Validación por expertos del contenido del diagnóstico enfermero de NANDA-I Fatiga (00093) / Expert Validation of the Content for the NANDA-I Nursing Diagnosis of Fatigue

Introducción: La fatiga constituye un importante problema de salud que precisa de una adecuada valoración, diagnóstico y planificación de cuidados enfermeros centrados en quienes la sufren. Objetivo: Validar el contenido del diagnóstico enfermero NANDA-I Fatiga (00093) en la versión incluida en una base de datos clínica. Métodos: Estudio descriptivo y exploratorio de validación de contenido diagnóstico mediante expertos siguiendo la propuesta de Fehring. El ámbito de estudio fue España. La recogida de datos se realizó entre los meses de junio 2019-marzo 2020. Los expertos participantes disponían de experiencia y formación en el uso de lenguajes estandarizados enfermeros. Resultados: De las 13 Características Definitorias con las que cuenta el diagnóstico incluido en la base de datos, siete fueron validadas como mayores, cinco como menores y una no fue validada. Los 16 Factores Relacionados del diagnóstico fueron validados. El Índice de Validez de Contenido del diagnóstico fue de 0,81. Conclusiones: El diagnóstico obtuvo un Índice de Validez de Contenido elevado. Los componentes del diagnóstico NANDA-I Fatiga (00093) en la versión de la base de datos clínica guardan correspondencia con los presentes en el diagnóstico NANDA-I Fatiga (00093) en la Clasificación NANDA-I 2018-2020. Se considera que la investigación actual contribuye a incrementar la precisión diagnóstica al identificar Características Definitorias claves de la presencia del diagnóstico. Al tiempo valida Factores Relacionados influyentes en el diagnóstico no incorporados en los componentes del diagnóstico NANDA-I Fatiga (00093) en la edición de la Clasificación NANDA-I 2018-2020(AU)

Introduction: Fatigue is an important health concern that requiring appropriate assessment, diagnosis and nursing care planning focused on those who suffer from it. Objective: To validate the content of NANDA-I nursing diagnosis of fatigue (00093) in the version included in a clinical database. Methods: Descriptive and exploratory study of diagnostic content validation by experts following Fehring's proposal. The setting of the study was Spain. Data collection was carried out between June 2019 and March 2020. The participating experts had experience and training in the use of standardized nursing languages. Results: Of the thirteen characteristics that define the diagnosis included in the database, seven were validated as major, five as minor and one was not validated. All sixteen related factors of the diagnosis were validated. The content validity index of the diagnosis was 0.81. Conclusions: The diagnosis obtained a high content validity index. The components of the NANDA-I diagnosis of fatigue (00093) in the clinical database version correspond with those present in the NANDA-I diagnosis of fatigue (00093) in the NANDA-I Classification 2018-2020. The current research is considered to contribute with an increase in diagnostic accuracy by identifying key defining characteristics for the diagnosis. At the same time, it validates related factors that have an influence on the diagnosis but are not incorporated among the components of the NANDA-I diagnosis of fatigue (00093) in the 2018-2020 edition of the NANDA-I Classification(AU)

Cardiovascular exercise and motor learning in non-disabled individuals: A systematic review with a behavioral emphasis

Abstract Aim: This systematic review aimed to investigate the acute effects of cardiovascular exercise on motor learning of non-disabled individuals. Methods: Forty studies were identified through database searching (PsycINFO, CENTRAL, Google Scholar, Scielo, and PUBMED). The studies demonstrated heterogeneity and were classified into two categories to guide the analyses: (1) - studies that investigated the effects of exercise-induced fatigue during practice on the performance in the retention test; (2) - studies that verified the acute impact of the cardiovascular exercise in close temporal proximity to the task practice on motor learning. Results: The studies demonstrated that (1) - the practice under fatigue conditions did not impair motor learning and that (2) - the cardiovascular exercise bout performed in close temporal proximity to task practice enhances the motor learning processes. Conclusion: Cardiovascular exercise enhances motor learning processes; however, these priming effects are dependents on the timing between practice and exercise, type of exercise, and task characteristics.

