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Zhong H, Wei F, Song Y, Chen H, Ni Z. Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study. Front Public Health 2023; 11:1133657. [PMID: 36992898 PMCID: PMC10040810 DOI: 10.3389/fpubh.2023.1133657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
PurposeThis study aimed to explore health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWH) in Sichuan, China.MethodsA total of 401 PLWH were recruited from the city of Panzhihua between August 2018 and January 2019. Demographic characteristics and disease-related data were collected by self-administered questionnaires and medical system records. Health-related quality of life (HRQoL) was measured by the medical outcome study HIV health survey (MOS-HIV), which measured ten subdimensions and two summarized dimensions, the physical health summary score (PHS) and the mental health summary score (MHS). Logistic regression models were used to explore the variables independently associated with quality of life.ResultsThe PHS and MHS measured by MOS-HIV were 53.66 ± 6.80 and 51.31 ± 7.66, respectively. Younger age, higher educational level, no methadone use, higher CD4 lymphocyte counts, less symptom counts and heathy BMI significantly were associated with higher HRQOL in the univariate χ2-test analysis. Education level was found to have a significant influence on patients' quality of life, both in physical health (P = 0.022) and mental health (P = 0.002) dimensions. Younger age (P = 0.032), higher CD4 lymphocyte counts (P = 0.007), less symptom counts (P < 0.001) and health BMI level (P < 0.001) were positively related to the PHS of quality of life in the multivariable logistic regression model.ConclusionThe HRQoL of PLWH in Sinchuan Province was relatively low. Age, educational level, methadone use, CD4 lymphocyte counts, symptom counts and BMI were positively related to quality of life. This study indicates that health caregivers should pay more attention to comorbidity issues and mental health in PLWH, especially for those with lower education levels, unhealthy body mass index, more symptomatic presentation and older age.
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Affiliation(s)
- Hua Zhong
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fuling Wei
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuqing Song
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Chen
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Hong Chen
| | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- School of Nursing, Yale University, New Haven, CT, United States
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Wilson NL, Hoffman TJ, Heath SL, Saag MS, Miaskowski C. HIV Symptom Clusters are Similar Using the Dimensions of Symptom Occurrence and Distress. J Pain Symptom Manage 2022; 63:943-952. [PMID: 35235857 PMCID: PMC10408902 DOI: 10.1016/j.jpainsymman.2022.02.337] [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: 10/18/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT People living with HIV infection (PLWH) in the United States continue to experience a high symptom burden despite improvements in antiretroviral therapy. OBJECTIVES The purpose of this study was to determine if the number and types of symptom clusters differed based on whether symptom occurrence rates or distress ratings were used to create the clusters. METHODS Data from 2,000 patients with complete symptom occurrence rates and distress scores on the 20-item HIV Symptom Index from their first ambulatory clinic visit at one of six national HIV centers of excellence in the Center for AIDS Research Network of Integrated Clinical Systems were used in these analyses. Exploratory factor analysis was used to create the symptom clusters. RESULTS The same four symptom clusters (i.e., gastrointestinal, psychological, pain, body image) were identified using occurrence rates and distress ratings. For both dimensions of the symptom experience, the psychological, pain, and body image clusters each had the same symptoms. For the gastrointestinal cluster, four symptoms loaded on the occurrence dimension and six symptoms loaded on the distress dimension. CONCLUSION The number and types of symptom clusters were relatively similar across the occurrence and distress dimensions of the symptom experience. Symptom clusters in PLWH may provide insights into the development of targeted interventions for multiple co-occurring symptoms.
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Affiliation(s)
- Natalie L Wilson
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA.
