El efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis: un estudio de metaanálisis / The effect of foot reflexology on fatigue in hemodialysis patients: a meta-analysis study / O efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise: um estudo de metanálise

Objetivo: analizar el efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis, combinando los resultados de estudios independientes sobre este tema. Método: estudio de metaanálisis. Se realizó una búsqueda bibliográfica en siete bases de datos. La calidad metodológica de los estudios incluidos se evaluó mediante las herramientas propuestas por el Joanna Briggs Institute. Para el metaanálisis se utilizó el programa Comprehensive Meta-Analysis v3. Resultados: en el metaanálisis se incluyeron ocho estudios. El resultado de la diferencia de medias estandarizada del metaanálisis = 1,580 (Intervalo de Confianza de 95% = 1,075 - 2,085 p = 0,000). El resultado del análisis de subgrupos realizado sobre la base de la diferencia de medias estandarizada en el número de sesiones de reflexología podal = 1,478 (Intervalo de Confianza de 95% = 1,210 - 1,747, p = 0,000). Conclusión: se concluyó que la reflexología podal puede utilizarse para reducir la fatiga en pacientes en hemodiálisis. En los estudios investigados no se proporcionó información sobre los posibles efectos secundarios y negativos de la reflexología podal.

Objective: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. Method: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. Results: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). Conclusion: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology.

Objetivo: analisar o efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise, combinando os resultados de estudos independentes sobre este assunto. Método: estudo de metanálise. Foi realizada uma pesquisa bibliográfica em sete bases de dados. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Para a metanálise, foi utilizado o Comprehensive Meta-Analysis v3. Resultados: oito estudos foram incluídos na metanálise. O resultado da diferença média padronizada da metanálise = 1,580 (Intervalo de Confiança de 95% = 1,075 - 2,085 p = 0,000). O resultado da análise de subgrupo realizada com base na diferença média padronizada do número de sessões de reflexologia podal = 1,478 (Intervalo de Confiança de 95% = 1,210 - 1,747, p = 0,000). Conclusão: a reflexologia podal pode ser utilizada para reduzir a fadiga em pacientes em hemodiálise. Não foram fornecidas informações nos estudos investigados sobre os possíveis efeitos colaterais e negativos da reflexologia podal.

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.

Educational technology for fatigue management related to antineoplastic chemotherapy / Tecnología educativa en el manejo de la fatiga relacionada con la quimioterapia antineoplásica / Tecnologia educativa para manejo da fadiga relacionada à quimioterapia antineoplásica

ABSTRACT Objective: To construct and validate an educational technology (ET) on fatigue and non-pharmacological strategies for the management of this symptom in people with cancer undergoing outpatient antineoplastic chemotherapy. Method: This is a methodological study composed of three stages: 1) elaboration of the ET using the theoretical-methodological model of Doak, Doak and Root; 2) validation of content and appearance by seven nurses via the content validity index (CVI); and 3) a pilot test with 10 patients. Results: The ET "Knowing and coping with fatigue" contemplates the definition of fatigue, its causes and the interventions of physical exercise practice, sleep hygiene, energy conservation and behavioral intervention. The overall CVI obtained with the judges was 0.95. Conclusion: The ET presented content and appearance validity for health education regarding fatigue related to antineoplastic chemotherapy in outpatient cancer patients.

RESUMEN Objetivo: Construir y validar una tecnología educativa (TE) sobre fatiga y estrategias no farmacológicas para el manejo del síntoma en personas con cáncer en tratamiento quimioterápico antineoplásico ambulatorio. Método: Estudio metodológico que consta de tres etapas: 1) elaboración de la TE utilizando el modelo teórico-metodológico de Doak, Doak y Root; 2) validación de contenido y apariencia por siete jueces enfermeros, por medio del índice de validez de contenido (IVC); y 3) realización de una prueba piloto con 10 pacientes. Resultados: La TE "Conociendo y lidiando con la fatiga" contempla la definición de fatiga, sus causas y las intervenciones con la práctica de ejercicios físicos, la higiene del sueño, la conservación de energía y la intervención comportamental. El IVC total obtenido con los jueces fue de 0,95. Conclusión: La TE presentó validez de contenido y apariencia para la educación en salud con relación a la fatiga relacionada a la quimioterapia antineoplásica en pacientes oncológicos ambulatorios.

