Search Results (342)

Background: As COVID-19 transitions to an endemic phase, long COVID symptoms remain a significant public health issue affecting both physical and mental health. A notable proportion of college students report symptoms such as fatigue, cough, and brain fog persisting for weeks or months post-infection. Objectives: This study explored the prevalence and contributing factors of long COVID symptoms among both infected and uninfected students in medicine-related departments. Methods: A cross-sectional study was conducted using online self-reported questionnaires completed by 1523 undergraduate and graduate students in medicine-related departments at a medical university. Participants who had tested positive for COVID-19 within the past three months were excluded. The survey assessed long COVID symptoms, with comparisons conducted between infected and uninfected groups. Multivariate logistic regression identified risk factors associated with long COVID symptoms. Results: Of the 1118 participants, 47.5% of those with a prior COVID-19 diagnosis reported long COVID symptoms within the past month. Significant differences between the infected and uninfected groups were observed in physical, cognitive, and psychological health. Logistic regression identified that prior COVID-19 diagnosis had an association with the presence of long COVID symptoms (odds ratio = 1.48, p = 0.024) after adjusted model analysis. Meanwhile, higher anxiety levels (odds ratio = 1.09, p < 0.001) and a BMI ≥ 24 (odds ratio = 4.50, p < 0.01) were identified as significant risk factors for post-infection syndrome among previously infected students. Sex and exercise habits also influenced symptom prevalence. Conclusions: Since late 2023, with those experiencing cumulative infections surpassing half of Taiwan’s population, long COVID symptoms have persisted as a widespread concern affecting both physical and mental health, continuing into 2025. This study underscores critical risk factors and symptom patterns among students in medicine-related departments, reinforcing the urgency of sustained surveillance and targeted interventions to facilitate comprehensive recovery. Full article

A psoriasis vulgaris flare is characterized by a rapid intensification of symptoms, which is often triggered by various factors that can worsen the condition. The risk factors for these exacerbations are numerous and include obesity, antihypertensive drugs, and psychological stress. Moreover, links have been documented between type II diabetes, hypertension, and psoriasis vulgaris. The present case report describes a 52-year-old female patient who presented at the clinic with disseminated erythematous-squamous plaques and patches covered by thick, white-pearly, easily detachable scales, along with stress, fatigue, anxiety, severe pruritus, irritability, insomnia, and decreased self-esteem. Her past medical regimen included various conventional topical options, including calcipotriol combined with betamethasone, clobetasol, betamethasone combined with salicylic acid, and betamethasone combined with gentamicin, yet the condition remained refractory, with periodic flare-ups. The integrated and personalized therapeutic approach aimed to target both the dermatological issues and the associated systemic and psychological factors contributing to the condition. The therapeutic strategy implemented in this case combined psychological counseling sessions, a very low-calorie ketogenic diet, oral supplementation with anti-inflammatory and antioxidant vitamins and minerals, topical treatments utilizing urea and Dead Sea-mineral-based formulations, and rosemary extract-based scalp care, without requiring additional conventional treatment. This comprehensive approach led to significant improvement, ultimately achieving complete remission of the patient’s psoriasis. The associated comorbidities were well controlled with the specified medication, without any further complications. Thus, the importance of alternative options was emphasized, particularly in the context of an incurable disease, along with the need for continued research to improve the ongoing therapeutic management of psoriasis vulgaris. Such approaches are essential to reducing the risk of flare-ups and to achieving better management of associated risk factors. Full article

Background/Objectives: Fibromyalgia syndrome (FMS) is a chronic pain condition in which executive function (EF) alterations have been reported, though strikingly, relationships between simple executive functions (EFs) (updating, inhibition, and mental flexibility) and high-order ones, such as planning and problem-solving, have not been addressed yet in this population. This research aimed to firstly explore how low-level EFs play a role in planning and problem-solving performances. Methods: Thirty FMS patients and thirty healthy participants completed a series of neuropsychological tests evaluating low- and high-order EFs. Clinical and emotional symptoms were assessed with self-report questionnaires, while pain and fatigue levels were measured with numerical scales. Importantly, specific drug restrictions were accounted for. Results: Patients scored lower in most neurocognitive tests, with statistical significance noted only for visuospatial working memory (WM) and two planning and problem-solving tests. Pain, fatigue, and sleep disturbances showed important effects on most of the cognitive outcomes. Multiple regression analyses reflected that planning and problem-solving were successfully and partially predicted by updating, inhibition, and mental flexibility (though differences emerged between tasks). Conclusions: Our study confirms the presence of cognitive impairments in FMS, especially in high-order EFs, supporting patients’ complaints. Clinical symptoms play a role in FMS dyscognition but do not explain it completely. For the first time, as far as the authors know, simple EF influences on planning and problem-solving tests have been described for FMS patients. These results might help in unraveling the dysexecutive profile in FMS to design more adjusted treatment options. Full article

