Theories of fatigue: application in HIV/AIDS

Experience of fatigue and associated factors among adult people living with HIV attending ART clinic: a hospital-based cross-sectional study in Ethiopia

OBJECTIVE

This study aimed to determine the prevalence of fatigue and the factors associated among adult people living with HIV attending antiretroviral therapy clinic in Gondar town, Ethiopia.

DESIGN

Cross-sectional.

SETTING

Governmental health facility that provides HIV care in Gondar town.

OUTCOME MEASURE

Fatigue is defined by nine items version Fatigue Severity Scale.

PARTICIPANTS

Adult (aged 18 and above) people living with HIV in Gondar town (n=392).

RESULT

A total of 408 HIV seropositive adults were approached for consent, among which 392 participants consented to participate in this study, with a response rate of 96.1%. The mean age of the participants was 40.5±8.5 years. The prevalence of HIV-related fatigue was 53.3% and about 66% of women living with HIV experienced fatigue. The factors associated with fatigue experience were; female gender (adjusted OR (AOR): 2.61, 95% CI 1.01 to 5.3), being married (AOR: 0.18, 95% CI 0.10 to 0.9), low income (AOR: 7.1, 95% CI 4.6 to 22.15), unemployed (AOR: 2.79, 95% CI 1.19 to 9.84), parity (AOR: 4.87, 95% CI 2.18 to 17.9), being anaemic (AOR: 12.45, 95% CI 5.6 to 41.01), depression (AOR: 4.51, 95% CI 1.91 to 11.20), mild weight loss (AOR: 4.2 95% CI 2.56 to 13.9) and moderate weight loss (AOR: 5.1, 95% CI 1.85 to 16.12), respectively.

CONCLUSION

The findings of this study revealed that experiencing fatigue is quite common among adult people living with HIV. It is important for the healthcare professionals and people living with HIV to understand; the possible causes of fatigue, remedies and ways to reclaim energy. The predisposing factors and complications that cause fatigue should be aggressively diagnosed and treated by the clinicians. Further qualitative studies exploring the reasons for experiencing HIV-related fatigue might help designing interventions.

Relationships between expression of BCS1L, mitochondrial bioenergetics, and fatigue among patients with prostate cancer

Introduction: Cancer-related fatigue (CRF) is the most debilitating symptom with the greatest adverse side effect on quality of life. The etiology of this symptom is still not understood. The purpose of this study was to examine the relationship between mitochondrial gene expression, mitochondrial oxidative phosphorylation, electron transport chain complex activity, and fatigue in prostate cancer patients undergoing radiotherapy (XRT), compared to patients on active surveillance (AS).

Methods: The study used a matched case–control and repeated-measures research design. Fatigue was measured using the revised Piper Fatigue Scale from 52 patients with prostate cancer. Mitochondrial oxidative phosphorylation, electron-transport chain enzymatic activity, and BCS1L gene expression were determined using patients’ peripheral mononuclear cells. Data were collected at three time points and analyzed using repeated measures ANOVA.

Results: The fatigue score was significantly different over time between patients undergoing XRT and AS (P<0.05). Patients undergoing XRT experienced significantly increased fatigue at day 21 and day 42 of XRT (P<0.01). Downregulated mitochondrial gene (BC1, ubiquinol-cytochrome c reductase, synthesis-like, BCS1L, P<0.05) expression, decreased OXPHOS-complex III oxidation (P<0.05), and reduced activity of complex III were observed over time in patients with XRT. Moreover, increased fatigue was significantly associated with downregulated BCS1L and decreased complex III oxidation in patients undergoing XRT.

Conclusion: Our results suggest that BCS1L and complex III in mitochondrial mononuclear cells are potential biomarkers and feasible therapeutic targets for acute XRT-induced fatigue in this clinical population.