Validation of the Pollard' s classification criteria (2010) for rheumatoid arthritis patients with fibromyalgia / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the sensitivity and specificity of Pollard' s classification criteria(2010) for the diagnosis of rheumatoid arthritis (RA) patients withfibromyalgia (FM) in Chinese patients, and to assess the clinical features and psychological status of RA-FM patients in a real-world observational setting.@*METHODS@#Two hundred and two patients with rheumatoid arthritis were enrolled from the outpatients in Rheumatology and Immunology Department in Peking University People' s Hospital. All the patients were evaluated whether incorporating fibromyalgia translation occured using the 1990 American College of Rheumatolgy (ACR)-FM classification criteria. Forty two RA patients were concomitant with FM, while the other one hundred and sixty RA patients without FM were set as the control group.@*RESULTS@#There was no significant difference in general demography between the two groups (P>0.05). In this study, the Pollard' s classification criteria (2010) for RA-FM in Chinese patients had a high sensitivity of 95.2% and relatively low specificity of 52.6%. Compared with those patients without FM, RA patients with FM (RA-FM patients) had higher Disease Activity Scale in 28 joints (DAS-28) score (5.95 vs. 4.38, P=0.011) and much more 28-tender joint counts (TJC) (16.5 vs.4.5, P < 0.001).RA-FM patients had worse Health Assessment Questionnaire (HAQ) score (1.24 vs. 0.66, P < 0.001) and lower SF-36 (28.63 vs. 58.22, P < 0.001). Fatigue was more common in RA-FM patients (88. 1% vs. 50.6%, P < 0.001) and the degree of fatigue was significantly increased in RA-FM patients (fatigue VAS 5.55 vs. 3.55, P < 0.001). RA-FM patients also had higher anxiety (10 vs.4, P < 0.001) and depression scores (12 vs.6, P < 0.001). erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time and 28-swollen joint counts (SJC) showed no difference between these two groups.@*CONCLUSION@#The Pollard' s classification criteria (2010) for RA-FM are feasible in Chinese rheumatoid arthritis patients. The Pollard' s classification criteria is highly sensitive in clinical application, while the relativelylow specificity indicates that various factors need to be considered in combination. RA patients with FM result in higher disease activity, worse function aland psychological status. RA patients with FM also have poorer quality of life. DAS-28 scores may be overestimated in RA patients with FM. In a RA patient thatdoes not reach remission, the possibility of fibromyalgia should be con-sidered.

Síndrome pos-COVID-19: solo sabemos que sabemos poco / Pos-COVID-19 syndrome: we only know how little we know

La COVID-19 puede producir síntomas persistentes luego de la infección inicial. En cuadros más graves, pueden corresponder a la evolución propia de una patología crítica o a secuelas inflamatorias/fibróticas pulmonares, entre otras. Esto puede confirmarse por estudios respiratorios e imagenológicos. En el caso de la COVID-19 no grave, el denominado síndrome pos-COVID-19, se trata de síntomas persistentes luego de al menos 28 días sin una secuela orgánica clara. Los síntomas más comunes en este caso son fatiga, cefalea y disnea, que pueden persistir meses luego de la infección inicial. Su curso puede ser oscilante e incluso aumentar progresivamente. El espectro de síntomas es muy amplio y requiere una adecuada evaluación del paciente. Se cree que tiene su origen en la desregulación inmunológica luego de la infección inicial. Su evaluación y seguimiento requieren un adecuado manejo sintomático y acompañamiento por el profesional a cargo. (AU)

Patients who underwent COVID-19 can develop persisting symptoms and sequelae. Severe cases may exhibit systemic complications of critical care and/or inflammatory/fibrotic lung injury. Imaging and respiratory function tests can assist in the evaluation of both. Nonsevere cases can also develop persisting symptoms for more than 28 days, which has been defined as the post COVID-19 syndrome. The most common symptoms in said syndrome are fatigue, headache and dyspnea, which can last for months. Its course can be oscillating or even increase progressively within the first months. The considerable range of symptoms requires proper patient assessment. Post-infectious immune disregulation is believed to be the source of this syndrome. Proper assessment and followup warrant measured symptom management and emphatic care by the attending physician. (AU)

The efficiency of a mixed exercise program on quality of life and fatigue levels in patients with breast cancer

SUMMARY OBJECTIVE: Exercise is a nonpharmacological supportive therapy which has been specifically identified to reduce postoperative complications or adverse events of cancer or treatments. Although there are few studies combining resistance and aerobic exercise in cancer survivors, exercise programs are very rare in different places in the literature. This study aims to investigate the effects of mixed-type exercise in different venues on weight, body mass index, fatigue, and quality of life in cancer survivors. METHODS: This is a descriptive, intervention study. Participants were included in the study, and the exercise process was between January and November 2019. The exercise group consisted of 32 patients who had just completed their breast cancer treatment and did not have distant metastases, and they applied a mixed exercise program including resistance at home and aerobic exercise in the fitness center for 12 weeks. The patients with breast cancer in the control group (30 patients) did not receive any exercise program. RESULTS: Subjective feelings of fatigue and decrease in concentration, motivation, and physical activity significantly decreased after exercise (p<0.001, p<0.001, p=0.006, p=0.008, and p<0.001, respectively) in the study group. The results also showed that physical health, general health status, and emotional and social health status significantly increased with the exercise program (p<0.001, p<0.001, p=0.004, and p=0.003, respectively). CONCLUSION: Our results show that a mixed (fitness center and home) 12-week exercise program provides an improvement in general health and reduces the side effects of the treatments and fatigue in patients with breast cancer. For a good prognostic process after medical treatment, exercise can be recommended in every accessible area.

Transcranial direct current stimulation as a strategy to manage COVID-19 pain and fatigue

SUMMARY The novel coronavirus disease (COVID-19) has infected millions of people worldwide and generated many sequels in the survivors, such as muscular pain and fatigue. These symptoms have been treated through pharmacological approaches; however, infected people keep presenting physical limitations. Besides, the COVID-19 damage to the central nervous system has also been related to the presence of some physical impairment, so strategies that focus on diverse brain areas should be encouraged. Transcranial Direct Current Stimulation (tDCS) is a non-pharmacological tool that could be associated with pharmacological treatments to improve the central nervous system function and decrease the exacerbation of the immune system response. tDCS targeting pain and fatigue-related areas could provide an increase in neuroplasticity and enhancements in physical functions. Moreover, it can be used in infirmaries and clinical centers to treat COVID-19 patients.