Background and Objectives: Uterine cancer is the most common gynaecologic malignancy in developed countries, yet the psychosocial sequelae of treatment are incompletely described. This prospective, single-centre study quantified six-month changes in the quality of life (QoL) and perceived stress in women with newly diagnosed uterine cancer and explored clinical moderators of change. Methods: Participants completed four validated self-report questionnaires: the 36-item Short-Form Health Survey (SF-36), the 26-item World Health Organization Quality-of-Life-BREF (WHOQOL-BREF), the 30-item EORTC QLQ-C30 and the 10-item Perceived Stress Scale (PSS-10) before therapy and again six months after surgery ± adjuvant chemoradiation. Subgroup analyses were performed for stage (FIGO I–II vs. III–IV). Results: Mean SF-36 Physical Functioning improved from 58.7 ± 12.1 to 63.1 ± 12.6 (Δ = +4.4 ± 7.3; p = 0.000, d = 0.36). PSS declined from 24.1 ± 5.6 to 20.8 ± 5.4 (Δ = −3.3 ± 5.0; p < 0.001, d = 0.66). The WHOQOL-BREF Physical and Psychological domains rose by 4.4 ± 6.9 and 3.5 ± 7.3 points, respectively (both p < 0.01). EORTC QLQ-C30 Global Health increased 5.1 ± 7.6 points (p < 0.001) with parallel reductions in fatigue (−5.4 ± 9.0) and pain (−4.8 ± 8.6). Advanced-stage patients showed larger reductions in stress (ΔPSS −3.5 ± 2.5 vs. −2.3 ± 2.3; p = 0.036) but similar QoL gains. ΔPSS correlated inversely with ΔWHOQOL Psychological (r = −0.53) and ΔSF-36 Mental Health (r = −0.49) and positively with ΔEORTC Global Health (r = −0.42) (all p < 0.001). Conclusions: Over six months, multimodal uterine cancer treatment was associated with clinically meaningful QoL improvements and moderate stress reduction. Greater stress relief paralleled superior gains in psychological and global health indices, highlighting the importance of integrative survivorship care. Full article

Heart rate variability (HRV), particularly the root mean square of successive differences (RMSSD), is widely used as a non-invasive indicator of autonomic nervous system activity and physiological recovery. This study examined whether daily short-term HRV, measured under standardised morning conditions, was associated with self-reported wellness in a non-clinical adult population. Over a 14-day period, 41 participants completed daily five-minute HRV recordings using a Polar H10 chest sensor and the Kubios mobile app, followed by ratings of sleep quality, fatigue, stress, and physical recovery. Bayesian ordinal mixed-effects models revealed that higher RMSSD values were associated with better self-reported sleep (β = 0.510, 95% HDI: 0.239 to 0.779), lower fatigue (β = 0.281, 95% HDI: 0.020 to 0.562), and reduced stress (β = 0.353, 95% HDI: 0.059 to 0.606), even after adjusting for covariates. No association was found between RMSSD and perceived muscle soreness. These findings support the interpretability of RMSSD as a physiological marker of daily recovery and stress in real-world settings. While the effect sizes were modest and individual variability remained substantial, results suggest that consistent HRV monitoring may offer meaningful insight into subjective wellness—particularly when contextualised and tracked over time. Full article