RESUMO Objetivo: Construir e validar tecnologia educativa (TE) sobre fadiga e estratégias não farmacológicas para manejo desse sintoma em pessoas com câncer em tratamento quimioterápico antineoplásico ambulatorial. Método: Estudo metodológico composto por três etapas: 1) elaboração da TE, utilizando o modelo teórico-metodológico de Doak, Doak e Root; 2) validação de conteúdo e aparência por sete juízes enfermeiros, por meio do índice de validade de conteúdo (IVC); e 3) realização de teste piloto com 10 pacientes. Resultados: A TE "Conhecendo e lidando com a fadiga" contempla a definição de fadiga, suas causas e as intervenções de prática de exercícios físicos, higiene do sono, conservação de energia e intervenção comportamental. O IVC global obtido com os juízes foi de 0,95. Conclusão: A TE apresentou validade de conteúdo e aparência para a educação em saúde com relação à fadiga relacionada à quimioterapia antineoplásica em pacientes oncológicos ambulatoriais.

Paciente con cansancio / Tired patient

El médico de familia está capacitado para resolver la mayoría de los problemas de salud de sus pacientes. Dentro del consultorio, el cansancio constituye un motivo de consulta muy frecuente. Su abordaje debe incluir la evaluación del contexto del paciente y un enfoque sistémico que incluya otros niveles diagnósticos y terapéuticos. Se presenta el caso de una paciente que, a partir de este motivo de consulta tan frecuente y junto a intervenciones de su médico de cabecera, logró modificar el foco del problema y comenzar un tratamiento acorde. (AU)

Family physicians are able to solve the majority of their patients' health issues. In the office, fatigue is a common complaint. Its approach should include the evaluation of the context of the patient and a systemic approach that includes other diagnostic and therapeutic levels. We present the case of a patient who went to his doctor with a common complaint and was able to change the focus of the problem and begin a consistent treatment. (AU)

Uso da acupressão para minimizar desconfortos na gestação / Utilización de acupresión para minimizar las incomodidades en el embarazo / Using acupressure to minimize discomforts during pregnancy

RESUMO Objetivo Descrever respostas emitidas por gestantes, quanto à melhora dos desconfortos gravídicos após aplicação da técnica da acupressão. Método Estudo qualitativo e descritivo desenvolvido com 15 gestantes entre novembro de 2013 e fevereiro de 2014 em uma Unidade Básica de Saúde de Natal-RN, Brasil. A coleta de dados ocorreu por meio de entrevista não estruturada, e os depoimentos, depois de transcritos e tratados de acordo com a proposta operativa de Minayo, foram lidos criteriosamente, comparados entre si e organizados em dois grupos. Resultados As categorias suscitadas foram: Repercussões positivas da acupressão e Recomendações do uso da acupressão. Segundo as gestantes, os desconfortos da gravidez como câimbras, cansaço nos membros inferiores, lombalgia e cefaleia diminuíram com o uso da acupressão. Conclusões Baseado nos resultados obtidos, a acupressão deve ser introduzida pela(o) enfermeira(o) em consultas pré-natais como recurso terapêutico em prol da obtenção do bem-estar da gestante.

RESUMEN Objetivo Describir las respuestas de las mujeres embarazadas correspondiente a la mejora de las molestias gravídicas después de la aplicación de la acupresión. Método Estudio cualitativo, descriptivo desarrollado con 15 mujeres embarazadas entre noviembre de 2013 y febrero 2014 en una Unidad Básica de Salud de Natal-RN, Brasil. Los datos fueron recolectados a través de entrevistas no estructuradas y las declaraciones, después de transcriptas y tratadas según propuesta operative de Minayo, fueron leídas con atención, comparadas y organizadas en dos grupos. Resultados Se plantearon las siguientes categorías: Repercuciones positivas de la acupresión y Recomendaciones de uso de la acupresión. Mediante el uso de acupresión en las mujeres embarazadas se obtuvo disminución de calambres, fatiga en las piernas, dolor de espalda y dolor de cabeza. Conclusiones Basándose en los resultados, la acupresión debe ser introducida por la enfermera en las reuniones prenatales como recurso terapéutico para obtener bienestar de la mujer embarazada.

ABSTRACT Objective To describe responses issued by pregnant women, and the improvement of the gravidic discomforts after the use of the acupressure technique. Method Qualitative and descriptive study conducted with 15 pregnant women between November 2013 and February 2014 in a Basic Health Unit in Natal, RN, Brazil. The data were collected through unstructured interviews and depositions that were then transcribed and treated according to Minayo's operative proposal, carefully read, compared and organized into two groups. Results The categories that resulted were: Positive effects of acupressure, and the recommended use of acupressure. According to pregnant women, the discomforts of pregnancy cramps, fatigue in the legs, lower back pain and headaches decreased with the use of acupressure. Conclusions Based on the results, acupressure should be introduced by the nurse in pre-natal care as a therapeutic resource for the pregnant woman's well-being.