The Effect of Body Awareness Therapy on Pain, Fatigue and Health-related Quality of Life in Female Patients with Tension-type Headaches and Migraine

ABSTRACT Objective: To examine the effect of body awareness therapy on pain, fatigue and quality of life in women with tension-type headaches (TTH) and migraine. Methods: Socio-demographic features of patients who are included in the study were recorded. Visual analogue scale was used for pain and fatigue severity scale was used for fatigue, Nottingham health profile (NHP) was used for life quality related to health. Following the first evaluation, body awareness therapy (BAT) was applied to patients for six weeks per 60 minutes in three sessions. Results: Among patients with TTH, there was statistical difference between visual analogue scale, fatigue severity scale and total NHP score before and after BAT (p < 0.05). Among patients with migraine, there was statistical difference between total NHP score before and after BAT (p < 0.05). Conclusion: Body awareness therapy is an effective method that can be used in order to increase life quality related to health among female patients with TTH and migraine.

Fatigue in Parkinsons disease: Brazilian validation of the modified fatigue impact scale / Fadiga na doença de Parkinson: validação brasileira da escala modificada de impacto da fadiga

ABSTRACT Background: The instruments that measure the impact of fatigue on physical, cognitive and psychosocial aspects has yet to be validated in Brazilian population with Parkinson's disease (PD). The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the Modified Fatigue Impact Scale (MFIS-PD/BR). Methods: Ninety PD individuals were recruited. The adaptation of the MFIS-PD was performed by translation and back translation methodology. Psychometric analysis was applied in order to perform the administration of the socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson's Disease Rating Scale (UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), Geriatric Depression Scale (GDS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16), and MFIS-PD/BR with retest of the MFIS-PD/BR after 7 days. Results: The adaptation phase kept the same items of original MFIS-PD. The Cronbach's alpha for the MFIS-PD/BR was 0.878 when all responses items were scored. The test-retest intraclass correlation coefficients was above 0.80 (p<0.01) for the MFIS-PD/BR score, which was moderately correlated with the HADS, GDS, MDS-UPDRS score total and non-motor experiences of daily living, FSS and PFS-16. It was revealed the MFIS-PD/BR>29 points as cut-off point to indicate fatigued subjects with accuracy of 0.835 (p<0.001). Conclusions: The MFIS-PD/BR is valid and reproducible to use in assessing the fatigue symptom in Brazilian PD subjects.

RESUMO Introdução: Os instrumentos que mensuram o impacto da fadiga nos aspectos físicos, cognitivos e psicossociais ainda não foram validados na população brasileira com doença de Parkinson (DP). O objetivo deste estudo foi adaptar culturalmente e avaliar as propriedades psicométricas da versão brasileira da escala modificada de impacto da fadiga (MFIS-PD/BR). Métodos: Setenta indivíduos com DP foram recrutados. A adaptação do MFIS-PD foi realizada pela metodologia de tradução e retrotradução. Na análise psicométrica foi realizada a administração de questionário socioclínico, Miniexame do estado mental (Mini-Mental State Examination - MMSE), Escala Unificada de Avaliação da DP (Unified Parkinson's Disease Rating Scale - UPDRS Parte I-IV), escala de incapacidade Hoehn-Yahr (HY), escala hospitalar de ansiedade e depressão (Hospital Anxiety and Depression Scale - HADS), escala de depressão geriátrica (Geriatric Depression Scale - GDS), escala de gravidade da fadiga (Fatigue Severity Scale - FSS), escala de fadiga de Parkinson (Parkinson Fatigue Scale - PFS-16) e a MFIS-PD/BR com reteste após 7 dias. Resultados: A fase de adaptação manteve os mesmos itens do MFIS-PD original. O coeficiente alfa de Cronbach para o MFIS-PD/BR foi de 0,878 quando todos os itens das respostas foram pontuados. Os coeficientes de correlação intraclasse teste-reteste foram superiores a 0,80 (p<0,01) para o escore MFIS-PD/BR, que foi moderadamente correlacionado com o escore HADS, GDS, MDS-UPDRS, total e aspectos não-motores da vida diária, FSS e PFS-16. Foi revelado o ponto de corte do MFIS-PD/BR>29 pontos para indicar indivíduos fatigados com acurácia de 0,835 (p<0,001). Conclusões: O MFIS-PD/BR é válido e reprodutível para a avaliação do sintoma de fadiga em indivíduos brasileiros com DP.

Impacto respiratório e sintomatológico do alívio da ascite através da paracentese em pacientes com cirrose hepática / Respiratory and symptomatic impact of ascites relief by paracentesis in patients with hepatic cirrhosis

ABSTRACT BACKGROUND: Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients. OBJECTIVE: To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters. METHODS: Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale). RESULTS: There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child "C" with higher MELD score, volume drained in paracentesis with higher MELD score and with Child "C". We also observed a negative correlation between tidal volume and respiratory rate. CONCLUSION: Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.