Long-COVID (LC) is characterized by diverse and persistent symptoms, potentially mirroring different molecular pathways. Recent data might offer that one of them is mediated by functional autoantibodies (fAAb) targeting G protein-coupled receptors (GPCR). Thus, the aim of this study was to investigate the clinical phenotype of patients with LC in relation to their GPCR-fAAb seropositivity. The present study recruited 194 patients with LC and profiled them based on self-reported symptoms. GPCR-fAAb seropositivity was identified by using a cardiomyocyte bioassay, testing the presence and functionality of the AAbs. Logistic regression, clustering, and decision tree analyses were applied to examine associations between GPCR-fAAb profiles and self-reported symptoms considering age and gender. The most prevalent GPCR-fAAbs in patients with LC were fAAB targeting the β2 adrenergic receptor (β2-fAAb, 92.8%), the muscarinergic M2 receptor (M2-fAAb, 87.1%), the Angiotensin II type 1 receptor (AT1-fAAb, 85.6%), and angiotensin (1–7) Mas receptor (MAS-fAAb, 85.6%). β2-fAAb showed a significant relation with dizziness, lack of concentration, and POTS, while Endothelin Type A receptor functional autoantibody (ET-A-fAAb) was significantly related to deterioration of pre-existing neurological disorders. Statistical analysis indicated a strong positive correlation between M2- and β2-fAAb; as in addition, an association of β2-fAAb and gender was observed to one of the major clinical symptoms (fatigue/PEM), a critical impact of GPCR-fAAb on LC-pathogenesis can be assumed. Summing up, the present data show that specific GPCR-fAAb are associated with distinct clinical phenotypes. Especially, the combination of M2- and β2-fAAb seemed to be essential for the LC-phenotype with a combination of fatigue/PEM and lack of concentration as major clinical symptoms. Full article

Objective: This study aims to investigate the feasibility of an online music therapy protocol for individuals previously diagnosed with COVID-19, focusing on their perceptions of their respiratory symptoms and the intervention’s impact on psychosocial measures. Methods: A within-subject experimental design was applied to examine an eight-week weekly online music therapy protocol, including singing, wind instrument playing, and music visualizations. All self-report data were collected bi-weekly throughout the 16-weeks study period, including baseline and post-tests. The measures for respiratory symptoms included the Medical Research Council’s Dyspnea Scale (MRC Dyspnea), Chronic Respiratory Questionnaire-Mastery Scores (CRQ Mastery), and Visual Analogue Scale for breathlessness. The measures for the secondary psychosocial outcomes were the Beck Depression Inventory-Short Form, the Generalized Anxiety Disorder 7-item, the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale, the Epworth Sleepiness Scale, the EuroQol 5-Dimension 5-Level, and the Connor-Davidson Resilience Scale. Results: Twenty-four participants were enrolled. The participants perceived a reduction in respiratory symptoms, and shortness of breath (MRC Dyspnea). Planned comparisons showed significant decreases in MRC from baseline to post-treatment (p = 0.008). The mixed-effects model, including pre-baseline and post-treatment, was significant (p < 0.001). Significant changes in Breathing VAS were consistent with improvements in MRC Dyspnea, showing a significant baseline-to-post difference (p = 0.01). The CRQ Mastery showed significant improvements from baseline to Week 12 (p < 0.001). No significant changes were observed in other secondary measures. Conclusions: Our preliminary findings suggest that this protocol is feasible, and as a result, may help individuals previously diagnosed with COVID-19 to cope with lasting respiratory symptoms and improve their perception of shortness of breath. Live music-making, including playing accessible wind instruments and singing, may contribute to an increase sense of control over breathing. As this was a feasibility study, we conducted multiple uncorrected statistical comparisons to explore potential effects. While this approach may increase the risk of Type I error, the findings are intended to inform hypotheses for future confirmatory studies rather than to draw definitive conclusions. Full article

Background/Objectives: The main objective of the present study is to assess the short-term effects of Forest Bathing (FB) conducted in a Mediterranean forest on individuals with fibromyalgia (FM) and/or chronic fatigue syndrome/myalgia encephalomyelitis (CFS/ME) on perceived pain, fatigue, state anxiety, positive and negative affect, mood states, and state mindfulness. Methods: A total of 44 participants with FM and/or CSF/ME agreed to participate in this study. The FB session consisted of a 3 km silent walk, lasting three hours and guided by a specialized psychologist and a mountain guide to guarantee the safety of the activity. Paired-sample t-tests were used to analyze the pre–post changes in perceived pain, fatigue, state anxiety, positive and negative affect, mood states, and mindfulness. Results: All reported variables but self-reported pain showed statistically significant pre–post variations after the FB session. Particularly, large-to-very-large improvements in positive and negative affect, state anxiety, tension, depression, anger, and vigor were found. Small-to-moderate effect sizes for fatigue, friendliness, and state mindfulness were also reported. Conclusions: This study provides preliminary evidence of the short-term benefits of FB in individuals with FM and/or CFS/ME, especially on state anxiety and negative affect. Full article