Hacia una terapia multimodal en el cansancio oncológico: estudio piloto fase 2, prospectivo, randomizado y doble ciego / Towards multimodal therapy in cancer fatigue: a pilot phase 2 study, prospective, randomized and double blind

El cansancio oncológico es uno de los síntomas más frecuentes e incapacitantes en este tipo de pacientes, tanto durante su tratamiento como en estados avanzados de su enfermedad y afecta en forma significativa la dimensión física, afectiva y cognitiva del paciente. Sin embargo, es el síntoma menos estudiado por la oncología moderna.Actualmente, no contamos con un estándar de tratamiento. La mejor evidencia disponible muestra en pequeño estudio asociado al beneficio de la dexametasona versus placebo en fatiga oncológica en casos con enfermedad avanzada; además, existe evidencia de resultados positivos mediante estrategias no farmacológicas, como los programas de ejercicios aeróbicos y técnicas de manejo del estrés. Este estudio tiene por propósito investigar la eficacia en el cansancio oncológico en enfermedad avanzada de un tratamiento multimodal (basado en estrategias no farmacológicas más uso de dexametasona) versus tratamiento farmacológico sólo usando dexametasona (terapia unimodal). Para ello, en estudio prospectivo y doble ciego, se randomizó 1:1 80 pacientes entre 20 y 80 años de edad con neoplasias avanzadas a tratamiento multimodal o brazo A (terapia farmacológica y no farmacológica) versus terapia unimodal o brazo B (terapia farmacológica sola). Al inicio del estudio se permitió el ingreso de pacientes con fatiga 4 o más sobre 10 aplicando instrumento Brief Fatigue Inventory, que es una forma de Escala Visual Análoga (EVA) aplicada al cansancio oncológico; y al menos otros 2 síntomas relacionados (depresión, ansiedad y/o insomnio), con función cognitiva normal, sin infecciones sobreagregadas, sin neoplasia encefálica, con función tiroidea normal y hemoglobina mayor de 9 gr/dl (recuérdese que una disfunción tiroidea o la anemia favorecen la sensación de fatiga y de no excluirse estos factores no permitiría sacar conclusiones válidas). Al mes de tratamiento se reevaluó mediante EVA la fatiga (end point primario)...

The Cancer Fatigue is one of the most common and disabling symptoms in these patients both during treatment and in advanced stages of their disease; and significantly affect the physical , emotional and cognitive dimension of the patient. And yet it is the symptom less studied by modern oncology. Currently we do not have a standard treatment. The best available evidence shows benefit in small study of dexamethasone versus placebo in cancer fatigue in patients with advanced disease; there is also evidence of positive results by non-pharmacological strategies such as aerobic exercise programs and stress management techniques. This study is aimed to investigate the efficacy in cancer fatigue in advanced disease of a multimodal treatment (based on nonpharmacological strategies more use of dexamethasone) versus using dexamethasone treatment alone (unimodal therapy). To do this in prospective, double-blind study 80 patients 1:1 between 20 and 80 years old with advanced malignancies were randomized to arm A multimodal treatment (pharmacological and nonpharmacological therapy) versus unimodal therapy or arm B (single drug therapy). At study entry patients were allowed to fatigue 4 or more out of 10 using Brief Fatigue Inventory instrument, which is a form of visual analog scale (EVA) applied to cancer fatigue; and at least 2 other related symptoms (depression, anxiety and / or insomnia), with normal cognitive function , without a superimposed infections, without brain cancer, with normal thyroid function and increased hemoglobin 9 g / dl (remember that thyroid dysfunction or anemia favors the sensation of fatigue and not excluded these factors would not draw valid conclusions)...

Efeito da hidrocinesioterapia sobre qualidade de vida, capacidade funcional e qualidade do sono em pacientes com fibromialgia / Effect of hydrotherapy on quality of life, functional capacity and sleep quality in patients with fibromyalgia