| | - Thomas J Hoffman
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Sonya L Heath
- Division of Infectious Diseases, School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Michael S Saag
- Division of Infectious Diseases, School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
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3
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Brady V, Whisenant M, Wang X, Ly VK, Zhu G, Aguilar D, Wu H. Characterization of Symptoms and Symptom Clusters for Type 2 Diabetes Using a Large Nationwide Electronic Health Record Database. Diabetes Spectr 2022; 35:159-170. [PMID: 35668892 PMCID: PMC9160545 DOI: 10.2337/ds21-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A variety of symptoms may be associated with type 2 diabetes and its complications. Symptoms in chronic diseases may be described in terms of prevalence, severity, and trajectory and often co-occur in groups, known as symptom clusters, which may be representative of a common etiology. The purpose of this study was to characterize type 2 diabetes-related symptoms using a large nationwide electronic health record (EHR) database. METHODS We acquired the Cerner Health Facts, a nationwide EHR database. The type 2 diabetes cohort (n = 1,136,301 patients) was identified using a rule-based phenotype method. A multistep procedure was then used to identify type 2 diabetes-related symptoms based on International Classification of Diseases, 9th and 10th revisions, diagnosis codes. Type 2 diabetes-related symptoms and co-occurring symptom clusters, including their temporal patterns, were characterized based the longitudinal EHR data. RESULTS Patients had a mean age of 61.4 years, 51.2% were female, and 70.0% were White. Among 1,136,301 patients, there were 8,008,276 occurrences of 59 symptoms. The most frequently reported symptoms included pain, heartburn, shortness of breath, fatigue, and swelling, which occurred in 21-60% of the patients. We also observed over-represented type 2 diabetes symptoms, including difficulty speaking, feeling confused, trouble remembering, weakness, and drowsiness/sleepiness. Some of these are rare and difficult to detect by traditional patient-reported outcomes studies. CONCLUSION To the best of our knowledge, this is the first study to use a nationwide EHR database to characterize type 2 diabetes-related symptoms and their temporal patterns. Fifty-nine symptoms, including both over-represented and rare diabetes-related symptoms, were identified.
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Affiliation(s)
- Veronica Brady
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | - Meagan Whisenant
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | - Xueying Wang
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Vi K. Ly
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Gen Zhu
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - David Aguilar
- McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hulin Wu
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
- Corresponding author: Hulin Wu,
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Shu Z, Wang J, Sun H, Xu N, Lu C, Zhang R, Li X, Liu B, Zhou X. Diversity and molecular network patterns of symptom phenotypes. NPJ Syst Biol Appl 2021; 7:41. [PMID: 34848731 PMCID: PMC8632989 DOI: 10.1038/s41540-021-00206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022] Open
Abstract
Symptom phenotypes have continuously been an important clinical entity for clinical diagnosis and management. However, non-specificity of symptom phenotypes for clinical diagnosis is one of the major challenges that need be addressed to advance symptom science and precision health. Network medicine has delivered a successful approach for understanding the underlying mechanisms of complex disease phenotypes, which will also be a useful tool for symptom science. Here, we extracted symptom co-occurrences from clinical textbooks to construct phenotype network of symptoms with clinical co-occurrence and incorporated high-quality symptom-gene associations and protein-protein interactions to explore the molecular network patterns of symptom phenotypes. Furthermore, we adopted established network diversity measure in network medicine to quantify both the phenotypic diversity (i.e., non-specificity) and molecular diversity of symptom phenotypes. The results showed that the clinical diversity of symptom phenotypes could partially be explained by their underlying molecular network diversity (PCC = 0.49, P-value = 2.14E-08). For example, non-specific symptoms, such as chill, vomiting, and amnesia, have both high phenotypic and molecular network diversities. Moreover, we further validated and confirmed the approach of symptom clusters to reduce the non-specificity of symptom phenotypes. Network diversity proposes a useful approach to evaluate the non-specificity of symptom phenotypes and would help elucidate the underlying molecular network mechanisms of symptom phenotypes and thus promotes the advance of symptom science for precision health.
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Affiliation(s)
- Zixin Shu
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China
| | - Jingjing Wang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China
| | - Hailong Sun
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China
| | - Ning Xu
- The First Affiliated Hospital of Henan University of Chinese Medicine (Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan, Henan University of Chinese Medicine), Zhengzhou, 450046, China
| | - Chenxia Lu
- Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Hubei Academy of Traditional Chinese Medicine), Wuhan, 430061, China
| | - Runshun Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiaodong Li
- Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Hubei Academy of Traditional Chinese Medicine), Wuhan, 430061, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Xuezhong Zhou
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China.
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5
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Tabudlo JB. A Proposed Theory of Symptom Cluster Management. BELITUNG NURSING JOURNAL 2021; 7:78-87. [PMID: 37469941 PMCID: PMC10353591 DOI: 10.33546/bnj.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 07/21/2023] Open
Abstract
Background Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest. Objective This article presents the development of a Proposed Theory of Symptom Cluster Management. Methods The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles. Results The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced. Conclusion The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.
