Browsing by Subject "FATIGUE"

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  • Kokkonen, Kristiina; Tasmuth, Tiina; Lehto, Juho T.; Kautiainen, Hannu; Elme, Anneli; Jaaskelainen, Anna-Stina; Saarto, Tiina (2019)
    Background/Aim: To observe changes in symptoms and health-related quality of life (HRQoL) over 7 years among cancer patients at different stages of the disease. Patients and Methods: This prospective cross-sectional study at the Helsinki University Hospital Cancer Center, was carried out in 2006 and repeated in 2013. All participants filled in the EORTC-QLQ-C30 questionnaire. Results: Altogether, 581 patients responded (49% in 2006 and 54% in 2013). The disease was local in 51% and advanced in 49% of patients. The HRQoL was significantly lower, except for emotional and cognitive functions, and the symptom burden more severe in advanced cancer. The most prevalent symptoms were fatigue (93% and 85%; moderate/severe 22% and 9%), pain (65% and 47%; moderate/severe 16% and 5%), and insomnia (64% and 60%; moderate/severe 20 and 21%), respectively. No changes in HRQoL or symptoms were found at 7 years. Conclusion: There is a need for early integrated palliative care to improve HRQoL during cancer treatments.
  • Kouri, Vesa-Petteri; Olkkonen, Juri; Kaivosoja, Emilia; Ainola, Mari-Mia; Juhila, Juuso; Hovatta, Iiris; Konttinen, Yrjo T.; Mandelin, Jami (2013)
  • Olkkonen, Juri; Kouri, Vesa-Petteri; Hynninen, Joel; Konttinen, Yrjo T.; Mandelin, Jami (2015)
    Objective Patients with rheumatoid arthritis (RA) have altered circadian rhythm of circulating serum cortisol, melatonin and IL-6, as well as disturbance in the expression of clock genes ARNTL2 and NPAS2. In humans, TNF alpha increases the expression ARNTL2 and NPAS2 but paradoxically suppresses clock output genes DPB and PER3. Our objective was to investigate the expression of direct clock suppressors DEC1 and DEC2 (BHLHE 40 and 41 proteins) in response to TNF alpha and investigate their role during inflammation. Methods Cultured primary fibroblasts were stimulated with TNF alpha. Effects on DEC2 were studied using RT-qPCR and immunofluorescence staining. The role of NF-kappa B in DEC2 increase was analyzed using IKK-2 specific inhibitor IMD-0354. Cloned DEC2 was transfected into HEK293 cells to study its effects on gene expression. Transfections into primary human fibroblasts were used to confirm the results. The presence of DEC2 was analyzed in (RA) and osteoarthritis (OA) synovial membranes by immunohistochemistry. Results TNF alpha increased DEC2 mRNA and DEC2 was mainly detected at nuclei after the stimulus. The effects of TNF alpha on DEC2 expression were mediated via NF-kappa B. Overexpression, siRNA and promoter activity studies disclosed that DEC2 directly regulates IL-1 beta, in both HEK293 cells and primary human fibroblasts. DEC2 was increased in synovial membrane in RA compared to OA. Conclusion Not only ARNTL2 and NPAS2 but also DEC2 is regulated by TNF alpha in human fibroblasts. NF-kappa B mediates the effect on DEC2, which upregulates IL-1 beta. Circadian clock has a direct effect on inflammation in human fibroblasts.