The aim of this work is to explore and understand the lived experience of nurses who chose to schedule visits with an Emotional Support Animal (ESA), i.e., a dog, during their working shift. Background/Objectives: Nursing practice is rigorous, weighted with intense responsibility that creates an environment conducive to stress and anxiety for the nurses, who have reported a higher level of work stress than other healthcare professionals. Knowing and addressing the factors impacting mental health/nurses’ well-being is crucial to providing care to patients. Stressful work environments result in burnout, compassion fatigue, depression, anxiety, suicide, and resignation. Understanding nurses’ perspectives on work related stress encourages hospitals to structure practices supporting nurses’ mental health and ability to provide quality care. Methods: A qualitative hermeneutic phenomenological approach was employed. Participants scheduled six weekly 10-min visits with Rex, a certified Service Dog for anxiety depression and PTSD, and registered ESA. A sample of 11 RNs participated in Rex visits at the workplace; field notes were taken during observations of visits. Semi-structured 30-min interviews conducted via Zoom, audio-recorded, and transcribed with NVivo were conducted. Results: Data were examined with Interpretative Phenomenological Analysis. Four main themes emerged: Preparing for the unknown, Doing the work, Refueling and resetting-Visits with Rex, What about nurses? Conclusions: This study highlights the need for nurses and hospital systems to incorporate self-care/self-reflection, including time/opportunities for nurses’ stress management during their practice. Knowledge of nurses receiving ESA interventions sheds light on how to protect/preserve the well-being of nurses practicing in this demanding profession. ESAs for nurses in the workplace offers an option to utilize dog therapy to re-energize and continue their shift renewed and refreshed. Full article

Background/Objectives: Self-compassion, characterized by treating oneself with kindness during challenges, has been shown to alleviate anxiety and fear of recurrence in cancer patients by mitigating negative emotions such as depression and fatigue. Psychological flexibility and coping strategies have emerged as potential mediators in the relationship between self-compassion and emotional well-being, suggesting that these factors play a critical role in managing distress in cancer patients. However, further research is needed to clarify the mechanisms through which self-compassion, psychological flexibility, and coping interact to influence fear of recurrence and anxiety in cancer populations. Methods: Two hundred and ninety-six women who had completed cancer treatment completed self-report assessments of self-compassion, psychological flexibility, coping, fear of recurrence, and generalized anxiety. Structural equation modeling (SEM) was applied to test a multiple-mediation model, including serial and parallel pathways among the study variables. Results: Self-compassion was positively associated with psychological flexibility and coping strategies, and negatively associated with fear of recurrence and generalized anxiety. Path analysis identified significant serial and parallel mediation effects, where both positive and negative self-compassion were associated with lower fear of recurrence and generalized anxiety through pathways involving psychological flexibility and emotion- and meaning-focused coping. The findings highlight the protective role of self-compassion in reducing psychological distress, suggesting that enhancing self-compassion may improve emotional adjustment in cancer patients. Conclusions: Attitudes based on self-kindness and a nonjudgmental approach have significant potential in reducing fear of cancer recurrence and generalized anxiety in female cancer patients, emphasizing the mediating role of psychological flexibility and coping strategies. According to the acceptance and commitment therapy (ACT) model, these relationships highlight the important roles of personal resources and coping mechanisms in alleviating negative emotional states in women with cancer. Interventions focused on self-compassion and psychological flexibility could provide valuable support in coping with the emotional suffering associated with cancer. Full article

