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Liu Y, Ge P, Zhang X, Wu Y, Sun Z, Bai Q, Jing S, Zuo H, Wang P, Cong J, Li X, Liu K, Wu Y, Wei B. Intrarelationships between suboptimal health status and anxiety symptoms: A network analysis. J Affect Disord 2024; 354:679-687. [PMID: 38527530 DOI: 10.1016/j.jad.2024.03.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Suboptimal health status is a global public health concern of worldwide academic interest, which is an intermediate health status between health and illness. The purpose of the survey is to investigate the relationship between anxiety statuses and suboptimal health status and to identify the central symptoms and bridge symptoms. METHODS This study recruited 26,010 participants aged <60 from a cross-sectional study in China in 2022. General Anxiety Disorder-7 (GAD-7) and suboptimal health status short form (SHSQ-9) were used to quantify the levels of anxiety and suboptimal health symptoms, respectively. The network analysis method by the R program was used to judge the central and bridge symptoms. The Network Comparison Test (NCT) was used to investigate the network differences by gender, place of residence, and age in the population. RESULTS In this survey, the prevalence of anxiety symptoms, SHS, and comorbidities was 50.7 %, 54.8 %, and 38.5 %, respectively. "Decreased responsiveness", "Shortness of breath", "Uncontrollable worry" were the nodes with the highest expected influence. "Irritable", "Exhausted" were the two symptom nodes with the highest expected bridge influence in the network. There were significant differences in network structure among different subgroup networks. LIMITATIONS Unable to study the causal relationship and dynamic changes among variables. Anxiety and sub-health were self-rated and may be limited by memory bias. CONCLUSIONS Interventions targeting central symptoms and bridge nodes may be expected to improve suboptimal health status and anxiety in Chinese residents. Researchers can build symptom networks for different populations to capture symptom relationships.
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Affiliation(s)
- Yangyu Liu
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China
| | - Pu Ge
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100105, China
| | - Xiaoming Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Yunchou Wu
- School of Psychology, Southwest University, Chongqing 400715, China
| | - Zhaocai Sun
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China
| | - Qian Bai
- School of Management, Beijing University of Chinese Medicine, Beijing 100105, China
| | - Shanshan Jing
- College of Health Sciences, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China
| | - Huali Zuo
- Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Pingping Wang
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China
| | - Jinyu Cong
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China
| | - Xiang Li
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China
| | - Kunmeng Liu
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China.
| | - Yibo Wu
- School of Public Health, Peking University, Haidian District, Beijing 100191, China.
| | - Benzheng Wei
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China; Qingdao Key Laboratory of Artificial Intelligence Technology in Traditional Chinese Medicine, Qingdao 266112, China.
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Wang X, Gu D, Wei J, Pan H, Hou L, Zhang M, Wu X, Wang H. Network evolution of core symptoms after lung cancer thoracoscopic surgery:A dynamic network analysis. Eur J Oncol Nurs 2024; 70:102546. [PMID: 38513455 DOI: 10.1016/j.ejon.2024.102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES To investigate relationships between various symptoms occurring 1-2 and 5-6 days following days after thoracoscopic surgery, to identify core symptoms, and to monitor changes in core symptoms over time following lung cancer thoracoscopic surgery. METHODS We evaluated symptoms using the Anderson Symptom Scale (Chinese version) and the Lung Cancer-Specific Symptoms Template in 214 lung cancer patients hospitalized in the Department of Thoracic Surgery of a provincial hospital in Jiangsu Province from March 2023 to September 2023. Data was collected at 1-2 days and 5-6 days postoperatively. Symptom networks were constructed for each time point, and centrality indicators were analyzed to identify core symptoms while controlling for influencing factors. RESULTS According to the network analysis, fatigue (rs = 26.00、rc = 0.05、rb = 1.02) had the highest strength, closeness, and betweenness in the symptom network 1-2 days after lung cancer surgery. At 5-6 days after surgery, shortness of breath (rs = 27.00) emerged as the symptom with the highest strength, fatigue (rc = 0.04) had the highest closeness, and cough (rb = 1.08) ranked highest in betweenness within the symptom network. CONCLUSION Fatigue stands out as the most core symptom in the network 1-2 days after lung cancer surgery. Shortness of breath, fatigue and cough are the most core symptoms in the symptom network 5-6 days after surgery. Therefore, clinical staff can improve the postoperative symptom experience of lung cancer patients by developing symptom management programmes tailored to these core symptoms.
