Counteracting mental fatigue for athletes: a systematic review of the interventions

The deleterious effects of mental fatigue (MF) on athletes have been carefully studied in various sports, such as soccer, badminton, and swimming. Even though many researchers have sought ways to ameliorate the negative impact of MF, there is still a lack of studies that review the interventions used to counteract MF among athletes. This review aims to report the current evidence exploring the effects of interventions on MF and sport-specific performance, including sport-specific motor performance and perceptual-cognitive skills. Web of Science, Scopus, PubMed, and SPORTDicus (EBSCOhost) were combed through to find relevant publications. Additionally, the references and Google Scholar were searched for any grey literature. For the current review, we included only randomized controlled trials that involved athletes, a primary task to induce MF, interventions to counter MF with comparable protocols, and the outcomes of sport-specific motor performance and perceptual-cognitive skill. The selection criteria resulted in the inclusion of 10 articles. The manipulations of autonomous self-control exertion, person-fit, nature exposure, mindfulness, and transactional direct current stimulation showed that positive interventions counteract MF and improve sport-specific performance in different domains, including strength, speed, skill, stamina, and perceptual-cognitive skills. The selected interventions could significantly counteract MF and improve subsequent sport-specific performance. Moreover, self-regulation and attention resources showed the importance of the potential mechanisms behind the relevant interventions.

Quick coherence technique facilitating commercial pilots' psychophysiological resilience to the impact of COVID-19

This study investigates the effect of quick coherence technique (QCT) on commercial pilots' resilience to the unprecedented impact of a pandemic. Eighteen commercial pilots voluntarily participated in a 2-day training course on QCT followed by 2 months of self-regulated QCT practicing during controlled rest in the flight deck and day-to day life. There are subjective and objective assessments to evaluate the effects of QCT on commercial pilots' psychophysiological resilience. Results demonstrated that QCT training can significantly increase pilots' psychophysiological resilience thereby improving their mental/physical health, cognitive functions, emotional stability and wellness on both subjective (PSS & AWSA) and objective measures (coherence scores). Moreover, pilots who continued practicing self-regulated QCT gained the maximum benefits. Current research has identified great potential to enhance pilots' mental/physical health via QCT training. Operators can develop peer support programs for pilots to increase resilience and maintain mental and physical health using the QCT technique. Practitioner summary: QCT breathing has been proven to increase commercial pilots' resilience by moderating psychophysiological coherence, strengthening mental/physical capacity and sustaining positive emotions to deal with the challenges both on the flight deck and in everyday life.HIGHLIGHTSPilots have suffered from the impact of the Covid-19 pandemic across many factors including social, economic, mental, physical, emotional, and operational issuesBiofeedback training can increase commercial pilots' resilience by moderating psychophysiological coherence, strengthening mental and physical capacitySelf-regulated practicing QCT to form a habitual behaviour is required to sustain the maximum benefits either in the flight or day-to-day lifeQCT is an effective intervention for aviation authorities and airline operators to develop peer support programs to increase pilots' fatigue resilience.

Quantitative and qualitative workload assessment in steep terrain forest operations: fostering a safer work environment through yarder automation

Many forestry roles have changed from being manual tasks with a high physical workload to being a machine operator task with a high mental workload. Automation can support a decrease in mental fatigue by removing tasks that are repetitive and monotonous for the operators. Cable yarding presents an ideal opportunity for early adoption of automation technology; specifically the carriage movement along a defined corridor. A Valentini V-850 cable yarder was used in an Italian harvesting setting, in order to gauge the ergonomic benefit of carriage control automation. The study showed that automating yarder carriage movements improved the ergonomic situation of the workers directly involved in the related primary tasks. However, the caveat is that improving one work task may negatively affect the other work tasks, and therefore introducing automation to a worksite must be done after considering all impacts on the whole system. Practitioner summary: Automation decreased the winch operator's mental workload while improving overall productivity. At the same time, the mental and physiological workload of the operator tasked with bucking were slightly increased. Ideally, winch automation should be coupled with bucking mechanisation to balance the intervention and boost both operator well-being and productivity.

Effects of Five Amino Acids (Serine, Alanine, Glutamate, Aspartate, and Tyrosine) on Mental Health in Healthy Office Workers: A Randomized, Double-Blind, Placebo-Controlled Exploratory Trial

Background: The importance of maintaining good mental health with overall well-being has recently drawn attention from various spheres of academics and the working population. Amino acid intake has been reported to reduce depression symptoms and other mental health problems. However, the effectiveness of amino acid intake (i.e., single or combined) remains unknown. In this study, we assessed a combination of five amino acids (serine, alanine, glutamate, aspartate, and tyrosine; SAGAT) reported to regulate mental health. Methods: A randomized, double-blind, placebo-controlled exploratory trial was conducted. Participants, aged between 20 and 65 years with fatigue sensation, were randomized to receive either SAGAT or the placebo and ingested them for four weeks. A transient mental work was loaded at day 0 and after four weeks of intervention. As the primary outcomes, the fatigue sensation was assessed. The mood status, cognitive function, work efficiency, and blood marker were also measured as secondary outcomes. Results: The number of participants analyzed for the efficacy evaluation were 20 in SAGAT and 22 in the placebo. There were no significant differences in the primary outcomes. However, as the secondary outcomes, the SAGAT group showed a significant improvement in motivation and cognitive function in the recovery period after mental work loaded in a four-week intervention compared to the placebo. Conclusion: The current findings suggest that SAGAT contributes to maintaining proper motivation and cognitive function. Clinical Trial Registration: University Hospital Medical Information Network Clinical Trial Registry (ID: UMIN 000041221).