Background/Objectives: Personalized dietary recommendations are essential for managing chronic conditions such as diabetes and irritable bowel syndrome (IBS). However, traditional approaches often fall short in accounting for individual metabolic variability. This systematic review evaluates the effectiveness of artificial intelligence (AI)-generated dietary interventions in improving clinical outcomes among adults. Methods: Following PRISMA guidelines, we searched six electronic databases for peer-reviewed studies published between 19 November 2015 to 6 September 2024. Eligible studies included adults aged 18 to 91 who received AI-generated dietary recommendations based on biomarkers such as blood glucose, gut microbiome composition, and self-reported data. Study designs included randomized controlled trials (RCTs), pre-post studies, and cross-sectional analyses. The GRADE system was used to assess the quality of evidence. Results: Eleven studies met inclusion criteria (five RCTs, five pre-post designs, one cross-sectional). Most AI methods used in the included studies were based on machine learning (ML), including conventional ML algorithms, deep learning (DL), and hybrid approaches integrating ML with IoT-based systems. Interventions led to improved glycemic control, metabolic health, and psychological well-being. Notable outcomes included a 39% reduction in IBS symptom severity and a 72.7% diabetes remission rate. Among nine studies with comparison groups, six reported statistically significant improvements in AI groups, two found comparable or better outcomes, and one found no difference. Mild side effects such as fatigue and constipation were observed. Conclusions: AI-generated dietary interventions show promise in surpassing traditional approaches by providing personalized, data-driven recommendations. Further research is needed to validate long-term effects, refine intervention protocols, and enhance user adherence in both clinical and public health settings. Full article

Background/Objectives: A relevant subgroup of post-COVID-19 syndrome (PCS) patients suffers from post-exertional malaise (PEM) and cardiovascular or neurological symptoms, impairing daily functioning up to becoming even house- or bedbound. Recent data suggest that PCS summarizes different subgroups, one of them being characterized by an impaired microcirculation. Thus, the aim of the present study was to investigate local deoxygenation, measured with non-invasive near-infrared regional spectroscopy (NIRS), and its association with self-reported fatigue in patients with PCS compared to controls in light exercise. Methods: 150 participants (100 PCS patients and 50 controls) were recruited. PEM was assessed using FACIT, Chalder, and Bell scoring and Canadian Criteria. NIRS was used to measure local oxygenation while kneading a stress ball and during recovery. Results: PCS patients showed fatigue scores of 30 (Bell score), 20.6 (FACIT fatigue score), and 9.914 (Chalder fatigue score). Decreased deoxygenation peaks at the start of exercise were observed in patients with PCS, compared to controls (p = 0.0002). Multivariate analysis identified a subgroup, showing an association between strong fatigue and restricted oxygenation dynamics. Conclusions: NIRS could be a potential tool to assess deoxygenation deficits even in moderate to severely impaired PCS patients using light exercise protocols. Full article

Background and Objectives: Extant research on the relationship between fatigue and depression in people with rheumatic diseases portrays a divergent picture. While caring for persons with this medical condition, one issue that represents individual confidence in carrying out specific tasks, namely self-efficacy level, has attracted significant attention. Yet, the information regarding whether self-efficacy may pose a clue linking these two major symptoms is still unknown. The aim of this study, therefore, is to examine whether self-efficacy mediates the association between fatigue and depressive symptoms among persons with rheumatoid arthritis (RA). Materials and Method: A cross-sectional study of 224 females with RA from a hospital in Taiwan was conducted between January and October 2023. We then distributed anonymous self-reported questionnaires instructing participants to provide information on their demographic characteristics, levels of fatigue, self-efficacy, and depressive symptoms. The bootstrap via PROCESS macro in SPSS was executed to analyze if self-efficacy would mediate the effect of fatigue on emergence of depressive symptoms. Results: For those participants captured at baseline, a negative association was noted between fatigue and self-efficacy, as well as between self-efficacy and depressive symptoms. Results of the mediation analysis revealed a remarkable indirect effect of fatigue on depressive symptoms through self-efficacy, with a regression coefficient of 0.21 (95% confidence intervals: 0.06–0.37). Conclusions: This work extends current understanding of the roles that fatigue and self-efficacy play in predicting depression among people with RA and further clarified the potential mediating role of self-efficacy in buffering against depressive symptomatology. Interventions that extend from the management of fatigue and further incorporate the improvement of self-efficacy sense into the stereotypical therapy should greatly mitigate the distressing symptoms for patients with RA. Full article