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Affiliation(s)
- Xiaobo Wang
- Wuxi Medical College, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu Province, 214122, China.
| | - Danfeng Gu
- Department of Nursing, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Binhu District, Wuxi, Jiangsu Province, 214122, China.
| | - Jinrong Wei
- Department of Nursing, Yangzhou Hospital of Traditional Chinese Medicine, Jiangsu Province, 225000, China.
| | - Haoran Pan
- Wuxi Medical College, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu Province, 214122, China.
| | - Lijia Hou
- Wuxi Medical College, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu Province, 214122, China.
| | - Mingqi Zhang
- Wuxi Medical College, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu Province, 214122, China.
| | - Xinyan Wu
- Wuxi Medical College, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu Province, 214122, China.
| | - Huihong Wang
- Department of Nursing, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Binhu District, Wuxi, Jiangsu Province, 214122, China.
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Liang M, Zhong T, Knobf MT, Chen L, Xu M, Cheng B, Pan Y, Zhou J, Ye Z. Sentinel and networked symptoms in patients with breast cancer undergoing chemotherapy. Eur J Oncol Nurs 2024; 70:102566. [PMID: 38513452 DOI: 10.1016/j.ejon.2024.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE It was designed to identify the symptom clusters and sentinel symptoms among patients with breast cancer receiving chemotherapy at the community level, and to explore core and bridge symptoms at the global level. METHODS A cross-sectional survey was conducted using the MD Anderson Symptom Inventory. Patients with breast cancer receiving chemotherapy, recruited from the "Be Resilient to Breast Cancer" project between January 2023 and December 2023, were included in the study. Symptom clusters and their sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis. RESULTS A total of 468 patients with breast cancer participated in the current study. At the community level, three symptom clusters and their corresponding sentinel symptoms were identified: a gastrointestinal symptom cluster (with nausea as the sentinel symptom), a psycho-sleep-related symptom cluster (with distress as the sentinel symptom), and a neurocognition symptom cluster (with dry mouth as the sentinel symptom). At the global level, fatigue emerged as the core symptom, while disturbed sleep and lack of appetite as bridge symptoms. CONCLUSION Addressing nausea, distress, and dry mouth are imperative for alleviating specific symptom clusters at the community level. Furthermore, targeting fatigue, disturbed sleep, and lack of appetite are crucial to break the interactions among diverse symptoms at the global level.
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Affiliation(s)
- Minyu Liang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Tong Zhong
- Tumor Radiotherapy Department, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
| | - M Tish Knobf
- School of Nursing, Yale University, Orange, CT, United States
| | - Lisi Chen
- Department of Medical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, China
| | - Min Xu
- Galactophore Department, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, China
| | - Beibei Cheng
- Thyroid and Breast Department, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
| | - Yichao Pan
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Jian Zhou
- Galactophore Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| | - Zengjie Ye
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
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Tarantino N, Norman B, Enimil A, Asibey SO, Martyn-Dickens C, Guthrie KM, Kwara A, Bock B, Mimiaga MJ, Brown L. HIV symptom severity and associated factors among young people with HIV in Ghana. AIDS Care 2024:1-9. [PMID: 38184890 PMCID: PMC11227599 DOI: 10.1080/09540121.2023.2299332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACTAdolescents and young adults (young people) with HIV (YPWH) often struggle with treatment self-management. Many have symptoms due to HIV disease, medication side-effects, or comorbid conditions. Our study investigated the severity of HIV-related symptoms among YPWH aged 18-24 with detectable viral loads from an HIV clinic in Ghana (N = 60) and potential correlates of severity across a range of factors. Results indicated that YPWH currently experienced, on average, 13 symptoms (SD = 12.33). Six of the 10 most common symptoms were from two domains: fatigue and psychological. The most common symptoms were headaches (62%), weakness (53%), and fear/worries (52%). No differences were observed in number or severity of symptoms between youth based on HIV transmission status. Bivariate correlates of symptom severity were found with six that remained significant or approached significance in a multivariate model predicting severity: living with a parent/guardian, higher perceived access to HIV care, and higher treatment readiness were associated with lower severity while greater travel time to the HIV clinic, psychological distress, and more missed clinic appointments were associated with higher severity. Our findings suggest that interventions to address symptoms among YPWH should be multilevel and include strategies (e.g., telehealth, home care) to increase access to care.