Can Nurses Self-Assess Fatigue?: Implications for Nurse Leaders

OBJECTIVE

The aims of this study were to describe nurses' self-perceptions of fatigue and to examine nurses' acceptance of specific fatigue countermeasures.

BACKGROUND

The work of nurses places them at a high risk of fatigue. Evidence suggests 75% to 80% of nurses in the United States experience high levels of fatigue.

METHODS

This descriptive, cross-sectional correlational study surveyed 279 nurses.

RESULTS

Results suggest that almost half of nurses (46%) are not able to accurately self-assess fatigue. Nurses expressed acceptance of several workplace fatigue reduction strategies.

CONCLUSIONS

It may be unrealistic to expect nurses to self-assess fatigue levels and make decisions about their ability to safely provide patient care. Reliable methods for assessing fatigue in the workplace are needed. Several strategies exist that may be used to alleviate fatigue, and many were acceptable to nurses. Nurse leaders are well positioned to implement changes that impact the occurrence of nurse fatigue and thereby the quality of patient care.

Development and validation of Work-Related Activities during Non-Work Time Scale (WANTS) for doctors

Work-related activities during non-work time may influence the intershift recovery of post-work fatigue. Currently there is no valid and reliable scale available to measure the frequency for such activities among doctors. Therefore, this study aims to develop and validate 'Work-Related Activities during Non-Work Time Scale' (WANTS) that measure the frequency of work-related activities during non-work time for doctors. This was a scale development and validation study among doctors involving item generation, content and construct validation, and reliability assessment. 23-item seven-point Likert-type scale was developed through deductive (literature search) and inductive (interview with source population, authors' experiences, and expert opinion) methods. The content-validated scale was pre-tested, and the improved scale was subsequently administered to randomly-selected 460 doctors working at public hospital setting. Response rate was 77.76% (n = 382). Initial exploratory factor analysis (EFA) with principal axis factoring (PAF) using varimax rotation revealed unstable six-factor structure consisting of 17 variables; thus, we tested one- to six-factor model, and found that four-factor model is the most stable. Further analysis with principal component analysis (PCA) with a single component on each factor found that 17-variables four-factor model is stable. These factors were labelled as 'work-related thought', 'work-to-home conversation', 'task spillover' and 'superior-subordinate communication'. It showed good internal consistency with overall alpha value of 0.837. The scale is thus valid and reliable for measuring the frequency of each construct of work-related activities during non-work time among doctors.

COVID-19 pandemic response fatigue in Africa: causes, consequences, and counter-measures

A notable decline in adherence to COVID-19 preventive measures has been observed despite the increasing number of cases following the suspension of lockdown measures. The African governments have positively responded to the COVID-19 pandemic in previous times, however presently the COVID-19 response on the African continent is in a state of fatigue. Therefore, public vigilance on COVID-19 needs to be reinvigorated through behavioral change communication via different channels of disseminating information. In addition, support systems and social protection should be established to address the COVID-19 pandemic fatigue. Also, increased funding should be made available for enhancing the COVID-19 outbreak response.

Burning out physical and emotional fatigue: Evaluating the effects of a programme aimed at reducing burnout among mental health nurses

Burnout is a common problem among mental health nurses. High levels of burnout result in job dissatisfaction, rapid turnover of staff, physical and psychological discomfort, and a reduction in the quality of patient care. While there is an abundance of research relating to burnout per se, research regarding the impact of burnout prevention programmes is lacking. This study aimed to measure the effects of a burnout prevention programme on mental health nurses working in Saudi Arabia (SA). A quasi-experimental design was used to test the effectiveness of a two-day burnout prevention workshop. The sample consisted of an intervention group (n = 154) and a control group (n = 142). Data collected using the Maslach Burnout Inventory (MBI) measured the effects of the workshop at 1-, 3-, and 6-month intervals after completion of the programme. Data were analysed using the latest version of SPSS. Means, standard deviations, frequencies, and percentages were used to describe the sample and levels of burnout. A t-test, ANOVA, multiple linear regression, and chi-squared were used to measure the effect of the workshop before and at the three time points after exposure. Findings indicate the programme was effective with a significant reduction being reported 1 month after the intervention. However, although not returning to baseline scores, burnout scores had increased at 6 months. In conclusion, while the overall efficacy of the burnout reduction programme is evident, mental health nurses would benefit from having opportunity to use some of the strategies on a regular basis.