Background: Many older Australian adults with cochlear implants (CI) lack funding for replacement sound processors, risking complete device failure and reduced quality of life. The need for replacement CI devices for individuals with obsolete sound processors and no access to funding poses an increasing public health challenge in Australia and worldwide. We aimed to investigate the clinical and cost-effectiveness of upgrading obsolete CI sound processors in older adults. Methods: Alongside an Australian Government-funded upgrade program, a prospective, mixed-methodology design study was undertaken. Participants were aged 65 and over, with obsolete Cochlear™ sound processors and no funding for replacements. This study compared speech perception in noise, as well as self-reported outcome measures, including cognition, listening effort, fatigue, device benefit, mental well-being, participation, empowerment and user experiences, between upgraded and obsolete hearing aid processors. The economic impact of the upgrade was evaluated using two state-transition microsimulation models of adults using CIs. Results: The multi-site study ran from 20 May 2021 to 21 April 2023, with recruitment from June 2021 to May 2022. A total of 340 Cochlear™ sound processors were upgraded in 304 adults. The adults’ mean age was 77.4 years (SD 6.6), and 48.5% were female. Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech understanding in noise and reduced communication difficulties, self-reported listening effort and fatigue. Semi-structured interviews have revealed that upgrades alleviated the anxiety and fear of sudden processor failure. Health economic analysis found that the cost-effectiveness of upgrades stemmed from preventing device failures, rather than from access to newer technology features. Conclusions: Our study identified significant clinical and self-reported benefits from upgrading Cochlear™ sound processors. Economic value came from avoiding scenarios where a total failure of device renders its user unable to access sound. The evidence gathered can be used to inform policy on CI processor upgrades for older adults. Full article

Background: Cancer survivors who do not engage in regular physical activity often experience persistent psychological distress and fatigue, which can significantly impact their quality of life. While handgrip strength (HGS) is recognized as an indicator of overall health and physical resilience, the combined role of HGS and physical inactivity in predicting psychological distress and fatigue in this population remains unclear. This study aimed to examine the relationships between self-reported physical inactivity, HGS, and psychological distress, specifically depressive symptoms, anxiety, and cancer-related fatigue (CRF), in physically inactive cancer survivors. Methods: This cross-sectional study included 42 physically inactive cancer survivors (mean age = 63.2 years, SD = 8.96) recruited from the Cancer Institute (IRCCS) in Bari, Italy. Physical inactivity was quantified based on self-reported weekly physical activity minutes, with all participants engaging in less than 150 min per week. The participants underwent HGS assessment and completed validated psychological measures, including the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2), and the Fatigue Severity Scale (FSS). Results: Bivariate correlations were examined via Spearman’s rank correlation coefficients, and multiple linear regression analyses were performed to identify independent predictors of psychological distress and fatigue, adjusting for covariates such as age, sex, cancer type, and time since treatment completion. Both lower HGS and greater physical inactivity were significantly correlated with greater depressive symptoms (HGS: ρ = −0.524, p < 0.001; physical inactivity: ρ = −0.662, p < 0.001), greater fatigue severity (HGS: ρ = −0.599, p < 0.001; physical inactivity: ρ = −0.662, p < 0.001), and increased trait anxiety (HGS: ρ = −0.532, p < 0.001; physical inactivity: ρ = −0.701, p < 0.001). No significant associations were found between physical inactivity or HGS and state anxiety (p > 0.05). Multiple regression analyses confirmed that both HGS and physical inactivity independently predicted depressive symptoms (HGS: β = −0.435, p = 0.009; physical inactivity: β = −0.518, p = 0.002), trait anxiety (HGS: β = −0.313, p = 0.038; physical inactivity: β = −0.549, p < 0.001), and fatigue (HGS: β = −0.324, p = 0.033; physical inactivity: β = −0.565, p < 0.001), even after adjusting for covariates. Low physical activity and reduced muscle strength independently predict psychological distress and fatigue in cancer survivors. Conclusions: These findings highlight the potential exacerbating role of physical inactivity in both physical and psychological vulnerability, underscoring the need for interventions promoting regular exercise. Integrating strength assessments and structured physical activity programs may be key strategies in survivorship care to improve mental well-being and overall quality of life. Full article