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Affiliation(s)
- Nicholas Tarantino
- Providence College, Department of Psychology, Providence, RI, USA
- Rhode Island Hospital, Department of Psychiatry, Providence, RI, USA
| | - Betty Norman
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, Department of Medicine, Kumasi, Ghana
| | - Anthony Enimil
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, Department of Child Health, Kumasi, Ghana
| | | | | | - Kate M. Guthrie
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
| | - Awewura Kwara
- University of Florida College of Medicine, Department of Medicine, Gainesville, FL, USA
| | - Beth Bock
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
| | - Matthew J. Mimiaga
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Larry Brown
- Rhode Island Hospital, Department of Psychiatry, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
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Zhu Z, Qi X, Pei Y, Wang J, Wu B. Longitudinal relationships in the psychopathology of depressive symptoms in middle-aged and older adults in China. Aging Ment Health 2023; 27:1692-1701. [PMID: 36597893 PMCID: PMC10318117 DOI: 10.1080/13607863.2022.2164253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To develop symptom networks and examine the longitudinal relationships of depressive symptoms among middle-aged and older adults in China. METHOD This study used three-wave data from the China Health and Retirement Longitudinal Study (2013 (T1), 2015 (T2), and 2018 (T3)). Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). A multilevel vector autoregression model (VAR) was used to identify ten depressive symptoms dynamically interacting with each other over time. RESULTS A total of 3,558 participants were included in the final analysis. The strongest direct effects were 'D10: felt fearful' -> 'D6: felt everything I did was an effort' (β = 0.14). 'D10: felt fearful' reported the largest value of out-predictability (r = 0.064) and out-strength (r = 0.635). 'D3: felt depressed' reported the largest value of in-predictability (r = 0.077) and in-strength (r = 0.545). Substantial heterogeneity in the network may stem from an individual's sex and place of residence. CONCLUSIONS 'Felt fearful' was the strongest predictor compared to the other nine depressive symptoms based on node centrality. Our study suggests that, after understanding the causes of fear, strategies to reduce fear should be incorporated into multimodal interventions for middle-aged and older adults with depressive symptoms.
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Affiliation(s)
- Zheng Zhu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- School of Nursing, Fudan University, Shanghai, China
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Jing Wang
- School of Nursing, Fudan University, Shanghai, China
- School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- NYU Aging Incubator, New York University, New York, NY, USA
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Leng M, Han S, Sun Y, Zhu Z, Zhao Y, Zhang Y, Yang X, Wang Z. Identifying care problem clusters and core care problems of older adults with dementia for caregivers: a network analysis. Front Public Health 2023; 11:1195637. [PMID: 37637827 PMCID: PMC10449331 DOI: 10.3389/fpubh.2023.1195637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Background A shift in research interest from separate care problem to care problem clusters among caregivers of people living with dementia may contribute to a better understanding of dementia care. However, the care problems network among caregivers of people living with dementia are still unknown. This study aimed to identify care problem clusters and core care problems, and explore demographic variables associated with these care problem clusters among caregivers of people living with dementia. Methods Participants were recruited through memory clinics and WeChat groups. The principal component analysis was applied to identify care problem clusters. The network analysis was conducted to describe the relationships among care problems and clusters. Multiple linear models were used to explore the associated factors for the occurrence of the overall care problems and top three central care problem clusters. Results A total of 1,012 carer-patient pairs were included in the analysis. Nine care problem clusters were identified. In the entire care problem network, "deterioration in activities of daily living" was the most core care problem cluster across the three centrality indices, followed by "verbal and nonverbal aggression" and "loss of activities of daily living." Variables including marital status, years of dementia diagnosis, number of dementia medication type, and caregiver's educational attainment were associated with the prevalence of these three care problem clusters. Conclusion Our study suggests that there is a need to evaluate care problem clusters for the improvement of care problem management among people living with dementia. It is particularly important to include assessment and treatment of core care problem as an essential component of the dementia care.