RESUMO CONTEXTO: A cirrose hepática é uma doença altamente prevalente que, em estágio avançado, geralmente causa ascite e alterações respiratórias associadas. No entanto, existem poucos estudos avaliando e quantificando o impacto da ascite e do seu alívio através da paracentese na função pulmonar e em sintomas como fadiga e dispneia em pacientes cirróticos. OBJETIVO: Avaliar e quantificar o impacto da redução aguda do volume ascítico nos parâmetros respiratórios, sintomas de fadiga e dispneia em pacientes com cirrose hepática, bem como investigar possíveis correlações entre esses parâmetros. MÉTODOS: Trinta pacientes com cirrose hepática e ascite foram submetidos às seguintes avaliações pré e pós-paracentese: sinais vitais, padrão respiratório, mobilidade toracoabdominal (cirtometria), função pulmonar (ventilometria), grau de dispneia (escala numérica) e nível de fadiga (escala visual analógica). RESULTADOS: Houve maior prevalência de pacientes classificados como CHILD B e o escore MELD médio foi de 14,73±5,75. A comparação dos parâmetros pré e pós paracentese evidenciou após a paracentese: aumento do padrão respiratório predominantemente abdominal, melhora das variáveis ventilatórias, aumento das diferenças obtidas na cirtometria axilar e abdominal, redução do nível de dispneia e fadiga, redução da pressão arterial e aumento da saturação periférica de oxigênio. Correlações positivas encontradas: cirtometria xifoide com axilar, grau de dispneia com nível de fadiga, volume corrente com volume minuto, CHILD "C" com maior escore MELD, volume drenado na paracentese com maior escore MELD e com CHILD "C". Também observamos uma correlação negativa entre volume corrente e a frequência respiratória. CONCLUSÃO: Uma vez que a drenagem da ascite em pacientes com cirrose hepática melhora os volumes pulmonares e a expansão torácica, além de reduzir sintomas como fadiga e dispneia, podemos concluir que a ascite tem um impacto respiratório e sintomatológico negativo nesses pacientes.

Escala de autoavaliação Inflammatory Bowel Disease-Fatigue: tradução, adaptação cultural e propriedades psicométricas da versão Brasileira (IBD-F Brasil) / The inflammatory bowel disease-fatigue patient self-assessment scale: translation, cross-cultural adaptation and psychometric properties of the brazilian version (ibd-f brazil)

ABSTRACT BACKGROUND: Fatigue is a common symptom in patients with inflammatory bowel diseases (IBD). A translated and culturally adapted, instrument with robust psychometric for measuring fatigue in Brazilian patients with IBD is needed. OBJECTIVE: To translate and cross-culturally adapt the inflammatory Bowel Disease Fatigue Scale (IBD-F) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with IBD. METHODS: Data from 123 patients with IBD were collected. In addition to IBD-F, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) was used. The measurement properties tested were: internal consistency, reproducibility (reliability and agreement), construct validity, internal and external responsiveness, and ceiling and floor effects. RESULTS: The Brazilian-Portuguese version of the IBD-F showed excellent internal consistency (Cronbach's alpha of 0.95), excellent reproducibility (ICC=0.97) and a minimal detectable change of 6.0 points. The construct validity was demonstrated with a good correlation between the IBD-F and FACIT-F (r=- 0.46). Effect sizes used for measuring internal responsiveness were moderate among those with Crohn's (0.66) disease and low in patients with ulcerative colitis (0.24). The Brazilian-Portuguese version of the IBD-F presented with high external responsiveness for Crohn's disease (0.84) and with low external responsiveness for ulcerative colitis (0.33). The area under the curve considered for responsiveness was 0.84. Twenty-five percent of floor effects and no ceiling effect were recorded. CONCLUSION: The Brazilian-Portuguese version of IBD-F has adequate measurement properties and its use can be recommended in clinical practice and research.

RESUMO CONTEXTO: A fadiga é um sintoma comum em pacientes com doenças inflamatórias intestinais (DII). Um instrumento de avaliação de fadiga traduzido, culturalmente adaptado e com psicometria robusta para medir a fadiga em pacientes brasileiros com DII é necessário. OBJETIVO: Traduzir e adaptar culturalmente a Inflammatory Bowel Disease Fatigue Scale (IBD-F) para o português do Brasil e testar suas propriedades de medida em pacientes brasileiros com DII. MÉTODOS: Foram coletados dados de 123 pacientes com DII. Além do IBD-F, foi utilizada a Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). As propriedades de medida testadas foram: consistência interna, reprodutibilidade (confiabilidade e concordância), validade de construto, responsividade interna e externa e efeitos teto e chão. RESULTADOS: A versão em português do IBD-F mostrou excelente consistência interna (alfa de Cronbach de 0,95), excelente reprodutibilidade (ICC=0,97) e uma diferença mínima detectável de 6,0 pontos. A validade do construto foi demonstrada por meio de uma boa correlação entre o IBD-F Brasil e o FACIT-F (r= -0,46). Na análise de responsividade interna, os tamanhos de efeito obtidos foram moderado entre aqueles com doença de Crohn (0,66) e baixo em pacientes com colite ulcerativa (0,24). O IBD-F Brasil apresentou alta responsividade externa entre aqueles com doença de Crohn (0,84) e baixa responsividade externa em pacientes colite ulcerativa (0,33). A área sob a curva considerada para responsividade foi de 0,84. Foram registrados 25% de efeito chão e nenhum efeito teto nas avaliações realizadas. CONCLUSÃO: O IBD-F Brasil possui propriedades de medida adequadas e seu uso pode ser recomendado na prática clínica e na pesquisa em pacientes com DII.