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Affiliation(s)
- Jerick B. Tabudlo
- University of the Philippines Manila, College of Nursing, Philippines
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Differences in Health-Related Quality of Life Predictors in People Living With HIV With and Without Diabetes. J Assoc Nurses AIDS Care 2021; 31:544-552. [PMID: 31789685 DOI: 10.1097/jnc.0000000000000138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Diabetes is one of the most common comorbid conditions in people living with HIV (PLWH). Diabetes may affect health-related quality of life (HRQoL) for PLWH because they experience more symptoms, are prescribed more medications, and are required to do self-care activities. The purpose of our study was to compare predictors of the HRQoL for PLWH with and without diabetes. The study was a secondary analysis of data from the Center for AIDS Research Network of Integrated Clinical Systems cohort using multiple regression. Significant differences were found between PLWH with and without diabetes. The significant predictors of HRQoL for PLWH-alone were depression, anxiety, medication adherence, physical activity, smoking, and age. For PLWH with diabetes, the only significant predictors of HRQoL were anxiety and depression.
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Moise RK, Srithanaviboonchai K, Alsolami A, Soares MH, Elewonibi BR, Tolmasky ME, Wood MM. The Patient-Provider Continuum of Care: Narratives of People Living With Comorbid HIV and Diabetes in Northern Thailand. J Patient Exp 2020; 7:749-757. [PMID: 33294611 PMCID: PMC7705831 DOI: 10.1177/2374373519882226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Among South-East Asia Region countries, Thailand has a high prevalence of HIV with an increasing significant comorbidity of diabetes mellitus (DM). Objective: Guided by syndemics, the purpose of this qualitative study is to develop insight into the experience of patients living with comorbid HIV and DM in Northern Thailand for quality improvement. Methods: Interviews were conducted in 2 groups for content analysis: (1) people living with comorbid HIV and DM and (2) health-care staff providing care to patients living with the comorbidity. Results: Participants’ (N = 12) ages ranged from 42 to 56 (mean = 49). Health staff (N = 12) generated complementary narratives. All participants reported onset of diabetes after discovering they were HIV infected. Content analysis revealed emergent themes regarding (1) knowledge and perceptions and (2) management framed by syndemics and chronicity. Conclusion: Findings suggest routine training for patient education and provider integration of care. Macrosocial factors such as limited access and resources and biological factor such as drug interactions are noted as key considerations for future interventions and alterations in the care for patients with comorbid HIV and DM.
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Affiliation(s)
- Rhoda K Moise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ali Alsolami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary H Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bilikisu Reni Elewonibi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Michele M Wood
- Department of Public Health, California State University, Fullerton, CA, USA
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8
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Lu K, Yang K, Niyongabo E, Shu Z, Wang J, Chang K, Zou Q, Jiang J, Jia C, Liu B, Zhou X. Integrated network analysis of symptom clusters across disease conditions. J Biomed Inform 2020; 107:103482. [PMID: 32535270 DOI: 10.1016/j.jbi.2020.103482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
Identifying the symptom clusters (two or more related symptoms) with shared underlying molecular mechanisms has been a vital analysis task to promote the symptom science and precision health. Related studies have applied the clustering algorithms (e.g. k-means, latent class model) to detect the symptom clusters mostly from various kinds of clinical data. In addition, they focused on identifying the symptom clusters (SCs) for a specific disease, which also mainly concerned with the clinical regularities for symptom management. Here, we utilized a network-based clustering algorithm (i.e., BigCLAM) to obtain 208 typical SCs across disease conditions on a large-scale symptom network derived from integrated high-quality disease-symptom associations. Furthermore, we evaluated the underlying shared molecular mechanisms for SCs, i.e., shared genes, protein-protein interaction (PPI) and gene functional annotations using integrated networks and similarity measures. We found that the symptoms in the same SCs tend to share a higher degree of genes, PPIs and have higher functional homogeneities. In addition, we found that most SCs have related symptoms with shared underlying molecular mechanisms (e.g. enriched pathways) across different disease conditions. Our work demonstrated that the integrated network analysis method could be used for identifying robust SCs and investigate the molecular mechanisms of these SCs, which would be valuable for symptom science and precision health.