Effect of a posture correction-based intervention on musculoskeletal symptoms and fatigue among control room operators

This study was conducted to examine the effect of a posture correction-based intervention (with a biofeedback device) on the occurrence of musculoskeletal symptoms (MSS) and fatigue among control room operators in a petrochemical plant in Iran. A total of 188 office workers (91 in the case group and 97 in the control group) participated at baseline as well as at 6- and 12-month follow-up. A questionnaire survey (including the Nordic Musculoskeletal Questionnaire and Multidimensional Fatigue Inventory) and direct observations of working postures by using the Rapid Upper Limb Assessment (RULA) method were used. The occurrence of MSS in the shoulders, upper back, neck, and low back areas, as well as the mental and physical dimensions of fatigue were found to be the most common problems. The results showed considerable improvements in working postures (in the neck, trunk, and RULA grand scores) and the occurrence of MSS (particularly in the neck, shoulders, and upper back and low back areas) and fatigue (in particular the mental and physical aspects) after the intervention. The overall mean RULA grand score for the case group was significantly decreased after the intervention (mean scores of 5.1, 4.4, and 4.6 at pre-intervention, post-intervention 1, and post-intervention 2, respectively). A total of 81 operators (89.0%) reported some kind of MSS at baseline, which were reduced to 75 operators (82.4%) and 77 operators (84.6%) at post-interventions 1 and 2, respectively. Significant differences were also found between the pre- and post-intervention scores for the physical fatigue (mean of 12.19, 10.16, and 9.99 at pre-intervention, post-intervention 1, and post-intervention 2, respectively) and mental fatigue (mean of 14.03, 12.05, and 12.16 at pre-intervention, post-intervention 1, and post-intervention 2, respectively) dimensions. The findings confirm the effectiveness of this low-cost, simple, and easy-to-use ergonomic intervention.

We cannot be "forever young," but our children are: A multilevel intervention to sustain nursery school teachers' resources and well-being during their long work life cycle

INTRODUCTION

The aging of workers generally implies an increased number of workers with health problems or psychological diseases because of the growing distance between personal resources and job demands; the first may decrease, while the second are stable. In the preschool setting, the demands remain constant because children are always aged 0-3 years, while the preschool teacher's personal resources decrease with age. It is, therefore, necessary to propose multilevel interventions aimed at supporting work sustainability and workers' resources.

METHOD

This study involved twenty-seven preschools (324 teachers with an average age of 48.7 years): the control group included seventeen schools (190 teachers with an average age of 48.5 years), five schools were assigned to experimental group one (69 teachers with an average age of 48.8), and five schools were assigned to experimental group two (65 teachers with an average age of 49.1). In this context, we proposed two protocols of multilevel intervention comprising three solutions; two of these were common to both experimental groups: psychological counseling and psychosocial intervention. The third solution differed between groups: environmental redefinition (for group one); gymnastic and vocal hygiene (for group two). We hypothesized that the interventions improve teachers' work abilities, increase well-being, and decrease stress and burnout. Furthermore we hypothesized that there would be an improvement in the organizational climate of trust and in social job resources.

RESULTS

Data analysis showed that the interventions were effective. In particular, the experimental groups reported significant decreases in psychological exhaustion (EG2: ß = -1.48; p = .00), indolence (EG1: ß = -1.36; p = .00), and stress (EG2: ß = -0.94; p = .00). Furthermore, the experimental groups significantly increased their enthusiasm towards work (EG2: ß = 1.21; p = .01), vertical trust (EG1: ß = 0.54; p = .01), and the perception of coworker social support (EG2: ß = 0.54; p = .01). The protocol that involved the GC2 was particularly effective.

CONCLUSIONS

These results demonstrate the effectiveness of the intervention in a particular job setting (preschool classroom), emphasizing the need for implementing solutions aimed at supporting workers' well-being, especially in light of an aging workforce.

The Effects of Carbohydrates, in Isolation and Combined with Caffeine, on Cognitive Performance and Mood-Current Evidence and Future Directions

This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and glucoregulatory control. There is modest evidence to suggest modulating glycemic response may impact cognitive function. The evidence presented in this review identifies dose ranges of glucose and caffeine which improve cognition, but fails to find convincing consistent synergistic effects of combining caffeine and glucose. Whilst combining glucose and caffeine has been shown to facilitate cognitive performance and mood compared to placebo or glucose alone, the relative contribution of caffeine and glucose to the observed effects is difficult to ascertain, due to the paucity of studies that have appropriately compared the effects of these ingredients combined and in isolation. This review identifies a number of methodological challenges which need to be considered in the design of future hypothesis driven research in this area.