The impact of the presence of fibromyalgia on fatigue in patients with psoriatic arthritis: comparison with controls

Abstract Background: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. Methods: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. Results: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). Conclusion: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.(AU)

Síntomas subagudos y crónicos de la fiebre de chikungunya en un grupo de personas adultas en Ibagué, Colombia / Subacute and chronic symptoms of chikungunya fever in a group of adults in Colombia

Resumen Introducción. La fiebre de chikungunya en Colombia ocasiona una alerta en salud pública que se extiende en el tiempo, dadas las características subagudas y crónicas de la enfermedad. Objetivo. Describir los síntomas subagudos y crónicos en personas mayores de 18 años con fiebre de chikungunya en Ibagué, Colombia. Materiales y métodos. Se hizo un estudio descriptivo con muestreo en bola de nieve de 368 adultos de todas las comunas de Ibagué que presentaban síntomas de la fiebre de chikungunya de más de 12 días de duración. Resultados. Las articulaciones que presentaban dolor en la fase subaguda y crónica de la enfermedad fueron las de manos (84,2 %), rodillas (72,8 %) y tobillos (69,3 %); además de las articulaciones, la planta de los pies fue el sitio en que más frecuentemente se presentó dolor (48,8 %). El dolor articular en manos (p=0,017) y tobillos (p=0,001) y el dolor en la planta de los pies (p=0,002) fueron significativos en las mujeres. La fatiga o el cansancio generalizado se presentaron en el 58,9 % de las personas y se prolongó por más de un año en el 2,4 % de ellas. Conclusiones. Los síntomas de la fase subaguda y crónica de la fiebre de chikungunya coincidieron con los descritos en la literatura médica, su duración se extendió hasta por un año o más en algunos de los casos y su intensidad disminuyó con el tiempo. Los síntomas referidos fueron más comunes en las mujeres que en los hombres.

Abstract Introduction: In Colombia, chikungunya fever creates a warning in public health that extends over time given the subacute and chronic characteristics of the disease. Objective: To describe subacute and chronic symptoms in adult people who suffered chikungunya fever in the city of Ibagué, Colombia. Materials and methods: We conducted a descriptive study with snowball sampling in 368 adults from all the communes of Ibagué, Colombia, who had symptoms of chikungunya fever spanning for more than 12 days. Results: The joints that showed the greatest pain in the subacute and chronic phase of the disease were the hands with 84.2%, knees with 72.8%, and ankles with 69.3%. The soles of the feet were the non-articular areas with greater frequency of pain (48.8%). Joint pain in the hands (p=0.017) and ankles (p=0.001) and pain in the soles of the feet (p=0.002) were significant in women. General fatigue occurred in 58.9% of the subjects and in 2.4% of the population, it lasted for more than a year. Conclusions: The symptoms of the subacute and chronic phase of chikungunya fever were the same reported in the literature, they lasted up to a year or more, and decreased in intensity over time. The referred symptoms were more common in women than in men.

Clinical and functional variables can predict general fatigue in patients with acromegaly: an explanatory model approach

ABSTRACT Objective To evaluate whether hormonal profile, arterial function, and physical capacity are predictors of fatigue in patients with acromegaly. Subjects and methods: This is a cross-sectional study including 23 patients. The subjects underwent a Modified Fatigue Impact Scale (MFIS) assessment; serum growth hormones (GH) and IGF-1 measurements; pulse wave analysis comprising pulse wave velocity (PWV), arterial compliance (AC), and the reflection index (IR1,2); dominant upper limb dynamometry (DYN); and the six-minute walking distance test (6MWT). Multiple linear regression models were used to identify predictors for MFIS. The coefficient of determination R2 was used to assess the quality of the models' fit. The best model was further analyzed using a calibration plot and a limits of agreement (LOA) plot. Results The mean ± SD values for the participants' age, MFIS, PWV, AC, IR1,2, DYN, and the distance in the 6MWT were 49.4 ± 11.2 years, 31.2 ± 18.9 score, 10.19 ± 2.34 m/s, 1.08 ± 0.46 x106 cm5/din, 85.3 ± 29.7%, 33.9 ± 9.3 kgf, and 603.0 ± 106.1 m, respectively. The best predictive model (R2 = 0.378, R2 adjusted = 0.280, standard error = 16.1, and P = 0.026) comprised the following regression equation: MFIS = 48.85 - (7.913 × IGF-I) + (1.483 × AC) - (23.281 × DYN). Conclusion Hormonal, vascular, and functional variables can predict general fatigue in patients with acromegaly.