  • Mac Lennan, Eric Michael; Toliou, Athanasia; Granvik, Mikael (2021)
    The near-Earth objects (NEOs) (3200) Phaethon and (155140) 2005 UD are thought to share a common origin, with the former exhibiting dust activity at perihelion that is thought to directly supply the Geminid meteor stream. Both of these objects currently have very small perihelion distances (0.140 au and 0.163 au for Phaethon and 2005 UD, respectively), which results in them having perihelion temperatures around 1000 K. A comparison between NEO population models to discovery statistics suggests that low-perihelion objects are destroyed over time by a, possibly temperature-dependent, mechanism that is efficient at heliocentric distances less than 0.3 au. By implication, the current activity from Phaethon is linked to the destruction mechanism of NEOs close to the Sun. We model the past thermal characteristics of Phaethon and 2005 UD using a combination of a thermophysical model (TPM) and orbital integrations of each object. Temperature characteristics such as maximum daily temperature, maximum thermal gradient, and temperature at different depths are extracted from the model, which is run for a predefined set of semi-major axis and eccentricity values. Next, dynamical integrations of orbital clones of Phaethon and 2005 UD are used to estimate the past orbital elements of each object. These dynamical results are then combined with the temperature characteristics to model the past evolution of thermal characteristics such as maximum (and minimum) surface temperature and thermal gradient. The orbital histories of Phaethon and 2005 UD are characterized by cyclic changes in.., resulting in perihelia values periodically shifting between present-day values and 0.3 au. Currently, Phaethon is experiencing relatively large degrees of heating when compared to the recent 20, 000 yr. We find that the subsurface temperatures are too large over this timescale for water ice to be stable, unless actively supplied somehow. The near-surface thermal gradients strongly suggest that thermal fracturing may be very effective at breaking down and ejecting dust particles. Observations by the DESTINY+ flyby mission will provide important constraints on the mechanics of dust-loss from Phaethon and, potentially, reveal signs of activity from 2005 UD. In addition to simulating the recent dynamical evolution of these objects, we use orbital integrations that start from the Main Belt to assess their early dynamical evolution (origin and delivery mechanism). We find that dwarf planet (2) Pallas is unlikely to be the parent body for Phaethon and 2005 UD, and it is more likely that the source is in the inner part of the asteroid belt in the families of, e.g., (329) Svea or (142) Polana.
  • Ericsson, Christoffer R.; Nordquist, Hilla; Lindström, Veronica; Rudman, Ann (2021)
    Background Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics' professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period. Methods A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants' recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman's correlation coefficients. Results Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores. Conclusions Finnish paramedics' more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics' increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus.
  • Åberg, Fredrik (2016)
    Return to active and productive life is a key goal of modern liver transplantation (LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average post-LT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidney-transplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of (minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients' working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.
  • Stenholm, Sari; Ferrucci, Luigi; Vahtera, Jussi; Hoogendijk, Emiel O.; Huisman, Martijn; Pentti, Jaana; Lindbohm, Joni V.; Bandinelli, Stefania; Guralnik, Jack M.; Kivimäki, Mika (2019)
    Background: Frailty is an important geriatric syndrome, but little is known about its development in the years preceding onset of the syndrome. The aim of this study was to examine the progression of frailty and compare the trajectories of each frailty component prior to frailty onset. Methods: Repeat data were from two cohort studies: the Longitudinal Aging Study Amsterdam (n = 1440) with a 15-year follow-up and the InCHIANTI Study (n = 998) with a 9-year follow-up. Participants were classified as frail if they had > 3 frailty components (exhaustion, slowness, physical inactivity, weakness, and weight loss). Transitions between frailty components were examined with multistate modeling. Trajectories of frailty components were compared among persons who subsequently developed frailty to matched nonfrail persons by using mixed effects models. Results: The probabilities were 0.43, 0.40, and 0.36 for transitioning from 0 to 1 frailty component, from 1 component to 2 components, and from 2 components to 3-5 components (the frail state). The transition probability from frail to death was 0.13. Exhaustion separated frail and nonfrail groups already 9 years prior to onset of frailty (pooled risk ratio [RR] = 1.53, 95% confidence interval [CI] 1.04-2.24). Slowness (RR = 1.94, 95% CI 1.44-2.61), low activity (RR = 1.59, 95% CI 1.19-2.13), and weakness (RR = 1.39, 95% CI 1.10-1.76) separated frail and nonfrail groups 6 years prior to onset of frailty. The fifth frailty component, weight loss, separated frail and nonfrail groups only at the onset of frailty (RR = 3.36, 95% CI 2.76-4.08). Conclusions: Evidence from two cohort studies suggests that feelings of exhaustion tend to emerge early and weight loss near the onset of frailty syndrome.