Psychophysiological responses to short-term cooling during a simulated monotonous driving task

For drivers on monotonous routes, cognitive fatigue causes discomfort and poses an important risk for traffic safety. Countermeasures against this type of fatigue are required and thermal stimulation is one intervention method. Surprisingly, there are hardly studies available to measure the effect of cooling while driving. Hence, to better understand the effect of short-term cooling on the perceived sleepiness of car drivers, a driving simulator study (n = 34) was conducted in which physiological and vehicular data during cooling and control conditions were compared. The evaluation of the study showed that cooling applied during a monotonous drive increased the alertness of the car driver. The sleepiness rankings were significantly lower for the cooling condition. Furthermore, the significant pupillary and electrodermal responses were physiological indicators for increased sympathetic activation. In addition, during cooling a better driving performance was observed. In conclusion, the study shows generally that cooling has a positive short-term effect on drivers' wakefulness; in detail, a cooling period of 3 min delivers best results.

The Effects of a Restorative Intervention on Undergraduate Nursing Students’ Capacity to Direct Attention

Purpose: The purpose of this study was to examine the effects of a restorative intervention on undergraduate nursing students’ capacity to direct attention. Method: Kaplan and Kaplan’s attention restoration theory, which describes and links concepts of directed attention, attention fatigue, and restorative environments, formed the theoretical basis for this research. A convenience sample consisted of 33 students randomly assigned to nonintervention and intervention groups. The intervention was a 1-hr walk in natural surroundings. Both groups completed study instruments prior to and following the intervention. Findings: Intervention group students scored higher on a measure of quality of life at posttest (p < .05). Differences in a measure of perceived attention were not observed between groups over time. Both groups improved on other measures of attention; however, the results did not provide support for the hypotheses. Conclusion: Students were a highly functioning group participating in many activities they considered restorative, prior to the study.

Limitations of Continuous Glucose Monitor Usage

Much progress has been made in diabetes treatments since the first dose of insulin was administered in 1921. However, a truly transformational moment in diabetes care occurred when urine testing gave way to capillary blood home glucose monitoring. As improvements were made to these devices, continuous glucose monitoring (CGM) was introduced. The advantages of experiential learnings gleaned from seeing continuous real-time data have been borne out in numerous peer-reviewed journals. Limitations to use of CGM include patient's level of numeracy and literacy, development of alarm fatigue, interfering substances leading to erroneous readings, high rates of discontinuation, and poor reimbursement.

The Effects of Supplementation with a Vitamin and Mineral Complex with Guaraná Prior to Fasted Exercise on Affect, Exertion, Cognitive Performance, and Substrate Metabolism: A Randomized Controlled Trial

Exercise undertaken in a fasted state can lead to higher post-exercise mental fatigue. The administration of a vitamin and mineral complex with guaraná (MVM + G) has been shown to attenuate mental fatigue and improve performance during cognitively demanding tasks. This placebo-controlled, double-blind, randomized, balanced cross-over study examined the effect of MVM + G consumed prior to morning exercise on cognitive performance, affect, exertion, and substrate metabolism. Forty active males (age 21.4 ± 3.0 year; body mass index (BMI) 24.0 ± 2.4 kg/m2; maximal oxygen consumption (V̇O2max) 57.6 ± 7.3 mL/min/kg) completed two main trials, consuming either MVM + G or placebo prior to a 30-min run at 60% V̇O2max. Supplementation prior to exercise led to a small but significant reduction in Rating of Perceived Exertion (RPE) during exercise compared to the placebo. The MVM + G combination also led to significantly increased accuracy of numeric working memory and increased speed of picture recognition, compared to the placebo. There were no significant effects of supplementation on any other cognitive or mood measures or on substrate metabolism during exercise. These findings demonstrate that consuming a vitamin and mineral complex containing guaraná, prior to exercise, can positively impact subsequent memory performance and reduce perceived exertion during a moderate-intensity run in active males.

[Micropauses during surgery may benefit surgeons and patients]

Long working hours can lead to physical and mental fatigue. Surveys show that many surgeons suffer from musculoskeletal disorders. A method used to counter fatigue is frequent short pauses. Micropauses in prevention of musculoskeletal disorders appear to be effective, but more clinical research is needed. Studies show that micropauses may reduce muscular fatigue and improve concentration and precision of surgeons but the effect on patient outcome is still unknown.

Acute effects of a dietary non-starch polysaccharide supplement on cognitive performance in healthy middle-aged adults

OBJECTIVE

Certain plant polysaccharides may provide psychological health benefits. The aim of this study was to evaluate whether they can acutely improve mood and cognitive function.

METHOD

In a randomized, double-blind, placebo-controlled, between subjects design trial, 73 middle-aged adults consumed 4 g of a proprietary mixture of non-starch polysaccharides (NSPs) (Ambrotose® complex), a rice flour placebo, or a sucrose control. Participants completed testing at baseline and 30 minutes post-consumption. Acute effects of consumption on mood, cognition, and blood glucose were evaluated during mental tests designed to induce mental fatigue.

RESULTS

Significant improvement in recognition and working memory performance was observed in the group that consumed NSP compared with placebo or sucrose. Improvements in memory performance following NSP intake were independent of changes in blood glucose.

DISCUSSION

This is the first report of acute behavioural improvement following plant polysaccharide intake in healthy middle-aged adults under conditions of mental fatigue. The findings suggest that certain NSP may enhance memory performance through mechanisms other than elevated blood glucose.