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Affiliation(s)
- Minmin Leng
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Nursing, Peking University, Beijing, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Yajie Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yizhu Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Shang B, Chen R, Luo C, Lv F, Wu J, Shao X, Li Q. The relationship between alexithymia, depression, anxiety, and stress in elderly with multiple chronic conditions in China: a network analysis. Front Psychiatry 2023; 14:1209936. [PMID: 37529068 PMCID: PMC10389667 DOI: 10.3389/fpsyt.2023.1209936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Objective This study aimed to construct a network structure to investigate the connections between alexithymia, depression, anxiety, and stress in Chinese older adults with multiple chronic conditions (MCC), identifying core and bridge symptoms, and comparing the network structure across different levels of alexithymia. Methods This study used a cross-sectional survey design and convenience sampling to recruit participants from six cities in Jiangsu Province. The study assessed the levels of alexithymia, depression, anxiety, and stress in older adults with MCC using the Toronto Alexithymia Scale (TAS-20) and the Depression Anxiety and Stress Scale-21 (DASS-21). Network analysis was performed using R language to identify core and bridge symptoms in the network and compare the network structure across different levels of alexithymia. Results A total of 662 participants were included in the analysis, including 395 men and 267 women. The mean age was 70.37 ± 6.92 years. The finding revealed that the "Difficulty Identifying Feelings" (DIF) node had the highest strength centrality (strength = 2.49) and predictability (rp = 0.76) in the network. The next highest strength centrality was observed for "Meaningless" (strength = 1.50), "Agitated" (strength = 1.47), "Scared" (strength = 1.42), and "No look forward" (strength = 0.75). They were identified as core symptoms. The bridge strength analysis identified "Panic," "Scared," "No wind down," "No initiative," and "No positive" as the bridge symptoms. There were notable differences in the overall network structure and specific connections between the groups with and without alexithymia (p < 0.05). Conclusion "DIF" is a core node in the network of older adults with MCC, indicating its significance as a potential target for psychological interventions in clinical practice. Preventing and mitigating bridge symptoms such as "panic," "Scared," "No wind down," "No initiative," and "No positive" can effectively impede the spread of symptom activation, thereby interrupting or severing the connections among comorbidities in older adults. Additionally, compared to non-alexithymia individuals, the psychological issues of older adults with alexithymia require prioritized intervention from healthcare professionals.