INTRODUÇÃO: A síndrome da fibromialgia acomete 8% da população com mais de 40 anos de idade. Dos pacientes com fibromialgia, 75% queixam-se de má qualidade do sono. OBJETIVO: Avaliar os efeitos da hidrocinesioterapia sobre a capacidade funcional e a qualidade de sono em pacientes com fibromialgia. MÉTODOS: As pacientes foram atendidas na policlínica da UNASP. Foram avaliadas 60 pacientes portadoras de fibromialgia na faixa etária entre 30 e 65 anos. Das pacientes avaliadas, 20 foram excluídas e 10 desistiram devido à impossibilidade de apresentar-se no horário do programa de exercícios. Todas as pacientes responderam aos seguintes questionários: Questionário sobre o Impacto daFibromialgia (QIF), Índice da Qualidade do Sono de Pittsburgh e Escala de Sonolência de Epworth. As sessões foram realizadas duas vezes por semana, com duração de 60 minutos cada, por um período de dois meses. RESULTADOS: A média da idade das pacientes foi de 45 anos; 66% eram trabalhadoras ativas e 34% estavam afastadas do trabalho. Verificouse que imediatamente após participarem do programa da hidrocinesioterapia, as pacientes apresentaram melhora nos seguintes aspectos avaliados por meio do QIF: capacidade funcional, absenteísmo ao trabalho, capacidade de serviço, intensidade da dor, fadiga, cansaço matinal, rigidez (P < 0,0001), ansiedade (P = 0,0013) e depressão (P < 0,0001). Houve também melhora da qualidade do sono (P < 0,0001) e no grau de sonolência diurna (P = 0,0003). CONCLUSÃO: A hidrocinesioterapia promove melhora de qualidade do sono, capacidade funcional, situação profissional, distúrbio psicológicos e sintomas físicos da síndrome em pacientes com fibromialgia.

INTRODUCTION: Fibromyalgia affects 8% of the population over the age of 40 years, and 75% of the patients with fibromyalgia have poor sleep quality. OBJECTIVE: To assess the effects of hydrotherapy on the physical function and sleep quality of patients with fibromyalgia. METHODS: Patients were under clinical care at the UNASP Outpatient Clinic. This study assessed 60 female patients with fibromyalgia aged between 30 and 65 years. Out of the 60 patients assessed, 20 were excluded and 10 left the study because they could not comply with the time schedule. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ); Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Training sessions were performed twice a week for two months, each session lasting 60 minutes. RESULTS: Patients' mean age was 45 years, 66% were active workers, and 34% had quit work. Right after the hydrotherapy program, the patients improved the following aspects assessed by use of the FIQ: physical function, work absenteeism, ability to do job, pain intensity, fatigue, morning tiredness, stiffness (P < 0.0001), anxiety (P = 0,0013), and depression (P < 0.0001). Sleep quality (P < 0.0001) and daytime sleepiness (P = 0.0003) also improved. CONCLUSION: Hydrotherapy improves sleep quality, physical function, professional status, psychological disorders and physical symptoms in patients with fibromyalgia.

Melhora da dor, do cansaço e da qualidade subjetiva do sono por meio de orientações de higiene do sono em pacientes com fibromialgia / Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia

OBJETIVO: Avaliar a efetividade das orientações para higiene do sono em mulheres portadoras de fibromialgia. MATERIAIS E MÉTODOS: Setenta mulheres completaram o estudo. Na avaliação foram aplicados o Questionário de Impacto da Fibromialgia(FIQ), o Índice de Qualidade do Sono de Pittsburgh (PSQI) e um questionário geral, com dados pessoais e informações de hábitos de vida. Todas as pacientes receberam informações quanto à doença, além de um diário do sono, e apenas o grupo-experimental recebeu orientações para higiene do sono. Foi solicitado às pacientes que realizassem a higiene do sono, e as mesmas foram reavaliadas após três meses. RESULTADOS: A idade média das pacientes do grupo-controle foi 55,2 ± 7,12 anos, e a do grupo-experimental foi 53,5 ± 8,89 anos (P = 0,392). Nessas pacientes foram observadas diminuições da medida de Escala Visual Analógica de dor (P = 0,028), de cansaço (P = 0,021) e do componente 1 do PSQI (P = 0,030). O grupo que recebeu orientações para higiene do sono mostrou redução significativa na dificuldade de retorno ao sono quando acordava de madrugada (P = 0,031). O grupo-experimental apresentou aumento na porcentagem de relatos de "ambiente sem ruído" (variando de 42,9% para 68,6%), diminuição da porcentagem de relatos de "ambiente com pouco ruído" (variando de 40% para 22,9%) e diminuição na porcentagem de relatos de "ambiente com muito ruído" (variando de 17,1% para 8,6%). As alterações facilitaram o retorno ao sono quando as pacientes acordavam durante a madrugada. CONCLUSÃO: Uma cartilha com orientações de higiene do sono permitiu a alteração do comportamento das pacientes, que obtiveram melhora da dor e do cansaço, aumento da qualidade subjetiva do sono, além de facilitação do retorno ao sono após despertar durante a madrugada.

