicio hipopresivo asociado con entrenamiento de fuerza muscular y ejercicios aeróbicos sobre la fatiga, los síntomas de incontinencia urinaria, la función sexual y la calidad de vida en mujeres tratadas por cáncer ginecológico, en comparación con un grupo que realizará entrenamiento convencional. Métodos: El escenario para este estudio de ensayo clínico aleatorizado y simple ciego es el Laboratorio de Investigación Clínica, Departamento de Kinesiología, en una Universidad Chilena. Las pacientes serán asignadas aleatoriamente a un grupo experimental de ejercicios hipopresivos asociados con entrenamiento de fuerza muscular y ejercicios aeróbicos, o a un grupo de control de entrenamiento de fuerza muscular y ejercicios aeróbicos. Se realizarán doce sesiones de telerehabilitación. Participarán mujeres mayores de 18 años con cáncer ginecológico a quienes se les haya indicado radioterapia o quimioterapia. Se evaluarán la fatiga, la calidad de vida, los síntomas de incontinencia urinaria y la función sexual antes y después de la intervención. Resultados: esperados Los resultados de este ensayo clínico tienen importantes implicaciones en términos del tratamiento específico para la población con cáncer y generan nuevas técnicas en la práctica de kinesiólogos especializados en oncología. Se espera que el ejercicio hipopresivo reduzca los síntomas de incontinencia debido a la activación neuromuscular de los músculos del suelo pélvico. Sin embargo, se necesitan más estudios para confirmar los efectos beneficiosos de los ejercicios hipopresivos, ya sea en rehabilitación presencial o a distancia.

Assuntos

Terapia por Exercício , Fadiga , Neoplasias dos Genitais Femininos , Qualidade de Vida , Treinamento Resistido , Incontinência Urinária , Humanos , Feminino , Treinamento Resistido/métodos , Método Simples-Cego , Terapia por Exercício/métodos , Neoplasias dos Genitais Femininos/terapia , Incontinência Urinária/terapia , Incontinência Urinária/reabilitação , Fadiga/terapia , Fadiga/etiologia , Exercício Físico/fisiologia , Força Muscular/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Chile

RESUMO

BACKGROUND: Long COVID is defined as the persistence of COVID-19 symptoms four weeks after having undergone acute infection, according to the most recent CDC definition. It is estimated that there are 65 million people affected by this entity, although other figures speak of 200 million. OBJECTIVE: To characterize the population affected by long COVID in Mexico. MATERIAL AND METHODS: Patients older than 18 years who agreed to answer an online survey and who met the criteria for long COVID were included. RESULTS: Data from 203 subjects were included, with 138 (68.0%) being found to be females, and average age to be 41.8 years; 29.6% had severe disease, and 70.4%, mild to moderate disease; 89.7% had received prior COVID-19 vaccination: 6.9% had received one dose; 31.5%, two doses; and 51.2%, three or more doses. The main risk factors were diabetes, overweight or obesity, and hypertension. The most commonly reported symptom was fatigue, followed by other neuropsychiatric manifestations. CONCLUSION: It is important for the population affected by long COVID to be characterized in order to generate diagnostic and treatment protocols.

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ANTECEDENTES: El COVID persistente se define como la persistencia de síntomas de COVID-19 después de cuatro semanas de cursar con un cuadro agudo, según la definición más reciente de los Centers for Disease Control and Prevention. Se estima que existen 65 millones de personas afectadas por esta entidad, aunque algunos reportes indican 200 millones. OBJETIVO: Caracterizar a la población afectada por COVID persistente en México. MATERIAL Y MÉTODOS: Se incluyeron pacientes mayores de 18 años que consintieron responder a una encuesta en línea y que cumplían los criterios de COVID persistente. RESULTADOS: Se incluyeron los datos de 203 sujetos. Se identificó que 138 (68.0 %) contestaron ser del sexo femenino, con una media de edad de 41.8 años; 29.6 % presentó enfermedad grave y 70.4 %, enfermedad leve a moderada; 89.7 % había recibido vacunas previas para COVID-19: 6.9 %, una dosis; 31.5 %, dos dosis; y 51.2 %, tres o más dosis. Los principales factores de riesgo fueron diabetes, sobrepeso u obesidad e hipertensión arterial sistémica. El principal síntoma reportado fue fatiga, seguido de otras manifestaciones neuropsiquiátricas. CONCLUSIÓN: Es importante caracterizar a la población para generar protocolos de diagnóstico y tratamiento.