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Affiliation(s)
- Bin Shang
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Ruirui Chen
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Caifeng Luo
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Fei Lv
- Department of Nursing, Jingjiang College, Jiangsu University, Zhenjiang, China
| | - Jing Wu
- University Hospital, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Xiao Shao
- Endoscopy Center, Suqian First People’s Hospital, Suqian, China
| | - Qian Li
- Department of Neurology, Suzhou Xiangcheng People’s Hospital, Suzhou, China
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Zhu Z, Hu H, Wu B, Hu Y. Editorial: Mapping symptom networks among co-occurrence of psychological and somatic symptoms. Front Public Health 2023; 11:1210151. [PMID: 37287814 PMCID: PMC10242302 DOI: 10.3389/fpubh.2023.1210151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
- NYU Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Hui Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
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Zhou M, Gu X, Cheng K, Wang Y, Zhang N. Exploration of symptom clusters during hemodialysis and symptom network analysis of older maintenance hemodialysis patients: a cross-sectional study. BMC Nephrol 2023; 24:115. [PMID: 37106315 PMCID: PMC10132956 DOI: 10.1186/s12882-023-03176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have established networks of symptoms experienced by older patients on maintenance hemodialysis. Our goal was to examine the type of symptom clusters of older maintenance hemodialysis patients during dialysis and construct a symptom network to understand the symptom characteristics of this population. METHODS The modified Dialysis Symptom Index was used for a cross-sectional survey. Network analysis was used to analyze the symptom network and node characteristics, and factor analysis was used to examine symptom clusters. RESULTS A total of 167 participants were included in this study. The participants included 111 men and 56 women with a mean age of 70.05 ± 7.40. The symptom burdens with the highest scores were dry skin, dry mouth, itching, and trouble staying asleep. Five symptom clusters were obtained from exploratory factor analysis, of which the clusters with the most severe symptom burdens were the gastrointestinal discomfort symptom cluster, sleep disorder symptom cluster, skin discomfort symptom cluster, and mood symptom cluster. Based on centrality markers, it could be seen that feeling nervous and trouble staying asleep had the highest strength, and feeling nervous and feeling irritable had the highest closeness and betweenness. CONCLUSIONS Hemodialysis patients have a severe symptom burden and multiple symptom clusters. Dry skin, itching, and dry mouth are sentinel symptoms in the network model; feeling nervous and trouble staying asleep are core symptoms of patients; feeling nervous and feeling irritable are bridge symptoms in this symptom network model. Clinical staff can formulate precise and efficient symptom management protocols for patients by using the synergistic effects of symptoms in the symptom clusters based on sentinel symptoms, core symptoms, and bridge symptoms.
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Affiliation(s)
- Mingyao Zhou
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No.1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Xiaoxin Gu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No.1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Kangyao Cheng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No.1200 Cailun Road, Pudong New District, Shanghai, 201203, China.
| | - Yin Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No.1200 Cailun Road, Pudong New District, Shanghai, 201203, China.
| | - Nina Zhang
- Hemodialysis Room, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, No.600 Yishan Road, Xuhui District, Shanghai, 201306, China
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Montgomerie EK, Michel C, Sanchez-Covarrubias AP, Duthely LM. Stress, Support, and Length of Diagnosis Among Women Living with HIV/AIDS in the Southern USA, During the COVID-19 Pandemic. HIV AIDS (Auckl) 2023; 15:95-103. [PMID: 36922991 PMCID: PMC10010129 DOI: 10.2147/hiv.s388307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/22/2023] [Indexed: 03/11/2023] Open
Abstract
Background Health-related challenges caused and worsened by the global COVID-19 pandemic have proven broad and multifaceted, particularly for racial/ethnic minority women living with HIV (WLWH). The 2020 pandemic has affected the wellbeing and access to care for WLWH in Southeastern Florida, a region that experienced simultaneous high rates of COVID-19 and HIV. WLWH, over a short- or long-term period, likely utilize different coping mechanisms as they face these challenges. Methods This analysis compared pandemic-related stress and support endorsed by participants attending an urban clinic in South Florida, from January through May 2021. Participants completed an adapted version of the Pandemic Stress Index (PSI). The items in the PSI assessed emotional distress, stigma, and support, and were dichotomized, as either "stress" or "support". Mann-Whitney U-test assessed differences in distributions of PSI scores (stress and support) comparing long-term survivors (≥10 years with an HIV diagnosis) to those more recently diagnosed (<10 years). Results The cohort consisted of 63 WLWH, aged 21-71 (Mean = 42 years±12.95). The group of WLWH were almost evenly split, with 50.8% having been diagnosed in the last 10 years (short-term survivors). The high-stress group endorsed lower levels of support, compared to the low-stress group. There was a non-significant trend of higher stress scores for short-term survivors, compared to long-term survivors; and, higher support scores for long-term survivors, compared to short-term survivors. Conclusion Results suggest a trend in long-term survivor WLWH endorsing lower stress and higher support; the contrary was found for their short-term survivor counterparts. Patterns in COVID-19 related stressors and maladaptive behaviors need further exploration to establish suitable interventions that address disparities within groups of WLWH.
