Experiences of fatigue in daily life of people with acquired brain injury: a qualitative study.

PURPOSE: To develop an in-depth understanding of how survivors of acquired brain injury (ABI) experience fatigue and how fatigue affects everyday life. MATERIALS AND METHODS: We conducted semi-structured in-depth interviews with 16 adults with ABI fatigue, recruited from support groups in south east UK. Interviews were analysed using the frameworks method. RESULTS: We developed four themes: experiencing fatigue in the context of everyday activities, struggling to make sense of fatigue, coping with fatigue, and adjusting social participation in the context of fatigue. Fatigue was comprised of mental, physical, generalised, and motivational fatigue. Balancing fatigue against participation in daily activities was influenced by coping strategies and social support. Opportunities to socialize or participate in meaningful activities provided incentives for participants to push through their fatigue. CONCLUSIONS: This study highlights complex interactions that potentially mitigate the impact of fatigue on everyday life. Educational and self-management approaches to fatigue need to account for different types of fatigue in the contexts of an individual's daily activity. Assessment of fatigue should capture in-the-moment experiences of different types of fatigue and activity. Social support and participation in meaningful activities may help individuals to break the negative cycle of fatigue and inactivity.Implications for rehabilitationAssessment of fatigue after brain injury should capture the multidimensional nature of fatigue as well as contextual information about exacerbating activities and environments.Development of personalised coping strategies that account for perceived triggers of different subtypes of fatigue may help ABI survivors to broaden their activity and social participation.Social support and opportunities to participate in personally meaningful activities may help prevent or break a negative cycle of fatigue and inactivity for some ABI survivors.

Factors Associated With Participation in Life Situations for Adults With Stroke: A Systematic Review.

OBJECTIVES: To identify biopsychosocial factors associated with participation outcomes for adults with stroke and to investigate factors associated with participation at different time points poststroke. DATA SOURCES: Medline, CINAHL, AMED, PyschINFO, and Web of Science were systematically searched using keywords stroke, participation, and outcomes and their synonyms on May 15, 2017. STUDY SELECTION: Observational studies reporting on biopsychosocial factors and participation outcomes for community-dwelling adults with stroke were selected. Studies were eligible for inclusion if participation outcomes were measured using indices that mapped to the participation domain of the International Classification of Functioning, Disability and Health (ICF). Intervention studies were excluded. A second reviewer checked all studies against eligibility criteria at each stage. DATA EXTRACTION: Data were extracted on any statistically determined association between biopsychosocial factors and participation outcomes. DATA SYNTHESIS: The proportion of studies reporting significant associations with variables was classified according to the ICF. The exact binomial test was used to determine the probability that the proportion of studies reporting significant associations was due to chance alone. Qualitative descriptive summaries of each study allowed consideration of interactions between variables and changes in participation over time points. CONCLUSIONS: Although depressive symptoms, cognitive functioning, and mobility were found to have the strongest associations with participation, we found that other frequently occurring factors (such as fatigue and environmental factors) were less extensively considered. The diversity of outcome measures encountered within the review highlight the need for a consensus on a core set of outcome measures to evaluate long-term participation in life situations poststroke.

Detection of Staphylococcus aureus including MRSA on environmental surfaces in a jail setting.

We examined jail environmental surfaces to explore whether they might serve as reservoirs of viable methicillin-resistant Staphylococcus aureus (MRSA). We swabbed 132 surfaces, inoculated primary and secondary mannitol salts and oxacillin-resistant screening agar, and used API tests to identify S. aureus and E-tests to determine methicillin/oxacillin resistance. We recovered S. aureus from 10 (7.6%) surfaces; eight (6.1%) isolates were MRSA. We ran pulsed-field gel electrophoresis on six resistant isolates and observed three patterns, one of which was identical to that identified in a previous study of inmates' nasal specimens. Finding MRSA-contaminated surfaces on a variety of environmental surfaces in the absence of an overt outbreak emphasizes that correctional facilities should have protocols for environmental cleaning as a component of MRSA prevention.

Microbial evaluation of foodservice surfaces in Texas child-care centers.

Children under the age of 5 years experience a disproportionately high rate of bacterial enteric infections. Research has shown a relationship between inadequate child-care center sanitation and illnesses in children. This cross-sectional study assessed the sanitation levels of foodservice surfaces in a sample of 36 Texas child-care centers via recovery and identification of selected enteric gram-negative bacteria. The centers in this study had the capacity to care for 50 to 332 children and represented diverse socioeconomic and racial profiles. Forty-one percent (68 of 167) of total swab samples collected tested positive for bacteria. Twenty-seven different types of bacteria were identified from positive swab samples. Most of the bacteria found are considered opportunistic pathogens, which can pose serious health risks to those with compromised immune systems, such as young children. Two types of bacteria recovered, Salmonella paratyphi A and Klebsiella pneumonia, are considered nonopportunistic and can infect healthy individuals. The most common areas of bacterial contamination were the sink drain area of the dishwashing sink, the hand-washing sink faucet handles, the handle of the garbage can lid, and cutting boards. It is vital for child-care staff to wash their hands often and disinfect all surfaces, because even surfaces that appear clean can harbor microorganisms.