Assuntos

COVID-19 , Humanos , México/epidemiologia , COVID-19/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Fatores de Risco , Síndrome de COVID-19 Pós-Aguda , Índice de Gravidade de Doença , Adulto Jovem , Idoso , Vacinas contra COVID-19 , Obesidade/epidemiologia , Obesidade/complicações , Inquéritos e Questionários

RESUMO

A customized digital image correlation (DIC) system was implemented to monitor the strain produced in a cold-rolled AL-6XN stainless steel plate, 3.0 mm thick, subjected to quasi-static and cyclic loading tests. A comparison of the DIC strain measurements was made against those provided by conventional extensometers. Furthermore, the DIC system was used to monitor the fatigue crack initiation in low-cycle fatigue tests. The true stress-strain behavior for the AL-6XN material was properly captured by the DIC measurements. For low-cycle fatigue tests (strain control), the strain mapping generated by DIC allowed for identifying zones with higher strain than the nominal strain amplitude applied (εa) since the first stages of the fatigue life (FL). These zones become potential fatigue crack initiation sites.

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BACKGROUND: Breast cancer is a prevalent form of cancer among women worldwide, often accompanied by physical and psychological side effects due to the disease and the treatment's aggressiveness. Regular physical exercise has emerged as a non-pharmacological approach to improve the quality of life of breast cancer survivors. We herein report the protocol of the WaterMama Study, which aims to evaluate the effects of land- or water-based aerobic exercise programs, compared to a health education program, on cancer-related fatigue and other health-related outcomes in breast cancer survivors. METHODS: The WaterMama trial is a randomized, single-blinded, three-arm, parallel, superiority trial. We aim to recruit 48 women ≥ 18 years of age who have completed primary treatment for stage I-III breast cancer. Participants are randomly allocated in a 1:1:1 ratio to 12-week interventions of aerobic exercise training programs either in the aquatic or land environment (two weekly 45-min sessions) plus health education (a weekly 45-min session), or an active-control group receiving health education alone (a weekly 45-min session). The primary outcome is cancer-related fatigue, and the secondary outcomes include cardiorespiratory fitness, muscular performance, muscle morphology, functional capacity, mental health, cognitive function, pain, and quality of life. Outcomes assessments are conducted before and after the 12-week intervention period. The analysis plan will employ an intention-to-treat approach and per protocol criteria. DISCUSSION: Our conceptual hypothesis is that both aerobic exercise programs will positively impact primary and secondary outcomes compared to the health education group alone. Additionally, due to its multi-component nature, we expect the aquatic exercise program promote more significant effects than the land exercise program on cancer-related fatigue, muscular outcomes, and pain. TRIAL REGISTRATION: The study was prospectively registered at ClinicalTrials.gov NCT05520515. Registered on August 26, 2022. https://clinicaltrials.gov/ct2/show/NCT05520515.

Assuntos

Neoplasias da Mama , Sobreviventes de Câncer , Terapia por Exercício , Fadiga , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Feminino , Método Simples-Cego , Terapia por Exercício/métodos , Fadiga/etiologia , Resultado do Tratamento , Pessoa de Meia-Idade , Fatores de Tempo , Saúde Mental , Exercício Físico , Aptidão Cardiorrespiratória , Adulto , Educação em Saúde/métodos

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PURPOSE: Our study aimed to identify alterations in sleep, inflammatory mediators, fatigue and quality of life in women with dysmenorrhea and compare them to women without dysmenorrhea. METHODS: The sample comprised 328 women from a Brazilian cross-sectional sleep study, EPISONO (2007), who had undergone 1-night polysomnography (PSG) type I and completed questionnaires related to sleep quality, daytime sleepiness, insomnia, fatigue, anxiety, depression, and quality of life. Blood samples were used to assess levels of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP). The 2 groups were distributed based on the presence or absence of dysmenorrhea symptoms. RESULTS: Sleep efficiency was significantly lower in the group of women with dysmenorrhea (82.5% ± 13.8) compared to the non-dysmenorrhea group (86.2% ± 10.9). Dysmenorrhea was associated with significantly higher scores of fatigue and worse scores in the physical quality of life. No statistical differences were detected in inflammatory markers between the 2 groups. DISCUSSION: Fatigue and physical quality of life were presented in women with dysmenorrhea, as was reduced sleep efficiency, although no alteration on inflammatory markers were observed. CONCLUSION: These findings show that dysmenorrhea can have a deleterious effect on women's sleep, with repercussions on daily routines and quality of life.