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Affiliation(s)
- Emily K Montgomerie
- Department of Neurology, Stroke Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Cassandra Michel
- School of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - Alex P Sanchez-Covarrubias
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lunthita M Duthely
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Wen H, Zhu Z, Hu T, Li C, Jiang T, Li L, Zhang L, Fu Y, Han S, Wu B, Hu Y. Unraveling the central and bridge psychological symptoms of people living with HIV: A network analysis. Front Public Health 2023; 10:1024436. [PMID: 36684950 PMCID: PMC9846149 DOI: 10.3389/fpubh.2022.1024436] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Background People living with HIV (PLWH) experience multiple psychological symptoms. Few studies have provided information on central and bridge psychological symptoms among PLWH. This information has implications for improving the efficiency and efficacy of psychological interventions. Our study aimed to identify the central and bridge psychological symptoms of PLWH and to explore the interconnectedness among symptoms and clusters. Methods Our study used data from the HIV-related Symptoms Monitoring Survey, a multisite, cross-sectional study conducted during 2017-2021. We used R to visualize the network of 16 symptoms and analyzed the centrality and predictability indices of the network. We further analyzed the bridge symptoms among the three symptom clusters. Results A total of 3,985 participants were included in the analysis. The results suggested that sadness had the highest strength (r S = 9.69) and predictability (70.7%) compared to other symptoms. Based on the values of bridge strength, feeling unsafe (r bs = 0.94), uncontrollable worry (r bs = 0.82), and self-abasement (r bs = 0.81) were identified as bridge symptoms. We also found a strong correlation between sadness and self-abasement (r = 0.753) and self-loathing and self-blame (r = 0.744). Conclusion We found that sadness was the central psychological symptom of PLWH, indicating that sadness was the center of the psychological symptom network from a mechanistic perspective and could be a target for intervention. Deactivating bridge symptoms, including "feeling unsafe," "self-abasement," and "uncontrollable worry," could be more effective in preventing symptom activation from spreading (e.g., one symptom activating another).
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Affiliation(s)
- Huan Wen
- School of Public Health, Fudan University, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
| | - Tiantian Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Cheng Li
- School of Nursing, Fudan University, Shanghai, China
| | - Tao Jiang
- School of Nursing, Fudan University, Shanghai, China
| | - Ling Li
- School of Nursing, Fudan University, Shanghai, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yanfen Fu
- School of Nursing, Dali University, Dali, Yunnan, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York University, New York City, NY, United States
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
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12
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He J, Zhu Z, Sun M, Liu X, Yu J, Zhang L, Lu H. Barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV: A scoping review. Front Pharmacol 2023; 14:1013688. [PMID: 36937849 PMCID: PMC10017548 DOI: 10.3389/fphar.2023.1013688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: With the prolongation of life span and increasing incidence of comorbidities, polypharmacy has become a challenge for people living with HIV/AIDS (PLWH). This review aimed to identify barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV/AIDS. Methods: Nine electronic databases were searched for studies from 1996 to October 2021. Studies were included if they were conducted with adults living with HIV/AIDS and reported barriers and facilitators to maintaining a high level of polypharmacy adherence. This review presents a conceptual framework model to help understand the barriers and facilitators. Results: Twenty-nine studies were included. The majority of publications were observational studies. Eighty specific factors were identified and further divided into five categories, including individual factors, treatment-related factors, condition-related factors, healthcare provider-related factors, and socioeconomic factors, based on the multidimensional adherence model (MAM). Conclusion: Eighty factors associated with polypharmacy adherence among people living with HIV/AIDS were identified and grouped into five major categories. Healthcare providers can make decisions based on the five categories of relevant factors described in this paper when developing interventions to enhance polypharmacy adherence. It is recommended that medications be evaluated separately and that an overall medication evaluation be conducted at the same time to prevent inappropriate polypharmacy use.