Exploring our understanding of fatigue among adolescents living with HIV: Highlighting the unknown

Due to antiretroviral therapies, HIV is now a chronic illness rather than a terminal disease. Chronic symptoms, including fatigue, should be identified and managed to prevent or minimise their potential negative consequences. We apply a Symptom Management Model to conceptualise fatigue among adolescents with HIV. In the context of minimal research, we seek to identify a research agenda for resource-constrained contexts, where HIV prevalence remains high and treatment adherence is a significant problem. By better understanding and addressing the symptom of fatigue, treatment adherence, occupational, social and emotional functioning could be improved. We highlight conceptual, methodological and measurement-related caveats.

Exercise stereotypes and health-related outcomes in French people living with HIV: development and validation of an HIV Exercise Stereotypes Scale (HIVESS)

Background

The main objective of the current study was to develop and validate a French exercise stereotype scale for people living with HIV (PLHIV) in order to gain visibility to the possible barriers and facilitators for exercise in PLHIV and thus enhance their quality of life.

Methods

A series of four complementary studies was carried out with a total sample of 524 participants to: (a) develop a preliminary version of the HIV Exercise Stereotype Scale (HIVESS) (Stage 1), (b) confirm the factorial structure of the instrument (Stage 2), (c) evaluate the stability of the instrument (Stage 3), and (d) examine the construct and divergent validity of the scale (Stage 4).

Results

Results provided support for a 14-item scale with three sub-scales reporting stereotypes related to exercise benefits, exercise risks and lack of capacity for exercise with Cronbach’s alphas of .77, .69 and .76 respectively. Results showed good factorial structure, strong reliability and indicators of convergent validity relating to self-efficacy, exercise and quality of life.

Conclusion

The HIVESS presented satisfactory psychometric properties, constitutes a reliable and valid instrument to measure exercise stereotypes among PLHIV and has applications for future research and clinical practice.

Menopausal symptoms and physical activity in multiethnic groups of midlife women: a secondary analysis

AIMS

To explore the effect of diverse types of women's physical activity on menopausal symptoms among multiethnic groups of midlife women in the USA.

BACKGROUND

Although physical activity is one of the most widely used non-pharmacological methods for managing menopausal symptoms, there is a paucity of clinical guidelines for women and healthcare providers because the relationship between physical activity and menopausal symptoms has been found inconsistent in previous studies.

DESIGN

A secondary analysis of the data from a lager Internet survey study conducted in 2008-2010.

METHODS

A total of 481 midlife women among four ethnic groups were selected from the original study. The data were collected using the Kaiser Physical Activity Survey and the Midlife Women's Symptom Index. Bivariate correlation analyses and hierarchical multiple regression analyses were used to analyse the data.

RESULTS/FINDINGS

The household/caregiving activity index was positively associated with the prevalence scores of the psychological symptoms in both non-Hispanic Asians and non-Hispanic African Americans. The increased sports/exercise activity index was negatively associated with the severity scores of the physical symptoms in both Hispanics and non-Hispanic Whites. The occupational activity index and the active living activity index significantly predicted the severity scores of the psychosomatic symptoms in Hispanics and non-Hispanic African Americans, respectively.

CONCLUSION

Nurses who take care of multiethnic groups of midlife women who experience menopausal symptoms should be aware of diverse types of women's physical activities within the cultural context.

Identification of fatigue biomarkers in treated and treatment-naive HIV patients: preliminary results

Objective assessment in human immunodeficiency virus (HIV)-related fatigue has been elusive because the biological mechanisms are not well characterized. We tried to identify low-abundance plasma proteins that correlate with self-reported fatigue intensity in people living with HIV. We used plasma samples from 32 patients with HIV with varying degrees of fatigue who were either treated with nucleoside reverse transcriptase inhibitors or treatment naïve. The plasma samples were enriched for low-abundance proteins and trypsinized. The peptides were analyzed using shotgun proteomics. Five targets correlated with severity of fatigue: apolipoprotein A-1 (ApoA1), apolipoprotein B (ApoB), histine-rich glycoprotein, alpha-1 B glycoprotein, and orosomucoid 2. These targets were selected based on total abundance and spectral count differences, and ApoA1 and ApoB were analyzed via Western blots to verify the mass spectrometry results. ApoA1 levels were higher in untreated patients, while ApoB results suggested a possible positive trend in treated patients. Further analysis is needed to identify additional low-abundance proteins and confirm already-identified proteins as potential fatigue biomarkers.