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Affiliation(s)
- Kezhi Lu
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Kuo Yang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Edouard Niyongabo
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Zixin Shu
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Jingjing Wang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Kai Chang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Qunsheng Zou
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Jiyue Jiang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Caiyan Jia
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China.
| | - Baoyan Liu
- Data Center of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Xuezhong Zhou
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China; Data Center of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Anastasi JK, Pakhomova AM. Assessment and Management of HIV Distal Sensory Peripheral Neuropathy: Understanding the Symptoms. J Nurse Pract 2020; 16:276-280. [PMID: 33679267 DOI: 10.1016/j.nurpra.2019.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Distal sensory peripheral neuropathy (HIV-DSP) affects upwards of 50% of people living with HIV. Causing often debilitating symptoms of tingling, numbness and burning, HIV-DSP can result in disability, unemployment and low quality of life. Comorbidities further complicate nursing care, heightening risk of polypharmacy and symptom exacerbation. Therefore, a neurological sensory assessment, combined with the patient's self-report of symptoms, can help nurse practitioners visualize, quantify and understand symptoms. Common pharmacological interventions include antiepileptics, antidepressants, analgesics and medical marijuana. The complexity of care for individuals with HIV-DSP merits a comprehensive approach. Implications for practice include interdisciplinary management with neurologists, podiatrists, mental health providers, and nurse-led counseling inclusive of patient safety teaching.
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Affiliation(s)
- Joyce K Anastasi
- Special Studies in Symptom Management New York University / NYU Meyers
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10
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Zhu Z, Zhao R, Hu Y. Symptom Clusters in People Living With HIV: A Systematic Review. J Pain Symptom Manage 2019; 58:115-133. [PMID: 30951828 DOI: 10.1016/j.jpainsymman.2019.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 01/02/2023]
Abstract
CONTEXT An increasing number of studies regarding symptom management have begun to shift their focus from managing a single symptom to multiple symptom clusters. However, there is a lack of consistency of compositions among different studies and even in two different analyses reported in a single study within the same population. OBJECTIVES The aim of this systematic review was to summarize the compositions, measures, and data analysis techniques of symptom clusters in people living with HIV (PLWH). METHODS We conducted a comprehensive search to identify published studies about symptom clusters among PLWH. Databases including PubMed/MEDLINE, MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), Web of Science, and ProQuest Dissertations and Thesis were searched for studies published between January 2000 and December 2018. RESULTS Thirteen articles were eligible for inclusion. Five most commonly reported symptom clusters were found: 1) sad/depressed/loss of interest and nervous/anxious/worrying; 2) difficulty sleeping, problems with having sex, and fatigue/loss of energy; 3) fever/chills/sweat, nausea/vomiting, and loss of appetite; 4) numbness, muscle aches, and joint pain; and 5) dizziness and headache. CONCLUSION This systematic review summarized the compositions, measures, and analytical techniques of symptom clusters for PLWH. Although this review found unstable results on the compositions of symptom clusters and it was difficult to reach a definitive conclusion, the results still implicate the necessity of developing a threshold to decide what symptoms should be included in the clusters and the use of multiple data analysis techniques to obtain stable results.
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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
| | - Rui Zhao
- Children's Hospital of Fudan University, 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.
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Cioe PA, Gordon REF, Williams DM, Kahler CW. The effect of increased physical activity on symptom burden in older persons living with HIV. AIDS Care 2019; 31:1548-1554. [PMID: 30961364 DOI: 10.1080/09540121.2019.1601675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Advancements in antiretroviral therapy have extended the longevity of people living with HIV (PLWH). However, they often experience symptoms that negatively impact their quality of life, including fatigue, weight change, depression, pain, and memory loss. Although there is a dearth of data on the effect of physical activity (PA) for HIV-associated symptom management, increased PA has generally been associated with improvements in strength and overall quality of life. In this study, we enrolled 40 participants (mean age = 51.5; 40% female; 17.4 mean years living with HIV) and used Omron pedometers to measure daily step counts over 12 weeks. The 20-item HIV Symptom Index was administered at baseline and week 12. Increased PA was not associated with improvement in overall HIV symptom burden. However, bothersome symptoms were reduced, and total symptom burden was highly correlated with PA level at week 12 (r = -.48, p = .01), such that participants with higher step counts reported lower symptom burden. Significant gender differences in symptom burden were noted: males on average reported lower symptom burden. Further research is needed to examine associations between PA and HIV symptom burden and to further explore gender differences in HIV symptom burden to improve overall quality of life for all older PLWH.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Brown University School of Public Health , Providence , RI , USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence , RI , USA
| | - Rebecca E F Gordon
- Center for Alcohol and Addiction Studies, Brown University School of Public Health , Providence , RI , USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence , RI , USA
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence , RI , USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health , Providence , RI , USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence , RI , USA
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12
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Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, Vorderstrasse A. A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions. Behav Med 2019; 45:166-176. [PMID: 31343963 PMCID: PMC6793989 DOI: 10.1080/08964289.2019.1570074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.