Compassion, compassion fatigue, and burnout: key insights for oncology professionals

When cancer care clinicians become stressed, sad, isolated--and unaware of this--they are placing themselves at risk for burnout and their patients at risk for suboptimal care. Despite their best intentions, clinicians can sink from a healthy work state of compassion, empathy, and well-being into compassion fatigue and burnout. Lessons from first responders demonstrate the importance for clinicians to recognize the warning signs of compassion and fatigue and burnout, as this recognition can enable them to take action towards prevention and/or recovery. The recognition of these issues as a threat to clinician performance has outstripped the development of evidence-based interventions, but interventions tested to date are effective, feasible, and scalable. These interventions could be incorporated systematically into cancer care.

The calm before the storm? Burnout and compassion fatigue among undergraduate nursing students

Studies have consistently highlighted the deleterious impact of burnout and compassion fatigue on professional nurses' well-being and willingness to remain in the profession. Yet, as to what extent these noxious conditions are suffered among nursing students is still unclear. In this study 436 undergraduate nursing students completed surveys assessing their experiences of emotional exhaustion, depersonalization, lack of personal accomplishment, burnout, secondary traumatic stress, and compassion satisfaction (factors of burnout and compassion fatigue). There were no significant differences found between 3rd and 4th year students' reports of detrimental conditions and those of the 1st or 2nd year students. Furthermore, 4th year students reported significantly higher levels of personal accomplishment compared to 1st and 2nd year students. Semi-structured in-depth interviews with 3rd and 4th year students revealed that their clinical exposure during these years (especially during the 4th year) may enhance their other-orientation as well as promote role actualization, which may serve as protective features. Students did, however, express concern regarding an inevitable onset of burnout at some point during their professional careers. It is suggested that a key to understanding the onset and experience of burnout and compassion fatigue among nurses is to continue to examine the transition from student to professional nurse and the cultural atmosphere of nursing education compared to professional practice.

[Hygienic assessment of innovation procedures for lesson scheduling at school]

Hygienic assessment has established that education, by using innovation procedures for school lesson scheduling, diminishes the weariness of a schooling load and optimizes the pupils' psychosomatic status and school routine.

[Application of HHT to driving fatigue in EEG analysis]

Based on the fact that the signals of electroencephalogram (EEG) possess non-linear and non-stationary properties, Hilbert-Huang Transform (HHT) was proposed for the EEG analysis of driving fatigue. Firstly, C4-lead EEG was selected, and the data of normal driving state and fatigue driving state was analyzed by HHT to explore the differences. Then O2-lead EEG was chosen for contrastive analysis of differences between the different leads. It was found through the analysis that the EEG signals had different Hilbert marginal spectrums for different states, and there were also some differences at the same state for the two leads. It can be certain that HHT can well distinguish different states of drivers as a novel approach for driving fatigue detection, and the selected lead may affect detectable results to some extent.

Stretching and joint mobilization exercises reduce call-center operators' musculoskeletal discomfort and fatigue

AIM

We sought to evaluate musculoskeletal discomfort and mental and physical fatigue in the call-center workers of an airline company before and after a supervised exercise program compared with rest breaks during the work shift.

INTRODUCTION

This was a longitudinal pilot study conducted in a flight-booking call-center for an airline in São Paulo, Brazil. Occupational health activities are recommended to decrease the negative effects of the call-center working conditions. In practice, exercise programs are commonly recommended for computer workers, but their effects have not been studied in call-center operators.

METHODS

Sixty-four call-center operators participated in this study. Thirty-two subjects were placed into the experimental group and attended a 10-min daily exercise session for 2 months. Conversely, 32 participants were placed into the control group and took a 10-min daily rest break during the same period. Each subject was evaluated once a week by means of the Corlett-Bishop body map with a visual analog discomfort scale and the Chalder fatigue questionnaire.

RESULTS

Musculoskeletal discomfort decreased in both groups, but the reduction was only statistically significant for the spine and buttocks (p=0.04) and the sum of the segments (p=0.01) in the experimental group. In addition, the experimental group showed significant differences in the level of mental fatigue, especially in questions related to memory Rienzo, #181ff and tiredness (p=0.001).

CONCLUSIONS

Our preliminary results demonstrate that appropriately designed and supervised exercise programs may be more efficient than rest breaks in decreasing discomfort and fatigue levels in call-center operators.

Mitigating on-call symptoms through organizational justice and job control: a cross-sectional study among Finnish anesthesiologists

BACKGROUND

On-call duty has been shown to be associated with health problems among physicians. However, it cannot be abolished, as patient safety has to be assured. Thus, we need to find factors that could mitigate the negative health effects of on-call duty.

METHODS

The cross-sectional questionnaire of the buffering effects of organizational justice, job control, and social support on on-call stress symptoms was sent to all working Finnish anesthesiologists (n=550).