OBJECTIVE: To evaluate the effectiveness of sleep hygiene instructions for women with fibromyalgia. MATERIALS AND METHODS: Seventy women with fibromyalgia completed the study. The assessment comprised the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and a general questionnaire with personal data and lifestyle information. All patients received information about the disease and a sleep diary, but only the experimental group received the sleep hygiene instructions. Patients were asked to practice sleep hygiene, and, after three months, they were reevaluated by use of the same questionnaires. RESULTS: The mean age in the control group was 55.2 ±7.12 years, and, in the experimental group, 53.5 ±8.89 years (P = 0.392). The experimental group showed: a decrease in the pain Visual Analogue Scale values (P = 0.028), in fatigue (P = 0.021), and in the PSQI component 1 (P = 0.030); and a significant reduction in the difficulty falling asleep after waking up in the middle of the night (P = 0.031). The experimental group also showed an increase in the reporting percentage of "silent environment" (ranging from 42.9% to 68.6%), a decrease in the reporting percentage of "fairly quiet environment" (ranging from 40% to 22.9%), and a decrease in the reporting percentage of "noisy environment" (ranging from 17.1% to 8.6%). These changes facilitated falling asleep after waking up in the middle of the night. CONCLUSION: The sleep hygiene instructions allowed changing the patients' behavior, which resulted in pain and fatigue improvement, increased subjective quality of sleep, in addition to facilitating falling asleep after waking up in the middle of the night.

Novedades en enfermedades colestásicas / Latest advances in cholestatic diseases

Cholestatic liver diseases arise from impaired hepatobiliary production and excretion of bile. They have some common clinical manifestations and pathogenic features, but at the same time differences that require a special approach. Intrahepatic cholestasis of pregnancy and drug induced liver cholestasis are the most common reversible intrahepatic cholestasis. Primary biliary cirrhosis and primary sclerosing cholangitis are chronic cholestatic diseases. This review will be focused on these two types, in particular their clinical and therapeutic management and complications. While in recent years there has not been much change in the basic clinical approach of these diseases, every day we receive more information from both the basic and clinical science studies, which has enabled to develop new therapeutic lines and reject others that have not confirmed effectiveness.

Las enfermedades colestásicas se caracterizan por la disminución de la formación o excreción del flujo de bilis. Ellas tienen ciertas manifestaciones clínicas y mecanismos patogénicos comunes, pero a su vez diferencias que requieren un enfrentamiento no siempre similar. La colestasia intrahepática del embarazo(CIE) y la colestasia secundaria a fármacos son las más frecuentes dentro de las colestasias intrahepáticas reversibles. La cirrosis biliar primaria (CBP) y la colangitis esclerosante primaria (CEP), son las enfermedades colestásicas crónicas en que centramos esta revisión, en particular en los aspectos clínicos y de manejo terapéutico tanto de éstas, como de sus complicaciones. Si bien en los últimos años no ha habido un cambio significativo en el manejo fundamental de estas enfermedades, cada vez tenemos más información tanto en el área de ciencias básicas como en aspectos clínicos, lo que ha permitido ir desarrollando nuevas líneas terapéuticas y descartando otras que no han confirmado efectividad.

Effects of Aroma Self-Foot Reflexology Massage on Stress and Immune Responses and Fatigue in Middle-Aged Women in Rural Areas

PURPOSE: This study was done to examine the effects of aroma self-foot reflexology massage on stress and immune responses and fatigue in middle-aged women in rural areas. METHODS: The study was a nonequivalent control group pre-post test design. The participants were 52 middle-aged women from rural areas of which 26 were assigned to the experimental group and 26 to the control group. Data were collected from July to September, 2011 and analyzed using SPSS Win 17.0 version program. The intervention was conducted 3 times a week for six weeks. RESULTS: There were significant differences in reported perceived stress, systolic blood pressure, diastolic blood pressure and fatigue between the two groups. However, the issue of salivary cortisol and immune response were not significant. CONCLUSION: Aroma self-foot reflexology massage can be utilized as an effective intervention for perceived stress, systolic blood pressure, diastolic blood pressure and fatigue in middle-aged woman in rural areas.