  • Kuusalo, Laura; Puolakka, Kari; Kautiainen, Hannu; Karjalainen, Anna; Malmi, Timo; Yli-Kerttula, Timo; Leirisalo-Repo, Marjatta; Rantalaiho, Vappu; NEO-RACo Study Grp (2017)
    Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient's global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician's global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19-3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01-2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.
  • Utge, Siddheshwar; Räikkönen, Katri; Kajantie, Eero; Lipsanen, Jari; Andersson, Sture; Strandberg, Timo; Reynolds, Rebecca M.; Eriksson, Johan G.; Lahti, Jari (2018)
    Purpose: Corticosteroid-binding globulin (CBG) transports glucocorticoids in blood. Variation in genes SERPINA6 encoding for CBG, SERPINA2 and SERPINAI (serpin family A member 6, 2, and 1) have been shown to influence morning plasma cortisol and CBG in adults. However, association of this genetic variation with diurnal and stress-induced salivary cortisol remain unknown. This study aims to investigate the effect of genetic variation in SERPINA6/2/1 loci on diurnal and stress-induced salivary cortisol in children. Methods: We studied 186, 8-year-old children with genome-wide genotyping. We generated weighted polygenic risk score (PRS) based on 6 genome-wide significant SNPs (rs11621961, rs11629171, rs7161521, rs2749527, rs3762132, rs4900229) derived from the CORNET meta-analyses. Salivary cortisol was measured across one day and in response to the Trier Social Stress Test for Children (TSST-C). Results: Mixed models, adjusted for covariates, showed that the PRS x sampling time interactions associated with diurnal (P <0.001) and stress-induced (P = 0.009) salivary cortisol. In the high PRS group (dichotomized at median) the diurnal salivary cortisol pattern decreased less from awakening to bedtime than in the low PRS group (standardized estimates of sampling time -0.64 vs. -0.73, P <0.0001 for both estimates). In response to stress, salivary cortisol increased in the high PRS group while it remained unchanged in the low PRS group (standardized estimates of sampling time 0.12, P = 0.015 vs. -0.06, P = 0.16). These results were mainly driven by minor alleles of rs7161521 (SERPINA6) and rs4900229 (SERPINAI). Conclusions: Genetic variation in SERPINA6/2/1loci may underpin higher hypothalamic-pituitary-adrenocortical axis activity in children.
  • Pettersson, Kati; Mueller, Kiti; Tietavainen, Aino; Gould, Kristian; Haeggstrom, Edward (2019)
    Prolonged time awake increases the need to sleep. Sleep pressure increases sleepiness, impairs human alertness and performance and increases the probability of human errors and accidents. Human performance and alertness during waking hours are influenced by homeostatic sleep drive and the circadian rhythm. Cognitive functions, especially attentional ones, are vulnerable to circadian rhythm and increasing sleep drive. A reliable, objective and practical metrics for estimating sleepiness could therefore be valuable. Our aim is to study whether saccades measured with electro-oculography (EOG) outside the laboratory could be used to estimate the overall time awake without sleep of a person. The number of executed saccades was measured in 11 participants during an 8-min saccade task. The saccades were recorded outside the laboratory (Naval Academy, Bergen) using EOG every sixth hour until 54 hr of time awake. Measurements were carried out on two occasions separated by 10 weeks. Five participants participated in both measurement weeks. The number of saccades decreased during sustained wakefulness. The data correlated with the three-process model of alertness; performance differed between participants but was stable within individual participants. A mathematically monotonous relation between performance in the saccade task and time awake was seen after removing the circadian rhythm component from measured eye movement data. The results imply that saccades measured with EOG can be used as a time-awake metric outside the laboratory.