RESULTS

The response rate was 60% (n=328, 53% men). High organizational justice, job control, and social support were associated with a low number of symptoms while on call or the day after in crude analysis and when adjusted for age, gender, and place of work. Only the association between justice and symptoms was robust to additional adjustments for on-call burden and self-rated health. In the interaction analysis among those being on call at the hospital, we found that the higher the levels of job control or organizational justice, the lower the number of symptoms.

CONCLUSIONS

Job control and organizational justice successfully mitigated stress symptoms among those who had on-call hospital duties. It would be worth enhancing decision-making procedures, interpersonal treatment, and job control routines when aiming to prevent on-call stress and related symptoms.

Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help?

BACKGROUND

Because of concerns regarding sleep deprivation, the Accreditation Council for Graduate Medical Education limits duty hours and endorses education regarding sleep loss for residents. We assessed the effectiveness of a 60- to 90-minute lecture, the Sleep, Alertness, and Fatigue Education in Residency (SAFER) program, on sleep loss and recovery sleep in residents adhering to Accreditation Council for Graduate Medical Education duty hours.

METHODS

From July 1, 2003, through June 24, 2005, interns from the inpatient medicine service at the University of Chicago were asked to wear wristwatch activity monitors. In March 2005, interns received the SAFER program intervention. We used fixed-effects linear regression to estimate within-subject mean sleep per call day (on-call, precall, postcall, and second-day postcall sleep). These estimates were compared with recommended minimum levels of preventive (7 hours of precall) and recovery (16 hours during the 2 days after call) sleep in healthy populations using 2-tailed t tests. These analyses were repeated to test the effect of the SAFER program.

RESULTS

Fifty-eight of 81 interns (72%) participated for 147 intern-months (63%). Interns on call slept an average of 2.84 hours (95% confidence interval, 2.75-2.93 hours). Interns obtained less than recommended amounts of recovery sleep (14.06 hours [95% confidence interval, 13.84-14.28 hours]; P < .001). Intern preventive sleep was also less than recommended (6.47 hours [95% confidence interval, 6.39-6.56 hours]; P < .001). Interns attempted to compensate for their acute sleep loss; for each hour of on-call sleep loss, they received 18 minutes (95% confidence interval, 7-30 minutes) more recovery sleep (P = .003). The SAFER program had no significant beneficial effect on intern sleep.

CONCLUSIONS

Under the current duty-hour regulations of the Accreditation Council for Graduate Medical Education, residents continue to be sleep deprived. The SAFER program has no impact on resident precall or postcall sleep.

Effects of β-alanine supplementation on the onset of neuromuscular fatigue and ventilatory threshold in women

This study examined the effects of 28 days of beta-alanine supplementation on the physical working capacity at fatigue threshold (PWCFT), ventilatory threshold (VT), maximal oxygen consumption (VO2-MAX), and time-to-exhaustion (TTE) in women. Twenty-two women (age+/-SD 27.4+/-6.1 yrs) participated and were randomly assigned to either the beta-alanine (CarnoSyn) or Placebo (PL) group. Before (pre) and after (post) the supplementation period, participants performed a continuous, incremental cycle ergometry test to exhaustion to determine the PWCFT, VT, VO2-MAX, and TTE. There was a 13.9, 12.6 and 2.5% increase (p<0.05) in VT, PWCFT, and TTE, respectively, for the beta-alanine group, with no changes in the PL (p>0.05). There were no changes for VO2-MAX (p>0.05) in either group. Results of this study indicate that beta-alanine supplementation delays the onset of neuromuscular fatigue (PWCFT) and the ventilatory threshold (VT) at submaximal workloads, and increase in TTE during maximal cycle ergometry performance. However, beta-alanine supplementation did not affect maximal aerobic power (VO2-MAX). In conclusion, beta-alanine supplementation appears to improve submaximal cycle ergometry performance and TTE in young women, perhaps as a result of an increased buffering capacity due to elevated muscle carnosine concentrations.

Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained 'mentally demanding' tasks

Single doses of the traditional herbal treatment Panax ginseng have recently been shown to lower blood glucose levels and elicit cognitive improvements in healthy, overnight-fasted volunteers. The specific mechanisms responsible for these effects are not known. However, cognitive improvements may be related to the glycaemic properties of Panax ginseng. Using a double-blind, placebo-controlled, balanced-crossover design, 27 healthy young adults completed a 10 minute "cognitive demand" test battery at baseline. They then consumed capsules containing either ginseng (extract G115) or a placebo and 30 minutes later a drink containing glucose or placebo. A further 30 minutes later (i.e. 60 minutes post-baseline/capsules) they completed the "cognitive demand" battery six times in immediate succession. Depending on the condition to which the participant was allocated on that particular day, the combination of capsules/drink treatments corresponded to a dose of: 0mg G115/0 mg glucose (placebo); 200mg G115/0 mg glucose (ginseng); 0 mg G115/25 g glucose (glucose) or 200 mg G115/25 g glucose (ginseng/glucose combination). The 10 minute "cognitive demand" battery comprised a Serial Threes subtraction task (2 min); a Serial Sevens subtraction task (2 min); a Rapid Visual Information Processing task (5 min); and a "mental fatigue" visual analogue scale. Blood glucose levels were measured prior to the day's treatment, and before and after the post-dose completions of the battery. The results showed that both Panax ginseng and glucose enhanced performance of a mental arithmetic task and ameliorated the increase in subjective feelings of mental fatigue experienced by participants during the later stages of the sustained, cognitively demanding task performance. Accuracy of performing the Rapid Visual Information Processing task (RVIP) was also improved following the glucose load. There was no evidence of a synergistic relationship between Panax ginseng and exogenous glucose ingestion on any cognitive outcome measure. Panax ginseng caused a reduction in blood glucose levels 1 hour following consumption when ingested without glucose. These results confirm that Panax ginseng may possess glucoregulatory properties and can enhance cognitive performance.