Fadiga relacionada ao câncer: uma revisão / Cancer-related fatigue: a review

A fadiga relacionada ao câncer (FRC) é um dos sintomas mais prevalentes em pacientes com câncer, sendo reportada por 50 por cento a 90 por cento dos pacientes durante o curso da doença ou do seu tratamento, impactando na qualidade de vida de forma severa além de diminuir a capacidade funcional diária dos pacientes. Uma abordagem ampla deve ser realizada com orientações gerais sobre fadiga, além da determinação de um plano individualizado de abordagem terapêutica. Pacientes com fadiga moderada ou severa devem se beneficiar de ambas as medidas farmacológicas e não farmacológicas a serem adotadas, enquanto pacientes que apresentem fadiga leve que não interfira na qualidade de vida podem ser tratados com medidas não farmacológicas como única medida terapêutica. O tratamento não farmacológico se mostra promissor com o uso de terapias cognitivas-comportamentais (conservação de energia e organização de atividades diárias realizadas, ECAM), exercícios físicos e talvez terapias do sono. O tratamento farmacológico tem mostrado resultados promissores que incluem o uso de psicoestimulantes tais como metilfenidato e dexmetilfenidato, modanafil (em pacientes com fadiga severa) e agentes estimuladores de eritropoietina em pacientes com anemia associada à quimioterapia e hemoglobina menor que 10 mg/dL. Além dessas drogas, o uso de Guaraná (Paullinia cupana) tem-se mostrado uma opção promissora, com efeitos benéficos no tratamento da fadiga física e mental relacionada ao câncer. Por ser uma opção sem efeitos colaterais significantes e uma planta nacional, torna-se atrativo considerando o fácil acesso a esta medicação por seu baixo custo e fácil adesão ao tratamento. O tratamento pode ser oferecido através de uma abordagem multimodal e multidisciplinar que individualize as opções terapêuticas dentro de um contexto que promova o diagnóstico acurado da FRC, além de um tratamento específico e adequado para cada paciente que apresente este sintoma tão importante e de grande impacto na qualidade de vida de pacientes com câncer.

Cancer-related fatigue is the most prevalent cancer symptom, reported in 50 percent-90 percent of patients and severely impacts quality of life and functional capacity. The condition remains underreported and often goes untreated. Guidelines suggest screening for fatigue at the initial visit, when the diagnosis of advanced disease is made, and at each chemotherapy session, as well as the identification of treatable contributing factors such as anemia, hypothyroidism, depression and sleep disorders. Brief assessment tools such as the Brief Fatigue Inventory or the Visual Analog Scale may be appropriate in the initial scoring of fatigue severity, but the initial approach to treatment usually requires a more comprehensive assessment, education, and the determination of an individualized treatment plan. Patients with moderate or severe fatigue may benefit from both pharmacological and non-pharmacological interventions, whereas mild fatigue that does not interfere with quality of life can be treated with non-pharmacological measures alone. Non-pharmacological measures that have shown to be promising include cognitive-behavioral interventions such as energy conservation and activity management (ECAM), exercise and perhaps sleep therapy. Many other modalities may be beneficial and can be used on an individual basis, but there is insufficient evidence to promote any single treatment. Pharmacological therapies that have shown to be promising include the psycho-stimulants methylphenidate and dexmethylphenidate, modafinil (in severely fatigued patients only), and erythropoietin-stimulating agents in patients with chemotherapy-associated anemia and hemoglobin levels < 10 g/dL. Recently, our group reported impressive results with the use of the dry extract of Guarana (Paullinia cupana), with no significant side effects and at low cost, for the treatment of physical and mental cancer-related fatigue.

[Effect of Stachys lavandulifolia on fatigue, nausea and vomiting associated with primary dysmenorrheal]

Because of importance and outbreak of dysmenorrhea and Its effect on life of 50% of population in the world[women], this study was done. To evaluate the therapeutic effects of Stachys lvandulifolia on fatigue, nausea, and vomiting associated with primary dysmenorrhea. This was a randomized clinical trial performed on 50 women aged 18-25 years and 50-60 kg whight suffering from primary dysmenorrhea. Fatigue, nausea, and vomiting were evaluated by visual analogue scale [VAS]. Initially, the study population was requested to consume the Stachys lvandulifolia flowers at a dose of 10 gr of brewed powder three time a day and for a total of 5 days [2 days before pain to 3 days after pain], based on a common traditional administration. Later, the members of both groups were followed up for three cycles. Fatigue, nausea, and vomiting as well as the side-effects were evaluated following consumption of brewed powder of Stachys lvandulifolia flowers. Statistical analysis was performed using t-test and chi-square test. Following consumption of Stachys lvandulifolia the level of fatigue considerably reduced among test group and the difference was significant [p=0/000], statistically. Likewise, a significant difference in severity of nausea between the test and control groups was shown [p=0/006]. No statistically significant difference regarding the severity of vomiting was established between two groups. According to our data, it could be concluded that the use of Stachys lvandulifolia, based on a traditional administration, causes favorable therapeutic effects by reducing the degree of fatigue and nausea in primary dysmenorrhea with no obvious side-effect yet with no effect on vomiting

Effects of Self-Foot Reflexology on Stress, Fatigue, Skin Temperature and Immune Response in Female Undergraduate Students