Analysis on the risk factors for organ damage in patients with systemic lupus erythematosus: a cross-sectional single-center experience

ABSTRACT BACKGROUND: Organ damage in patients with systemic lupus erythematosus (SLE) occurs as a consequence of the disease itself, the therapy applied and the accompanying conditions and complications. Organ damage predicts further organ damage and is associated with an increased risk of death. OBJECTIVE: This study aimed to assess the degree of irreversible organ changes in SLE patients, using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI); to establish correlations between organ damage and disease activity, quality of life, intensity of fatigue and serological factors; and to ascertain the risk factors for organ damage. DESIGN AND SETTING: Cross-sectional single-center study conducted at the Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia. METHODS: 83 patients with SLE were enrolled: 58 patients formed the group with organ damage (SDI ≥ 1), and 25 patients without organ damage served as controls (SDI = 0). RESULTS: Organ damage correlated with age (P = 0.002), disease duration (P = 0.015), disease activity (grade 1, P = 0.014; and grade 2, P = 0.007), poor quality of life, severe fatigue (P = 0.047) and treatment with azathioprine (P = 0.037). The following factors were protective: use of hydroxychloroquine (P = 0.048) and higher scores obtained for the physical (P = 0.011), mental (P = 0.022) and general health (P = 0.008) domains. CONCLUSION: It is very important to evaluate risk factors for organ damage in the body, including physicians' overall assessment, to try to positively influence better treatment outcomes.

Sleep disturbances and daytime fatigue: data from the Brazilian National Health Survey, 2013 / Distúrbios do sono e fadiga durante o dia: dados da Pesquisa Nacional de Saúde, 2013 / Trastornos del sueño y fatiga diurna: datos de la Encuesta Nacional de Salud, 2013

Abstract: This study aims to describe the prevalence of sleep disturbances and daytime fatigue and their association with socio-demographic and behavioral factors. Data from the Brazilian National Health Survey conducted in 2013 with 60,202 adults (≥ 18 years old) were used. The outcomes evaluated were self-reported sleep disturbances and daytime fatigue in the last two weeks. Sleep disturbance was defined as the presence of difficulty to fall asleep, frequently waking up during the night or sleeping more than usual; daytime fatigue was defined as the presence of not feeling rested and motivated during the day, feeling tired and lacking energy. Sociodemographic, lifestyle and chronic health aspects were explored as exposures for both outcomes. Prevalence of sleep disturbances and daytime fatigue were 14.9% (14.4-15.4) and 11.9% (11.4-12.3), respectively. Both outcomes were more common in women, older people, people with no formal education, smokers and among physically inactive individuals. The association with education was inverse (the highest the level of education the lower the prevalence ratio - PR - of sleep disturbances and daytime fatigue; adjusted p-value for trend < 0.001). Prevalence of sleep disturbances combined with daytime fatigue was 6.7% (6.4-7.1) and was about 6 times higher among those with three or more chronic health disturbances (PR = 6.2; 95%CI: 5.3-7.2). Strategies to decrease the prevalence of sleep disturbances and daytime fatigue should be encouraged and focused on chronically ill individuals that share other modifiable risk factors.

Resumo: O objetivo deste estudo foi descrever a prevalência de distúrbios de sono e fadiga durante o dia e sua associação com fatores sociodemográficos e comportamentais. Dados da Pesquisa Nacional de Saúde realizada no Brasil em 2013 com 60.202 adultos (≥ 18 anos) foram usados. Os desfechos avaliados foram relatos de distúrbios de sono e fadiga durante o dia nas últimas duas semanas. Distúrbios do sono foram definidos como a presença de dificuldade em cair no sono, acordar com frequência durante a noite ou dormir mais do que o usual e a fadiga durante o dia foi definida como presença de não se sentir descansado e motivado durante o dia, se sentir cansado e falta de energia. Aspectos sociodemográficos, de estilo de vida e aspectos crônicos de saúde foram explorados como exposições para ambos os desfechos. As prevalências de distúrbios de sono e fadiga durante o dia foram 14,9% (14,4-15,4) e 11,9% (11,4-12,3), respectivamente. Ambos os desfechos foram mais comuns em mulheres, idosos, pessoas sem educação formal, fumantes e pessoas que não praticam atividade física. A associação com educação foi reversa (quanto maior a escolaridade, menor a razão de prevalência - RP - de distúrbios de sono e fadiga durante o dia; valor de p ajustado para tendência < 0,001). A prevalência de distúrbios de sono simultaneamente combinados com fadiga durante o dia foi de 6,7% (6,4-7,1) e foi em torno de seis vezes maior para os que tinham três ou mais distúrbios crônicos de saúde (RP = 6,2; IC95%: 5,3-7,2). Deve-se encorajar estratégias para reduzir a prevalência de distúrbios de sono e fadiga durante o dia direcionadas a indivíduos com doenças crônicas que compartilham outros fatores de risco modificáveis.

Resumen: El objetivo de este estudio fue describir la prevalencia de los trastornos de sueño y fatiga diurna, y su relación con factores sociodemográficos y de comportamiento. Se manejaron datos de la Encuesta Nacional de Salud que se llevó a cabo en Brazil en 2013 con 60.202 adultos (≥ 18 años de edad). En los resultados evaluados se autoinformaron trastornos del sueño y fatiga diurna al menos durante dos semanas. El trastorno del sueño se definió como presencia o dificultad en quedarse dormido, despertarse frecuentemente durante la noche o dormir más de lo normal y sufrir fatiga diurna, así como la sensación de no haber descansado y estar inactivo de día, sintiéndose cansado y falto de energía. Se investigaron aspectos sociodemográficos, estilo de vida y dolencias crónicas como la exposición a ambos resultados. La prevalencia de trastornos de sueño y fatiga diurna fueron 14,9% (14,4-15,4) y 11,9% (11,4-12,3), respectivamente. Ambos resultados fueron más comunes en mujeres, personas con edad avanzada, sin educación formal, fumadores e individuos físicamente inactivos. La asociación con la educación fue inversa (cuanto más alto era el nivel de educación, más bajo era la PR de trastornos del sueño y fatiga diurna; valor de p ajustado para tendencia < 0,001). La prevalencia de trastornos del sueño, combinada concomitantemente con la fatiga diurna, fue 6,7% (6,4-7,1) y casi 6 veces superior entre quienes sufrían tres o más trastornos crónicos de salud (PR = 6,2; 95%CI: 5,3-7,2). Las estrategias para disminuir la prevalencia de los trastornos del sueño y fatiga diurna deberían estar promovidas y centradas en personas enfermas crónicamente que compartan otros factores de riesgo modificables.