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Affiliation(s)
| | - Rueben Warren
- b Tuskegee University National Center for Bioethics in Research and Health Care
| | | | - Gail Melkus
- a New York University Rory Meyers College of Nursing
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13
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Zhu Z, Hu Y, Xing W, Guo M, Zhao R, Han S, Wu B. Identifying Symptom Clusters Among People Living With HIV on Antiretroviral Therapy in China: A Network Analysis. J Pain Symptom Manage 2019; 57:617-626. [PMID: 30465875 DOI: 10.1016/j.jpainsymman.2018.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT There exists a research interest shift from separate symptoms to symptom clusters among people living with HIV (PLWH), which may provide a better understanding of symptom management in HIV/AIDS care. However, the symptom clusters among Chinese PLWH are still unknown. OBJECTIVES The aim of our study was to identify symptom clusters and to examine demographic and health-related factors associated with these symptom clusters among PLWH prescribing antiretroviral therapy (ART) in China. METHODS From April to September 2017, we recruited 1116 participants through a convenience sampling in five HIV/AIDS designated facilities in the eastern, middle, and southwest regions of China. The principal component analysis was used to identify the symptom clusters. Association network was adopted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and the prevalence of each symptom clusters. RESULTS Five symptom clusters were identified, including cognitive dysfunction, mood disturbance, wasting syndrome, dizziness/headache, and skin-muscle-joint disorder. Cognitive dysfunction was the most central symptom cluster. Variables including primary caregiver during ART treatment, years of HIV diagnosis and ART use, having comorbidity, self-rated health, and quality of life were associated with the prevalence of these five symptom clusters. CONCLUSION Our study suggests that there is a need to evaluate symptom clusters for the improvement of symptom management among PLWH. It is particularly important to include assessment and treatment of cognitive symptoms as an essential component of the HIV care.
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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
| | - 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.
| | - 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
| | - Mengdi Guo
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Rui Zhao
- Fudan University School of Nursing, Shanghai, China
| | - Shuyu Han
- Fudan University School of Nursing, Shanghai, China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York City, New York, USA
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García AA, Bose E, Zuñiga JA, Zhang W. Mexican Americans' diabetes symptom prevalence, burden, and clusters. Appl Nurs Res 2019; 46:37-42. [PMID: 30853074 DOI: 10.1016/j.apnr.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/01/2019] [Accepted: 02/10/2019] [Indexed: 01/05/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM), serious and increasingly prevalent among Mexican Americans, produces symptoms related to high and low glucose levels, medication side effects, and long-term complications. This secondary analysis explored symptom prevalence, differences among symptom burden levels, and how symptoms clustered. METHODS Clinical measurements and survey data (demographic, quality of life, and the symptom subscale of the Diabetes Symptom Self-Management Inventory) collected from Mexican American adults with T2DM (n = 71) were analyzed for symptom prevalence, differences across levels of symptom burden, and symptom clusters. Agglomerative hierarchical and k-means clustering analyses were performed on a Gower matrix. Internal validation methods and rank aggregation were used to identify the best clustering method of the two techniques and to identify symptoms that clustered together. RESULTS Participants reported mean = 14 symptoms; tiredness and trouble sleeping were most prevalent. People with high symptom burden had significantly lower quality of life and perceptions of worse diabetes severity. Hierarchical clustering produced three symptom clusters: cluster 1 = 9 symptoms (e.g. intense thirstiness, dry mouth); cluster 2 = 9 symptoms (e.g., itching skin, weight gain, noise or light sensitivity); cluster 3 = 13 symptoms (e.g., nervous, headache, trouble concentrating, and memory loss). CONCLUSION Mexican Americans with T2DM report several co-occurring symptoms. Quality of life is significantly worse for people with high symptom burden. Three distinct symptom clusters were identified. Studies with larger samples are needed to further diabetes symptom science. Clinicians should assess and address patients' co-occurring symptoms as a potential means of decreasing symptom burden and improving quality of life.
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Affiliation(s)
- Alexandra A García
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America; The University of Texas at Austin Dell Medical School, Austin, TX, United States of America.
| | - Eliezer Bose
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Julie A Zuñiga
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Wenhui Zhang
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
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