Prediction of sickness absence: development of a screening instrument

OBJECTIVES

To develop a concise screening instrument for early identification of employees at risk for sickness absence due to psychosocial health complaints.

METHODS

Data from the Maastricht Cohort Study on "Fatigue at Work" were used to identify items to be associated with an increased risk of sickness absence. The analytical procedures univariate logistic regression, backward stepwise linear regression, and multiple logistic regression were successively applied. For both men and women, sum scores were calculated, and sensitivity and specificity rates of different cut-off points on the screening instrument were defined.

RESULTS

In women, results suggested that feeling depressed, having a burnout, being tired, being less interested in work, experiencing obligatory change in working days, and living alone, were strong predictors of sickness absence due to psychosocial health complaints. In men, statistically significant predictors were having a history of sickness absence, compulsive thinking, being mentally fatigued, finding it hard to relax, lack of supervisor support, and having no hobbies. A potential cut-off point of 10 on the screening instrument resulted in a sensitivity score of 41.7% for women and 38.9% for men, and a specificity score of 91.3% for women and 90.6% for men.

CONCLUSIONS

This study shows that it is possible to identify predictive factors for sickness absence and to develop an instrument for early identification of employees at risk for sickness absence. The results of this study increase the possibility for both employers and policymakers to implement interventions directed at the prevention of sickness absence.

The effect of a multidimensional exercise programme on symptoms and side-effects in cancer patients undergoing chemotherapy--the use of semi-structured diaries

The aim of this study was to evaluate the effects of a 6-week intervention with structured physical activity, relaxation, body-awareness techniques and massage on the symptoms/side-effects of cancer patients undergoing chemotherapy. The study was prospective and exploratory, and 54 patients completed assessments for all 6 weeks of the intervention. In order to obtain a continuous record of side-effects, a diary was developed for the patients' use throughout the intervention. The patients scored their symptoms/side-effects on a scale from 0 to 4, using the Common Toxicity Criteria and reported these scores in questionnaires. Twelve possible symptoms/side-effects were registered daily: lack of appetite, nausea, vomiting, diarrhea, paraesthesia, constipation, physical fatigue, mental fatigue, treatment-related fatigue, muscle pain, arthralgia and other pain. During the intervention a decrease in the scoring for 10 out of the 12 side-effects was found. Statistical significance was observed in the pain score (P=0.046) and the arbitrary-derived sum of the scores for symptoms and side-effects (P=0.036) respectively. Patients with evidence of disease (n=26) had significantly higher levels of symptoms/side-effects than patients with no evidence of disease (n=28) (P=0.027). The results indicate that a six weeks multidimensional exercise intervention undertaken by cancer patients with or without residual disease while undergoing chemotherapy can lead to a reduction in treatment-related symptoms.

The effect of lemon fragrance on simple mental performance and psychophysiological parameters during task performance

The purpose of this study is to effectively utilize fragrance in order to form a comfortable working environment, for which we obtained necessary data. The subjects were 14 female students. We made them do addition work in laboratories with and without lemon fragrance, and investigated their task performances, physiological changes and mood conditions. Our results showed that, although the existence or nonexistence of fragrance did not affect their work efficiency, it was revealed that fragrance mitigated exhaustion and maintained vigor.

Attention and Restoration in Post-RN Students

BACKGROUND

The impact of a restorative intervention using the natural environment on capacity to direct attention and issues that contribute to attention fatigue for diploma-prepared nursing students (Post-RN students) enrolled in a baccalaureate nursing program was examined.

METHODS

This study used a quasi-experimental comparison group design. Subjective (Attentional Functional Index) and objective (Finding A's Test and Symbol Digits Modalities Test) measures were employed.

RESULTS

Thirty-two students at two universities participated. Results of the split-plot analysis revealed a within-subject effect on the Attentional Functional Index (p < .05), a significant within-subject effect on the Finding A's Test (p < .05), and a significant within- and between-subject effect on the Symbol Digits Modalities Test (p < .05).

CONCLUSION

Recognizing and managing attention fatigue throughout the school year may enhance Post-RN students' abilities to direct attention and contribute to an enhanced academic experience.

Cardiovascular effects of coffee: is it a risk factor?