  • Onninen, Jussi; Hakola, Tarja; Puttonen, Sampsa; Tolvanen, Asko; Virkkala, Jussi; Sallinen, Mikael (2020)
    Driver sleepiness contributes to traffic accidents. However, sleepiness in urban public transport remains an understudied subject. To fill this gap, we examined the sleepiness, sleep, and on-duty sleepiness countermeasures (SCMs) in 23 tram drivers working morning, day, and evening shifts for three weeks. Sleepiness was measured using Karolinska Sleepiness Scale (KSS). Nocturnal total sleep time (TST) was measured with wrist actigraphy. SCMs and naps were self-reported with a smartphone application. Caffeine and napping were considered effective SCMs. Severe sleepiness (KSS >= 7) was observed in 22% of shifts with no differences between shift types. Rest breaks were associated with slight reductions in sleepiness. TST between days off averaged 7 h but was 1 h 33 min and 38 min shorter prior to morning and day shifts, respectively. The use of effective SCMs showed little variance between shift types. These results highlight the need for fatigue management in non-night-working tram drivers.
  • Palmberg, Lotta; Viljanen, Anne; Rantanen, Taina; Kaprio, Jaakko; Rantakokko, Merja (2020)
    Objective: We examined among older women the association of sleep quality, daytime tiredness, and sleep duration with unmet physical activity need, that is, wishing to be more physically active but perceiving no opportunity for it. Method: Cross-sectional logistic regression analyses among women aged 74 to 86 years (Finnish Twin Study on Aging, third wave, n = 302). Results: Thirty-one participants reported unmet physical activity need. Short sleepers had fivefold and long sleepers threefold odds for unmet physical activity need compared with normative sleepers, while for daytime tiredness the odds were double. Presence of daytime tiredness and unmet physical activity coincided with higher prevalence of chronic diseases, depressive symptoms and walking difficulties, which partly explains the observed associations. Poor sleep quality was not associated with unmet physical activity need. Discussion: Older women with nonoptimal sleep characteristics who perceive unmet physical activity need may benefit from solutions that improve their perceived opportunities for physical activity.
  • Onninen, J; Pylkkonen, M; Hakola, T; Puttonen, S; Virkkala, J; Tolvanen, A; Sallinen, M (2021)
    Identifying the causes of sleepiness in various safety-critical work environments is neces-sary for implementing more efficient fatigue management strategies. In transportation, little is known about drivers' own perceptions of these causes. Therefore, we instructed shift-working tram (n = 23) and long-haul truck drivers (n = 52) to report at the end of their shifts what made them sleepy if they felt so. These self-reports, measured on-duty sleepiness, and sleep amounts were recorded on every shift over a period of 2-3 weeks per driver. The causes of sleepiness were queried with smartphone applications and sleep logs. Sleepiness was measured with the Karolinska Sleepiness Scale (KSS) and sleep with wrist-worn actigraphs. Data were analyzed using generalized estimating equations. Sleep loss and insufficient rest breaks were commonly reported as causing sleepiness among the tram drivers, whereas time of day and sleep loss were the leading causes among the truck drivers. Other causes, such as traffic or cabin conditions, were not frequently men-tioned. During morning, day, and evening shifts, the truck drivers were less likely to report insufficient rest breaks as causing sleepiness than the tram drivers. Similarly, during morn-ing shifts, the truck drivers were less likely to attribute their sleepiness to sleep loss. In shifts with drives reporting severe sleepiness (KSS > 7 at least once, 18-21% of shifts), sleep loss was significantly reported as causing sleepiness among both groups. Reporting insuf-ficient rest breaks was associated with severe sleepiness among the tram drivers, whereas time of day showed the same among the truck drivers. The results highlight the need for addressing sleep-related fatigue in transportation and provide directions for future research with regard to secondary causes of sleepiness . (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).