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Duan DF, Zhou XL, Yan Y, Li YM, Hu YH, Li Q, Peng X, Gu Q, Li XY, Feng H, Tang AJ, Liu P, Xu HH, Liao RX, Ma DY. Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis. Ren Fail 2024; 46:2349121. [PMID: 38916144 PMCID: PMC11207921 DOI: 10.1080/0886022x.2024.2349121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/02/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management. METHODS The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis. RESULTS In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients. CONCLUSIONS This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.
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Affiliation(s)
- Di-fei Duan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xue-li Zhou
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yu Yan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | | | - Yan-hua Hu
- Jianyang People’s Hospital, Nanchang, China
| | - Qin Li
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiang Peng
- Panzhihua Central Hospital, Panzhihua, China
| | - Qin Gu
- West China Hospital, Sichuan University (for Huaxi Hospital in Meishan People’s Hospital), Chengdu, China
| | - Xiao-ying Li
- Xiquan People’s Hospital of Gansu Province, Lanzhou, China
| | - Hui Feng
- The Fifth People’s Hospital of Chengdu, Chengdu, China
| | | | - Pan Liu
- The Second People’s Hospital of Chengdu, Chengdu, China
| | - Hui-hui Xu
- The First People’s Hospital of Jiujiang City, Jiujiang, China
| | - Ruo-xi Liao
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Deng-yan Ma
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Xie M, Wang A, Zhang Z, Wang K, Yu Y. A Path Analysis on Quality of Life of People With HIV: Validation and Refinement of the Self-Regulatory HIV/AIDS Symptom Management Model. J Assoc Nurses AIDS Care 2024:00001782-990000000-00112. [PMID: 39145625 DOI: 10.1097/jnc.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
ABSTRACT This study explored the path affecting the quality of life (QOL) of people with HIV in China and clarified the applicability and interpretability of the Self-Regulatory HIV/AIDS Symptom Management Model. We conducted a cross-sectional survey in nine regions of China and collected information about demographics, symptom experience, social support, perceived symptom manageability, self-efficacy, and QOL. A total of 711 patients participated in this survey. After four rounds of path analysis were conducted, the most fit indices met the standards (χ 2 /df = 2.633, Root Mean Square Error of Approximation = 0.081, Goodness-of-Fit Index/Adjusted Goodness-of-Fit Index/Comparative Fit Index/Incremental Fit Index/Tucker-Lewis Coefficient > 0.9), and the relationships between variables were statistically significant ( p < .05). Among all the pathways, social support had the most significant impact on the QOL, with a total path coefficient of 0.665. Symptom experience, as a negative factor, had a total effect value of -0.361. This study showed how all the factors influencing QOL were interconnected, serving as a crucial theoretical foundation for intervention strategies in future clinical practice.
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Affiliation(s)
- Meilian Xie
- Meilian Xie, PhD, is a Chief Nurse, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Aiping Wang, PhD, is a Director, Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- Zhiyun Zhang, MHA, is a Director, Nursing Department, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Kerong Wang, BA, is a former Director, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Yanping Yu, BA, is a Nurse, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Aiping Wang
- Meilian Xie, PhD, is a Chief Nurse, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Aiping Wang, PhD, is a Director, Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- Zhiyun Zhang, MHA, is a Director, Nursing Department, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Kerong Wang, BA, is a former Director, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Yanping Yu, BA, is a Nurse, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhiyun Zhang
- Meilian Xie, PhD, is a Chief Nurse, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Aiping Wang, PhD, is a Director, Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- Zhiyun Zhang, MHA, is a Director, Nursing Department, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Kerong Wang, BA, is a former Director, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Yanping Yu, BA, is a Nurse, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Kerong Wang
- Meilian Xie, PhD, is a Chief Nurse, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Aiping Wang, PhD, is a Director, Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- Zhiyun Zhang, MHA, is a Director, Nursing Department, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Kerong Wang, BA, is a former Director, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Yanping Yu, BA, is a Nurse, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanping Yu
- Meilian Xie, PhD, is a Chief Nurse, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Aiping Wang, PhD, is a Director, Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- Zhiyun Zhang, MHA, is a Director, Nursing Department, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Kerong Wang, BA, is a former Director, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