PURPOSE: The purpose of this study was to evaluate the effects of self-foot reflexology on stress (perceived stress, urine cortisol level, and serum cortisol level), fatigue, skin temperature and immune response in female undergraduate students. METHODS: The research design was a nonequivalent control group pretest-post test design. Participants were 60 university students: 30 in the experiment group and 30 in the control group. The period of this study was from April to June 2010. The program was performed for 1 hr a session, three times a week for 6 weeks. The data were analyzed using the SPSS/WIN 17.0 program. RESULTS: The results showed that self-foot reflexology was effective in reducing perceived stress and fatigue, and raised skin temperature in female undergraduate students. But cortisol levels and immune response were not statistically significant different. CONCLUSION: The results of this study indicate that self-foot reflexology is an effective nursing intervention in reducing perceived stress and fatigue and, in improving skin temperature. Therefore, it is recommended that this be used in clinical practice as an effective nursing intervention for in female undergraduate students.

Effects of Foot Reflexology on Fatigue, Sleep and Pain: A Systematic Review and Meta-analysis

PURPOSE: The purpose of this study was to evaluate the effectiveness of foot reflexology on fatigue, sleep and pain. METHODS: A systematic review and meta-analysis were conducted. Electronic database and manual searches were conducted on all published studies reporting the effects of foot reflexology on fatigue, sleep, and pain. Forty four studies were eligible including 15 studies associated with fatigue, 18 with sleep, and 11 with pain. The effects of foot reflexology were analyzed using Comprehensive Meta-Analysis Version 2.0. The homogeneity and the fail-safe N were calculated. Moreover, a funnel plot was used to assess publication bias. RESULTS: The effects on fatigue, sleep, and pain were not homogeneous and ranged from 0.63 to 5.29, 0.01 to 3.22, and 0.43 to 2.67, respectively. The weighted averages for fatigue, sleep, and pain were 1.43, 1.19, and 1.35, respectively. No publication bias was detected as evaluated by fail-safe N. Foot reflexology had a larger effect on fatigue and sleep and a smaller effect on pain. CONCLUSION: This meta-analysis indicates that foot reflexology is a useful nursing intervention to relieve fatigue and to promote sleep. Further studies are needed to evaluate the effects of foot reflexology on outcome variables other than fatigue, sleep and pain.

Effects of Laughter Therapy on Postpartum Fatigue and Stress Responses of Postpartum Women

PURPOSE: The purpose of this study was to examine the effects of laughter therapy on postpartum fatigue and stress respon-ses of postpartum women. METHODS: The research design was a nonequivalent control group non-synchronized design. The participants were 67 postpartum women who agreed to participate in this study, selected by convenience sampling: (experiment group-33 and control group-34). The data were collected from August 5 to September 30, 2010. The experimental group received laughter therapy from a laughter therapy expert for 60 min, twice a week for 2 weeks, a total of 4 sessions. To evaluate the effects of laughter therapy, postpartum fatigue by self-report questionnaire and cortisol concentration in breast milk were measured. The data were analyzed using the SPSS WIN 13.0 Program. RESULTS: The first hypothesis that "the degree of postpartum fatigue in the experimental group participating in laughter therapy would be lower than that of the control group" was accepted. These findings indicate that laughter therapy has a positive effect on decreasing postpartum fatigue. CONCLUSION: The finding provides evidence for use of complementary and alternative nursing in Sanhujori facilities and obstetric units to reduce postpartum women's fatigue.

Effects of Self-Foot Reflexology on Stress, Fatigue and Blood Circulation in Premenopausal Middle-Aged Women

PURPOSE: This study was to examine the effects of self-foot reflexology on stress, fatigue and blood circulation in premenopausal middle-aged women. METHODS: A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants were 59 premenopausal, middle-aged women in their 40s and 60s living in G city: 30 in the experiment group and 29 in the control group. Data were collected from May to August 2008. Self-foot reflexology was performed three times a week for 6 weeks for 40 min at each session. RESULTS: The results showed that self-foot reflexology was effective in reducing perceived stress and fatigue and helped blood circulation in premenopausal middle-aged women. CONCLUSION: Self-foot reflexology may be an effective nursing intervention in reducing perceived stress and fatigue and in improving blood circulation.