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Affiliation(s)
- Jiamin He
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Shanghai Public Health Clinical Center, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Center for Evidence-based Nursing: A Joanna Briggs Institute Center of Excellence, Shanghai, China
- Rory Meyers College of Nursing, New York University, New York, NY, United States
- *Correspondence: Hongzhou Lu, ; Zheng Zhu,
| | - Meiyan Sun
- Department of Nursing, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xiaoning Liu
- Department of Infectious Disease, National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Junwen Yu
- School of Nursing, Fudan University, Shanghai, China
| | - Lin Zhang
- Department of Nursing, Shanghai Public Health Clinical Center, Shanghai, China
| | - Hongzhou Lu
- School of Nursing, Fudan University, Shanghai, China
- Department of Infectious Disease, National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
- *Correspondence: Hongzhou Lu, ; Zheng Zhu,
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13
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Identifying subtypes of HIV/AIDS-related symptoms in China using latent profile analysis and symptom networks. Sci Rep 2022; 12:13271. [PMID: 35918513 PMCID: PMC9345945 DOI: 10.1038/s41598-022-17720-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
The identification of subgroups of people living with HIV in China based on the severity of symptom clusters and individual symptoms is crucial to determine group-specific symptom management strategies. Participants reported 27 highly prevalent HIV/AIDS-related symptoms. Latent profile analysis based on symptom severity was used to identify person-centered subtypes of HIV/AIDS-related symptoms. Symptom networks were compared among subgroups identified by latent profile analysis. A total of 2927 eligible people living with HIV (PWH) were included in the analysis. Five profiles were identified: "Profile 1: all low symptom severity" (n2 = 2094, 71.54%), "Profile 2: medium symptom severity with syndemic conditions" (n3 = 109, 3.72%), "Profile 3: medium symptom severity with low functional status" (n1 = 165, 5.64%), "Profile 4: medium symptom severity in transitional period" (n4 = 448, 15.31%), and "Profile 5: all high symptom severity" (n5 = 111, 3.79%). Except for Profile 1 and Profile 5, the symptom severity was similar among the other three profiles. Profiles 1 (2.09 ± 0.52) and 4 (2.44 ± 0.66) had the smallest ∑s values, and Profiles 2 (4.38 ± 1.40) and 5 (4.39 ± 1.22) had the largest ∑s values. Our study demonstrates the need for health care professionals to provide PWH with group-specific symptom management interventions based on five profiles to improve their physical and psychological well-being. Future studies should be conducted in different contexts using different symptom checklists to further validate our results.
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14
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Liu X, Wang H, Zhu Z, Zhang L, Cao J, Zhang L, Yang H, Wen H, Hu Y, Chen C, Lu H. Exploring bridge symptoms in HIV-positive people with comorbid depressive and anxiety disorders. BMC Psychiatry 2022; 22:448. [PMID: 35790936 PMCID: PMC9254609 DOI: 10.1186/s12888-022-04088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/23/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prevalence of comorbid depressive and anxiety disorders in people living with HIV (PLWH) is high. However, it is unclear which symptom is the bridge symptom between depression and anxiety in PLWH. This study aimed to develop symptom networks for depression and anxiety and explore the bridge symptoms and interconnectedness between these disorders in PLWH with comorbid depressive and anxiety disorders. METHODS A multisite, hospital-based cross-sectional study was conducted from March 2020 to November 2021. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale. We visualized the symptom network using the qgraph package and computed the bridge expected influence of each node. The GLASSO layout was used to generate undirected association networks. RESULTS A total of 2016 individuals were included in the analysis. In the anxiety cluster, "not feeling relaxed" had the highest bridge expected influence and strength (rbridge expected influence = 0.628, rstrength = 0.903). In the depression cluster, "not feeling cheerful" was identified as having a high bridge expected influence (rbridge expected influence = 0.385). "Not feeling cheerful" and "not feeling relaxed" were the strongest edges across the depression and anxiety clusters (r = 0.30 ± 0.02). CONCLUSIONS Healthcare professionals should take note when PLWH report severe bridge symptoms. To enhance the levels of perceived cheerfulness and relaxation, positive psychology interventions could be implemented.