Intake of coffee, one of the most common beverages worldwide, is often reported as a cardiovascular risk factor; however, definitive data are lacking. Acute intake of coffee or beverages containing caffeine can increase blood pressure, heart minute volumes, and cardiac index, as well as activate the sympathetic nervous system in nonhabitual coffee drinkers. Interestingly, this is not observed in habitual coffee drinkers. Restriction of coffee or caffeinated beverages is no longer indicated in the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines for the treatment of hypertension. In fact, no clear association between coffee and the risk of hypertension, myocardial infarction, or other cardiovascular diseases has been demonstrated. In contrast to early studies, recent research indicates that habitual moderate coffee intake does not represent a health hazard and may even be associated with beneficial effects on cardiovascular health.

"Road trip" and "healthy diet": can they coexist?

Absolutely. Follow the tips below to prevent your next journey from becoming another guilt trip.

Taking the load off: investigations of how adaptive cruise control affects mental workload

It has been posited that Adaptive Cruise Control (ACC) represents a new generation of vehicle automation, in that it has the potential to relieve drivers of mental as well as physical workload. The results of previous research however, have raised some confusing issues about the specific effects of Adaptive Cruise Control (ACC) on driver mental workload (MWL)--some studies report reduced MWL compared to manual driving, while others find no effect. Two hypotheses are proposed in an attempt to explain these discrepancies: (a) that any potential MWL reductions due to ACC could be masked by the overriding influence of steering demand; or (b) that the tasks designed in some experiments do not exploit the adaptive nature of the ACC system, therefore precluding any potential benefits. Two related experiments were designed to test these hypotheses. It was found that the main reason for the discrepant findings was the nature of the driving task chosen--constant-speed tasks do not realise the mental workload benefits of ACC. Future researchers using ACC devices are advised to use variable-speed tasks to ensure that all aspects of device functionality are covered.

Reducing the effects of driving fatigue with magnitopuncture stimulation

The purpose of this study was to assess the effects of reducing driving fatigue with magnitopuncture stimuli on Dazhui (DU14) point and Neiguan (PC6) points using heart rate (HR), reaction time (RT) testing, right rate (RR), critical flicker fusion frequency (CFF) and subjective evaluation. Forty healthy subjects were randomly divided into two groups: study and control groups. All subjects were required to be well rested before the experiment. The subjects were engaged in high speed driving at a constant vehicle velocity of 80 km/h continuously for 3h on a test course simulating an expressway. During the driving magnitopunctures (Haci Five Elements Needle, 250 mT, made by Haci Company limited) were applied to the Dazhui (DU14) point and Neiguan (PC6) points for the study group when the subject performed the task for 2.5h, and for the control group magnitopunctures were applied to non-acupuncture points during the same time session. The results of this study show a significant effect of magnitopuncture stimuli on RT, RR and CFF. Subjective evaluation also exhibited significant differences (P < 0.05) between the two groups after the driving task. The findings showed that magnitopuncture stimuli on DU14 point and PC6 points could reduce the effects of driving fatigue.

A study on the student pilot's mental workload due to personality types of both instructor and student

The main purpose of this paper is to provide the ideal flight crew combination for instructor and student pilots in order to enhance the flight training effects based on Myers Briggs Type Indicator (MBTI) theory. In addition to personality, various levels of flight difficulty are considered in order to investigate their potential interaction effect in terms of student pilots' mental workload measured in heart rate, altitude deviation, NASA-TLX (Task Load Index) and subjective degree of personality harmony. Based on an experiment performed in a real flight situation, we found significant effects of personality combinations in terms of all four outcome measures. Both group C types of instructors and students who are concrete, realistic and have mechanical skills turn out to be the ideal flight crew combination. A structural equation model, fitted to analyse causality among the four response variables, implied that as the heart rate increased, the altitude deviation increased. In addition, as the altitude deviation and personality harmony increased, NASA-TLX increased. The results of this study are expected to provide a theoretical basis for manning the flight crew combinations and thereby enhancing the efficiency of flight training.

An environmental intervention to restore attention in women with newly diagnosed breast cancer

Earlier research indicated that attentional fatigue with reduced capacity to direct attention in women treated for breast cancer may be ameliorated by a theoretically based intervention involving regular exposure to the natural environment. This study tested the efficacy of a natural environment intervention aimed at restoring attention in 157 women with newly diagnosed breast cancer. Capacity to direct attention was assessed with a brief battery of objective measures at two time points: approximately 17 days before surgery (time 1) and 19 days after surgery (time 2). A randomly assigned intervention protocol was initiated after the first assessment and before any treatment. The intervention comprised a home-based program involving 120 minutes of exposure to the natural environment per week. The intervention group (n = 83) showed greater recovery of capacity to direct attention from the pretreatment (time 1) to the preadjuvant therapy period (time 2), as compared with the nonintervention group (n = 74). A significant effect of the natural environment intervention was observed even after control was used for the effects of age, education, attention scores at time 1, other health problems, symptom distress, and extent of surgery. The findings suggest therapeutic benefits for capacity to direct attention from early intervention aimed at restoring attention in women with newly diagnosed breast cancer.