Fadiga em Mulheres com Câncer de Mama Submetidas à Radioterapia / Fatigue in Women with Breast Cancer Submitted to Radiotherapy / Fatiga en Mujeres con Cáncer de Mama Sujeto a Radioterapia

Introdução: A fadiga em mulheres com câncer de mama após a radioterapia é um dos efeitos colaterais mais debilitantes, sendo um sintoma subjetivo, multidimensional e multifatorial. Objetivo: Caracterizar a fadiga em pacientes com câncer de mama em radioterapia que realizam o tratamento no Serviço de Radioterapia de um hospital de referência em tratamento oncológico do Estado de Goiás. Método: Trata-se de um estudo longitudinal. A Escala de Fadiga de Piper - revisada foi utilizada para avaliação de fadiga no início (T1), meio (T2) e final (T3) da radioterapia. Resultados: A amostra foi composta por 89 mulheres. A prevalência de fadiga em T1 foi de 26,9%. Houve aumento significativo da fadiga ao longo da radioterapia, sendo que, em T3, 50,8% das mulheres apresentavam fadiga. Houve predomínio da fadiga moderada em T2 e T3, e o aumento mais significativo da intensidade da fadiga foi verificado do momento T1 para T2. A dimensão afetiva da fadiga apresentou escore mais alto comparado às dimensões sensorial/psicológica. Conclusão: A presença e a intensidade da fadiga durante a radioterapia aumentaram significativamente, predominando a fadiga moderada na última semana do tratamento. A magnitude da fadiga exibiu escores mais altos na dimensão afetiva nas avaliações. Portanto, atenção maior à fadiga durante a radioterapia precisa ser dada pelos profissionais de saúde.

Introduction: Fatigue in women with breast cancer after radiotherapy is one of the most debilitating side effects, being a subjective, multidimensional, multifactorial symptom. Objective: To characterize fatigue in patients with breast cancer in radiotherapy who undergo treatment in the radiotherapy service of a reference hospital in cancer treatment in the State of Goiás. Method: This is a longitudinal study. The Piper Fatigue Scale - revised was used to evaluate fatigue at the beginning (T1), middle (T2) and final (T3) of the radiotherapy. Results: The sample consisted of 89 women. The prevalence of T1 fatigue was 26.9%. There was a significant increase in fatigue during radiotherapy, and in T3, 50.8% of the women presented fatigue. There was a predominance of moderate fatigue in T2 and T3, and the most significant increase in fatigue intensity was verified from T1 to T2. The affective dimension of fatigue presented a higher score compared to the sensorial/psychological dimensions. Conclusion: The presence and intensity of fatigue during radiotherapy increased significantly, with moderate fatigue predominating in the last week of treatment. The magnitude of fatigue exhibited higher scores in the affective dimension of the evaluations. Therefore, health professionals must focus more attention to fatigue during radiotherapy.

Introducción: La fatiga en mujeres con cáncer de mama después de la radioterapia es uno de los efectos colaterales más debilitantes, siendo un síntoma subjetivo, multidimensional, multifactorial. Objetivo: caracterizar la fatiga en pacientes con cáncer de mama en radioterapia que realizan el tratamiento en el servicio de radioterapia de un hospital de referencia en tratamiento oncológico del Estado de Goiás. Método: Se trata de un estudio longitudinal. La Escala de Fatiga de Piper - revisada fue utilizada para evaluación de fatiga al inicio (T1), medio (T2) y final (T3) de la radioterapia. Resultados: La muestra fue compuesta por 89 mujeres. La prevalencia de fatiga en T1 fue de 26,9%. Se observó un aumento significativo de la fatiga a lo largo de la radioterapia siendo que, en T3, el 50,8% de las mujeres presentaban fatiga. Se observó un predominio de la fatiga moderada en T2 y T3, y el aumento más significativo de la intensidad de la fatiga fue verificado del momento T1 para T2. La dimensión afectiva de la fatiga presentó una puntuación más alta en comparación con las dimensiones sensorial/psicológica. Conclusión: La presencia e intensidad de la fatiga durante la radioterapia aumentó significativamente, predominando la fatiga moderada en la última semana del tratamiento. La magnitud de la fatiga exhibió escores más altos en la dimensión afectiva en las evaluaciones. Por lo tanto, los profesionales de la salud deben prestar mayor atención a la fatiga durante la radioterapia.