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Affiliation(s)
- Xiaoning Liu
- grid.410741.7Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, 518112 Guangdong Province China ,grid.7445.20000 0001 2113 8111National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Hui Wang
- grid.410741.7Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, 518112 Guangdong Province China
| | - Zheng Zhu
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China. .,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
| | - Liyuan Zhang
- grid.410741.7Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, 518112 Guangdong Province China
| | - Jing Cao
- grid.410741.7Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, 518112 Guangdong Province China
| | - Lin Zhang
- grid.470110.30000 0004 1770 0943Department of Nursing, Shanghai Public Health Clinical Center, Shanghai, China
| | - Hongli Yang
- grid.508267.eDepartment of Nursing, Yunnan Provincial Infectious Disease Hospital, Kunming, Yunnan China
| | - Huan Wen
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China
| | - Yan Hu
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Congzhou Chen
- grid.7445.20000 0001 2113 8111School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Hongzhou Lu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, Guangdong Province, China.
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15
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Zhu Z, Sun Y, Kuang Y, Yuan X, Gu H, Zhu J, Xing W. Contemporaneous symptom networks of multidimensional symptom experiences in cancer survivors: A network analysis. Cancer Med 2022; 12:663-673. [PMID: 35651298 PMCID: PMC9844664 DOI: 10.1002/cam4.4904] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networks METHODS: Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer-related symptoms. We constructed contemporaneous networks with all 13 symptoms after controlling for covariates. RESULTS Distress (rs = 9.18, rc = 0.06), sadness (rs = 9.05, rc = 0.06), and lack of appetite (rs = 9.04, rc = 0.06) had the largest values for strength and closeness. The density of the "less than 5 years" network was significantly different from that of the "5-10 years" and "over 10 years" networks (p < 0.001). We found that while fatigue was the most severe symptom in cancer survivorship, the centrality of fatigue was lower than that of the majority of other symptoms. CONCLUSION Our study demonstrates the need for the assessment of centrality indices and network density as an essential component of cancer care, especially for survivors with <5 years of survivorship. Future studies are warranted to develop dynamic symptom networks and trajectories of centrality indices in longitudinal data to explore causality among symptoms and markers of interventions.
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Affiliation(s)
- Zheng Zhu
- School of NursingFudan UniversityShanghaiChina,Fudan University Centre for Evidence‐based Nursing: A Joanna Briggs Institute Centre of ExcellenceFudan UniversityShanghaiChina
| | - Yanling Sun
- School of Public HealthFudan UniversityShanghaiChina
| | - Yi Kuang
- School of NursingFudan UniversityShanghaiChina
| | - Xiaoyi Yuan
- School of NursingFudan UniversityShanghaiChina
| | - Haiyan Gu
- Department of Chronic Disease Prevention and ControlXuhui District Center for Disease Control and PreventionShanghaiChina
| | - Jing Zhu
- Department of Chronic Disease Prevention and ControlXuhui District Center for Disease Control and PreventionShanghaiChina
| | - Weijie Xing
- School of NursingFudan UniversityShanghaiChina,Fudan University Centre for Evidence‐based Nursing: A Joanna Briggs Institute Centre of ExcellenceFudan UniversityShanghaiChina
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16
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Zhu Z, Xing W, Hu Y, Wu B, So WKW. Paradigm shift: Moving from symptom clusters to symptom networks. Asia Pac J Oncol Nurs 2021; 9:5-6. [PMID: 35528791 PMCID: PMC9072174 DOI: 10.1016/j.apjon.2021.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Zheng Zhu
- Fudan University School of Nursing, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Weijie Xing
- Fudan University School of Nursing, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Yan Hu
- Fudan University School of Nursing, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York City, NY, USA
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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