[Effect of applying progressive muscle relaxation technique on fatigue in multiple sclerosis patients]

Fatigue is the most frequent and disabling symptom in 92% of multiple sclerosis [MS] patients. Fatigue interferes with daily functioning and prevents sustained physical exertion, limits work and social role performance, and is related to lower quality of their life. Complementary therapies are widely used in treatment of people with MS and Progressive Muscle Relaxation Technique [PMRT] is a form of complementary therapies. The aim of this study was to assess the effects of applying PMRT on fatigue in MS patients. In this Quasi-experimental study, a total of 66 MS patients were selected with convenient sampling according to specific criteria and then were divided randomly into two groups of experimental and control [33 patients in each group]. PMR performed for 63 sessions on experimental group during two months but no intervention was done for control group. Data were collected using demographic questionnaire, Fatigue Severity Scale [FSS], and Self report checklists. Statistical analysis was done by SPSS software and use of paired-t test, student-t test, analysis of variance [ANOVA] and correlation between variables. Student t-test showed that there was no significant difference between two groups in mean scores of fatigue before the study but this test showed significant difference between the two groups, one month [4.69 +/- 1.03 and 5.43 +/- 0.96, P<0.01] and two months [4.09 +/- 1.06 and 5.43 +/- 1.08, P<0.001] after intervention, respectively. ANOVA test with repeated measurements showed that there is a significant difference in mean score fatigue between two groups in 3 times [P<0.01]. The results of this study showed that PMR is practically feasible and could decrease fatigue of MS patients, so that applying this technique offered to these patients

[Effect of applying hydrotherapy on fatigue in multiple sclerosis patients]

Fatigue is a common symptom of Multiple Sclerosis [MS] that is purported to cause significant distress and have detrimental effects on daily living functioning, social and occupational obligations, and overall well-being. Complementary therapies are widely used by people with MS and Progressive Hydrotherapy is a form of complementary therapies. The aim of this study is to assess the effects of applying Hydrotherapy on fatigue of Multiple Sclerosis patients. This is a Quasi-experimental study. 50 Multiple Sclerosis patients were selected with convenient sampling according to specific criteria then assigned to experimental and control groups [25 patients in each group] with random allocation. Data collector tools included: demographic questionnaire, Fatigue Severity Scale [FSS], Self report checklists. Hydrotherapy performed for 24 sessions by experimental group during three months but no intervention was done for control group. Statistical analysis was done by SPSS software. There was no significant difference between two groups in mean scores of fatigue before the study but this test showed different significance between two groups, 4, 8 and 12 weeks after intervention [P<0.05]. ANOVA test with repeated measurements showed that there is a significant difference in mean score of fatigue between two groups in 4 times [P<0.05]. The results of this study show that Hydrotherapy is practically feasible and could decrease fatigue of MS patients; so that applying this technique offered to these patients

Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP

BACKGROUND & PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS) has been reported in the literature for many years. Both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. The primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (CPAP) treatment in OSAS patients with and without RLS. METHOD: A prospective and comparative study between a group of 13 patients with OSAS and a group of 17 patients with OSAS+RLS. Laboratory blood tests and polysomnography were performed at baseline. The Epworth Sleepiness Scale (ESS) and the PichotÆs questionnaire of fatigue/depression (PIC) were applied before and after 3 months of CPAP treatment. Results were compared. RESULTS: No significant differences were found on PSG and laboratory results at baseline. Both groups had similar ESS and PIC scores at baseline (p=0.73 and 0.08, respectively). After n-CPAP, OSAS+RLS patients showed higher ESS and PIC scores (p=0.017 and 0.03, respectively). CONCLUSIONS: Despite a favorable general response, n-CPAP seemed less effective in treating fatigue and sleepiness in the OSAS+RLS group.

OBJETIVO: A associação síndrome de apnéia obstrutiva do sono / síndrome de pernas inquietas (SAOS-SPI) tem sido mencionada na literatura há muito. Ambas podem ser responsáveis por queixas de fadiga e sonolência secundárias à fragmentação do sono noturno. O objetivo deste estudo é avaliar a evolução dos sintomas de fadiga e sonolência diurna excessiva antes e após o tratamento com pressão aérea positiva contínua (CPAP) em pacientes portadores de SAOS, com e sem SPI. MÉTODO: Estudo prospectivo e comparativo entre um grupo de 13 pacientes com SAOS e um grupo de 17 com SAOS +SPI. Exames laboratoriais e polissonografia (PSG) foram realizados no início do estudo. A escala de sonolência de Epworth (ESE) e o questionário de fadiga/depressão de Pichot (PIC) foram aplicados antes do tratamento com CPAP e 3 meses após. Os resultados foram comparados. RESULTADOS: No início do estudo não foram encontradas diferenças significativas na avaliação laboratorial e PSG. Ambos os grupos apresentavam inicialmente pontuação semelhante na avaliação da ESE e PIC (p=0,73 e 0,08, respectivamente). Após CPAP, os pacientes SAOS+SPI apresentaram maiores ESE e PIC (p=0,017 e 0,03, respectivamente). CONCLUSÃO: Apesar de resposta inicial favorável em ambos os grupos, o CPAP foi aparentemente menos eficaz na redução das queixas de fadiga e sonolência nos pacientes apnéicos com associação a SPI.