Assuntos

Dismenorreia , Interleucina-6 , Qualidade de Vida , Humanos , Feminino , Dismenorreia/sangue , Dismenorreia/fisiopatologia , Dismenorreia/psicologia , Adulto , Estudos Transversais , Adulto Jovem , Interleucina-6/sangue , Qualidade do Sono , Proteína C-Reativa/análise , Fadiga/sangue , Fadiga/etiologia , Fadiga/fisiopatologia , Fator de Necrose Tumoral alfa/sangue , Polissonografia , Brasil/epidemiologia , Inquéritos e Questionários , Ritmo Circadiano/fisiologia , Transtornos do Sono-Vigília/sangue , Depressão/sangue , Ansiedade/sangue

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BACKGROUND/OBJECTIVE: A high prevalence of fatigue and a positive association between fatigue and post-hemodialysis recovery have been reported in predominantly white populations of maintenance hemodialysis (MHD) patients. The present study evaluates associations between self-reported fatigue by the 11-item Chalder Fatigue Questionnaire (CFQ-11) and the need for post-hemodialysis recovery in a predominantly African-descent MHD population. METHODS: A total of 233 patients (94% Black or Mixed-Race) participating in the "Prospective Study of the Prognosis of Patients on Maintenance Hemodialysis" (PROHEMO), Salvador, Brazil were recruited for this cross-sectional study. The CFQ-11 was used to measure fatigue: <4 for absent or mild, ⩾4 for moderate to severe. Patients were also asked if they needed some time to recover after the hemodialysis. Logistic regression was used to estimate odds ratio (OR) of the association with adjustments for age, sex, race, educational level, economic class level, diabetes, hearth failure, and hemoglobin. RESULTS: Mean age was 51.5 ± 12.5 years. Moderate to severe fatigue (⩾4 points) was observed in 70.8% (165/233), and absent or mild fatigue (<4 points) in 29.2% (68/233). Compared to patients with fatigue scores <4 (20.6%), the need for post-hemodialysis recovery was 2.5 times greater in patients with fatigue scores ⩾4 (52.7%). The covariate-adjusted logistic regression OR was 4.60, 95% CI: 2.27, 9.21. CONCLUSION: This study in MHD patients of predominantly African descent supports self-reported fatigue assessed by the CFQ-11 as a relevant predictor of the need for post-hemodialysis recovery. The results offer a rationale for investigating whether interventions to prevent fatigue reduce the need of post-hemodialysis recovery.

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Fadiga , Diálise Renal , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fadiga/fisiopatologia , Estudos Transversais , Adulto , Brasil/epidemiologia , Inquéritos e Questionários , População Negra/estatística & dados numéricos , Estudos Prospectivos , Idoso , Prevalência , Recuperação de Função Fisiológica , Resultado do Tratamento

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OBJECTIVE: To investigate fatigue methods for the evaluation of translucent zirconia and to associate in vitro failures with clinically reported ones. DATA: Studies published in English that used fatigue tests on dental translucent zirconia. SOURCES: Two databases (MEDLINE/PubMed and Scopus) were electronically searched without any restriction on year of publication. STUDY SELECTION: A total of 4555 studies were identified. After removal of duplicates (78) and irrelevant articles (4316) that did not meet the inclusion criteria, 161 articles were considered eligible based on their titles and abstracts. These articles were fully read, leading to the inclusion of 41 studies in the review. RESULTS: The most widely used fatigue method for evaluation of translucent zirconia was step-stress (18 articles), followed by staircase (seven articles), and step-wise (two articles). Most studies had been conducted in a wet environment with the use of a stainless steel piston to apply load to cemented structures on a dentin-like substrate. Most fracture analyses indicated the fracture originated on the cementation or contact surface where the load was applied. Moreover, studies that utilized anatomical structures (dental crowns) reported fractures starting at the cervical margin of the crowns. CONCLUSION: Most studies used the step-stress method. Only three studies reported failures similar to those found in clinical trials that used translucent zirconia restorations. CLINICAL SIGNIFICANCE: The study findings can assist on correlating clinical failures to the ones observed in vitro.

Assuntos

Materiais Dentários , Falha de Restauração Dentária , Análise do Estresse Dentário , Teste de Materiais , Zircônio , Zircônio/química , Humanos , Materiais Dentários/química , Coroas , Propriedades de Superfície , Estresse Mecânico

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Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.