Fatigue and Sleep Disturbance Related to Perceived Stress in Chinese HIV-Positive Individuals: A Mixed Methods Study

BACKGROUND

Few studies of HIV+ individuals in China have examined the associations between HIV-related stress with sleep disturbance and fatigue, which are common complaints among people living with HIV/AIDS (PLWHA). We carried out this study to examine the relationships among perceived stress, sleep disturbance, and fatigue in PLWHA in China.

METHODS

A mixed methods study design was used during data collection in Shanghai, China, from December 2009 to March 2010. Qualitative in-depth interviews were conducted with 19 HIV+ females. Additionally, cross-sectional audio computer-assisted self-interviews (ACASI) were conducted to collect quantitative data from a convenience sample of 107 HIV+ patients (84% were male) including the following scales: 1) Perceived Stress Scale for PLWHA, 2) General Sleep Disturbance Scale, and 3) Fatigue Scale.

RESULTS

The major themes that emerged from the in-depth interviews were around life stress with HIV, sleep disturbance, and fatigue. Participants presented varying amounts of stress around worrying about whether to disclose their diagnosis and whether they might transmit the disease to their family. In addition, in the cross-sectional data, 40% of the participants reported clinically significant sleep disturbances (GSDS > 3) with an average of 3 nights of disturbed sleep in the past week (M=2.87, SD=1.21) and moderate fatigue severity (M=5.24, SD=2.27). In mediation analyses, the data suggests that the relationship between perceived stress and fatigue was largely (53%) mediated through sleep disturbance.

CONCLUSIONS

Chinese PLWHA described how stress had caused them to become sleepless and fatigued. The quantitative data also demonstrated significant levels of sleep disturbance and fatigue, where were due to perceived stress with HIV disease. A systematic self-management intervention to decrease perceived stress should be designed and implemented in mental health resource-limited settings such as China in order to reduce sleep disturbance and fatigue.

Influences of shift work on fatigue among nurses

AIM

To compare the symptoms of fatigue and physiological indices in nurses who work during the day with nurses who work in shifts.

METHOD

One-hundred and seven nurses were recruited and asked to assess their symptoms of fatigue before their work commenced and after it finished.

RESULTS

Using logistic regression analysis adjusted for covariates, it was found that nurses who work in shifts were more fatigued than nurses who work during the day (odds ratio = 2.44, P < 0.10). There was a significant difference regarding critical flicker fusion in the two groups of nurses (P = 0.032), and nurses who work in shifts had poorer physiological indices than nurses who work during the day.

CONCLUSION

It is clear that differing work schedules result in differing levels of fatigue, with shift work attributing to higher levels than day work.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to take into account the fatiguing effects of different work schedules when designing rostering patterns.

A 7-item version of the fatigue severity scale has better psychometric properties among HIV-infected adults: an application of a Rasch model

PURPOSE

To examine the psychometric properties of the 9-item Fatigue Severity Scale (FSS) using a Rasch model application.

METHODS

A convenience sample of HIV-infected adults was recruited, and a subset of the sample was assessed at 6-month intervals for 2 years. Socio-demographic, clinical, and symptom data were collected by self-report questionnaires. CD4 T-cell count and viral load measures were obtained from medical records. The Rasch analysis included 316 participants with 698 valid questionnaires.

RESULTS

FSS item 2 did not advanced monotonically, and items 1 and 2 did not show acceptable goodness-of-fit to the Rasch model. A reduced FSS 7-item version demonstrated acceptable goodness-of-fit and explained 61.2% of the total variance in the scale. In the FSS-7 item version, no uniform Differential Item Functioning was found in relation to time of evaluation or to any of the socio-demographic or clinical variables.

CONCLUSION

This study demonstrated that the FSS-7 has better psychometric properties than the FSS-9 in this HIV sample and that responses to the different items are comparable over time and unrelated to socio-demographic and clinical variables.