Burnout and depressive symptoms in intensive care nurses: relationship analysis / Burnout y sintomatología depresiva en enfermeros de terapia intensiva: análisis de relación / Burnout e sintomatologia depressiva em enfermeiros de terapia intensiva: análise de relação

ABSTRACT Objective: To analyze the existence of a relationship between burnout and depressive symptoms among intensive care unit nursing staff. Method: A quantitative, descriptive, cross-sectional study with 91 intensive care nurses. Data collection used a sociodemographic questionnaire, the Maslach Burnout Inventory - Human Services Survey, and the Beck Depression Inventory - I. The Pearson test verified the correlation between the burnout dimension score and the total score from the Beck Depression Inventory. Fisher's exact test was used to analyze whether there is an association between the diseases. Results: Burnout was presented by 14.29% of the nurses and 10.98% had symptoms of depression. The higher the level of emotional exhaustion and depersonalization, and the lower professional accomplishment, the greater the depressive symptoms. The association was significant between burnout and depressive symptoms. Conclusion: Nurses with burnout have a greater possibility of triggering depressive symptoms.

RESUMEN Objetivo: Analizar la existencia de relación entre burnout y la sintomatología depresiva en enfermeros de unidad de terapia intensiva. Método: Estudio cuantitativo, descriptivo, transversal, con 91 enfermeros de terapia intensiva. Se utilizó, en la colecta de datos, un cuestionario socio demográfico, el Maslach Burnout Inventory - Human Services Survey, y el Inventario de Depresión de Beck - versión I. El test de Pearson verificó la correlación entre la puntuación de las dimensiones de burnout e la puntuación total del Inventario de Beck. El test Exacto de Fisher fue utilizado para analizar si existe asociación entre las enfermedades. Resultados: Presentaron burnout 14,29% de los enfermeros y 10,98% tenían síntomas de depresión. Cuanto mayor el nivel de agotamiento emocional y despersonalización, y menor la realización profesional, mayor la sintomatología depresiva. La asociación fue significativa entre burnout y la sintomatología depresiva. Conclusión: Los enfermeros con burnout tienen una posibilidad mayor de desencadenar la sintomatología depresiva.

RESUMO Objetivo: Analisar a existência de relação entre o burnout e a sintomatologia depressiva em enfermeiros de unidade de terapia intensiva. Método: Estudo quantitativo, descritivo, transversal, com 91 enfermeiros de terapia intensiva. Utilizou-se, na coleta dos dados, um questionário sociodemográfico, o Maslach Burnout Inventory - Human Services Survey, e o Inventário de Depressão de Beck - versão I. O teste de Pearson verificou a correlação entre o escore das dimensões do burnout e o escore total do Inventário de Beck. O teste Exato de Fisher foi utilizado para analisar se existe associação entre as doenças. Resultados: Apresentaram burnout 14,29% dos enfermeiros e 10,98% tinham sintomas de depressão. Quanto maior o nível de exaustão emocional e despersonalização, e menor a realização profissional, maior foi a sintomatologia depressiva. A associação foi significativa entre o burnout e a sintomatologia depressiva. Conclusão: Os enfermeiros com burnout têm uma possibilidade maior de desencadear a sintomatologia depressiva.

Fadiga pré-operatória em pacientes com câncer: prevalência e fatores associados / Pre-operative fatigue in cancer patients: prevalence and associated factors

Este estudo objetivou descrever a prevalência de fadiga e identificar os fatores associados à fadiga em pacientes no pré-operatório de cirurgia oncológica. Pesquisa transversal, desenvolvida com 117 pacientes com câncer em pré-operatório (idade média= 51,2 anos; 76,9% mulheres; 65,8% viviam com companheiro; 70,9% não realizaram tratamento prévio para câncer). Instrumentos utilizados foram Escala de Fadiga de Piper ­ Revisada; Escala de Estresse Percebido; Escala Hospitalar de Ansiedade e Depressão; Escala Numérica de Dor; Escala Numérica de Sono e Escala de Karnofsky (KPS). Realizou-se teste de qui-quadrado, teste t-Student, ANOVA oneway. Constatamos que a prevalência da fadiga pré-operatória foi de 25,6% e a intensidade foi moderada/intensa. A dimensão afetiva de fadiga apresentou escore mais alto comparado às dimensões comportamental e sensorial/psicológica. Ansiedade, depressão, estresse, dor, sono e performance status se associaram à fadiga pré- operatória.

This study aimed to describe the prevalence of fatigue and to identify factors associated with fatigue in patients in the pre-operative phase for oncologic surgery. We conducted a cross-sectional study with 117 pre-operative cancer patients (mean age = 51.2 years; 76.9% women; 65.8% lived with a partner; 70.9% did not have previous cancer treatment). We used the instruments Piper Fatigue Scale-Revised; Perceived Stress Scale; Hospital Anxiety and Depression Scale; Pain Numerical Scale; Numerical Sleep Scale and Karnofsky Performance Status Scale. We conducted Chi-Square test, Student's t-test, and one-way ANOVA. We found a 25.6% prevalence of pre-operative fatigue and the intensity was moderate/severe. The affective fatigue dimension presented higher score compared to behavioral and sensorial/psychological dimensions. Anxiety, depression, stress, pain, sleep and performance status were associated with pre-operative fatigue.