Building dynamic models and theories to advance the science of symptom management research

AIM

This paper is a description, comparison, and critique of two models and two theories used to guide symptom management research, and a proposal of directions for new theory or model development.

BACKGROUND

Symptom management research has undergone a paradigmatic shift to include symptom clusters, longitudinal studies that examine symptom trajectories, and the effects of interventions on patient outcomes. Models and theories are used to guide descriptive and intervention research. Over the past 15 years, four conceptual models or theories (i.e. Theory of Symptom Management, the Theory of Unpleasant Symptoms, the Symptoms Experience Model and the Symptoms Experience in Time Model) were used in a variety of symptom management studies.

DATA SOURCES

Literature searches were performed in Medline and the Cumulative Index of Nursing and Allied Health Literature between 1990 and 2008 for models and theories that guide symptom management research. Related papers and book chapters were used as supporting documentation.

DISCUSSION

Comparison and critique of the models and theories revealed important gaps including lack of consideration of symptom clusters, failure to incorporate temporal aspects of the symptom experience and failure to incorporate the impact of interventions on patient outcomes.

CONCLUSION

New models and theories should incorporate current trends in symptom management research, capture the dynamic nature of symptoms and incorporate concepts that will facilitate transdisciplinary research in symptom management. Researchers and clinicians need to build more expansive and dynamic symptom management models and theories that parallel advances in symptom research and practice.

Presence, communication and treatment of fatigue and pain complaints in incurable cancer patients

OBJECTIVE

This study describes the experiences of fatigue and pain in incurable cancer patients and the treatment they receive.

METHODS

Patients were recruited via medical specialists from hospitals in the South and Southwest of the Netherlands. Hundred and twenty-five incurable cancer patients filled out a written questionnaire and were also interviewed at home.

RESULTS

Ninety percent reported to suffer from fatigue and 48% had pain. Forty-five percent had discussed fatigue with a healthcare professional and 55% had discussed pain. Fifteen percent reported to receive medical treatment for their fatigue and 29% received pain treatment. Treatment for fatigue and pain treatment had been recently adjusted in 4% of the patients with fatigue complaints and 21% of the patients with pain complaints.

CONCLUSION

Although fatigue is a more common problem than pain in patients with incurable cancer, less attention in the care is paid to fatigue and its treatment than to pain.

PRACTICE IMPLICATIONS

Fatigue deserves more attention in the care policy for incurable cancer patients and more research should be focused on interventions to address fatigue in this group of cancer patients.

Depressive symptoms in patients with chronic hepatitis C are correlated with elevated plasma levels of interleukin-1beta and tumor necrosis factor-alpha

Studies suggest that cytokines have a role in the biology of depression. In this study, we evaluated depression and cytokine levels in patients with and without chronic hepatitis C (HCV) to better assess how chronic infection alters cytokines levels and may contribute to depressive symptomotology. Twenty-three adults with (n=16) and without (n=7) HCV were recruited through the Portland VA Medical Center. Research participants were excluded for current substance abuse, psychotic disorder, liver cirrhosis, or interferon (IFN) therapy. Participants completed the Beck Depression Inventory-II (BDI-II) and a blood draw to evaluate plasma cytokine levels [i.e., interleukin (IL)-1beta, IL-10 and tumor necrosis factor (TNF)-alpha]. t-Tests were performed to compare cytokine levels in patients with or without HCV. HCV patients showed higher TNF-alpha values compared to patients without HCV (group means=7.94 vs. 3.41pg/mL, respectively, p=0.047). There were no significant differences between the groups for the other cytokines assessed. In patients with HCV, TNF-alpha and IL-1beta levels (but not IL-10) were correlated with BDI-II scores [r=0.594, p=0.020 and r=0.489, p=0.055 (trend), respectively]. Taken together, these results show an association between severity of depressive symptoms and expression of pro-inflammatory cytokines in patients with HCV. Future studies should investigate how inflammatory mediators play a role in the expression of specific depressive symptoms in patients with chronic infection. Patients with HCV represent an interesting model to examine this relationship.

Symptom Burden of Fatigue in Men and Women Living With HIV/AIDS in Southern Africa

HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.