- Yanping Yu, BA, is a Nurse, Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
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Giridharan P, Nagarajan K, Selvaraju S, Frederick A, Subbiah E, Mani S, Thiruvengadam K, Selvavinayagam TS, Padmapriyadarsini C. Estimating and Explaining the Differences in Health Care Seeking by Symptom Burden Among Persons With Presumptive Tuberculosis: Findings From a Population-Based Tuberculosis Prevalence Survey in a High-Burden Setting in India. Open Forum Infect Dis 2024; 11:ofae412. [PMID: 39130083 PMCID: PMC11310591 DOI: 10.1093/ofid/ofae412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024] Open
Abstract
Background There is a lack of research evidence on the quantitative relationship between symptom burden and health care seeking among individuals with presumptive tuberculosis (TB). Methods Data were derived from a cross-sectional population-based TB survey conducted between February 2021 and July 2022 in 32 districts of India. Eligible and consented participants (age >15 years) underwent TB symptom screening and history elicitation. Fairlie decomposition analysis was used to estimate the net differences in health care seeking due to varied symptom burden-from 1+ burden (>1 symptom) to 4+ burden (>4 symptoms)-and decomposed by observable covariates based on logit models with 95% CIs. Results Of the 130 932 individuals surveyed, 9540 (7.3%) reported at least 1 recent TB symptom, of whom 2678 (28.1%; 95% CI, 27.1%-28.9%) reportedly sought health care. The net differences in health care seeking among persons with symptom burden 1+ to 4+ ranged from 6.6 percentage points (95% CI, 4.8-8.4) to 7.7 (95% CI, 5.2-10.2) as compared with persons with less symptom burden. The presence of expectoration, fatigue, and loss of appetite largely explained health care seeking (range, 0.9-3.1 percentage points [42.89%-151.9%]). The presence of fever, cough, past TB care seeking, weight loss, and chest pain moderately explained (range, 5.3%-25.3%) health care seeking. Conclusions Increased symptom burden and symptoms other than the commonly emphasized cough and fever largely explained health care seeking. Orienting TB awareness and risk communications toward symptom burden and illness perceptions could help address population gaps in health care seeking for TB.
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Affiliation(s)
- Prathiksha Giridharan
- ICMR–National Institute for Research in Tuberculosis, Chennai, India
- Division of Infectious Disease Epidemiology, ICMR–National Institute of Epidemiology, Chennai, India
| | | | - Sriram Selvaraju
- ICMR–National Institute for Research in Tuberculosis, Chennai, India
| | - Asha Frederick
- Directorate of Medical and Rural Health Services & State TB Cell, Chennai, India
| | | | - Sasikumar Mani
- ICMR–National Institute for Research in Tuberculosis, Chennai, India
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Ma J, Bai X, Li J, Wen B. Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis. J Adv Nurs 2024. [PMID: 38787364 DOI: 10.1111/jan.16185] [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: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
AIMS The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified. METHODS In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis. RESULTS Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks. CONCLUSIONS Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process. IMPLICATIONS FOR PAEDIATRIC CANCER CARE This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers. REPORTING METHOD Study methods and results reported in adherence to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved in the study. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Jing Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Binbin Wen
- Xiangya School of Nursing, Central South University, Changsha, China
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Teng L, Zhou Z, Yang Y, Sun J, Dong Y, Zhu M, Wang T. Identifying central symptom clusters and correlates in patients with lung cancer post-chemotherapy: A network analysis. Asia Pac J Oncol Nurs 2024; 11:100383. [PMID: 38495643 PMCID: PMC10940888 DOI: 10.1016/j.apjon.2024.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/17/2024] [Indexed: 03/19/2024] Open
Abstract
Objective This study aims to investigate the network structures of symptoms and symptom clusters in patients with lung cancer post-chemotherapy, with a focus on identifying the central symptom cluster. Understanding the central cluster is crucial for targeted and effective symptom management. Methods Symptom occurrence and severity were assessed using the Memorial Symptom Assessment Scale (MSAS). Principal component analysis (PCA) was employed to explore symptom clusters, while network analysis unveiled the network structure and pinpointed the central symptom cluster. Results The study included 512 patients with lung cancer. Four distinct symptom clusters emerged: sickness behavior, psychological, lung cancer-specific, and epithelial. The sickness behavior symptom cluster was identified as the central symptom cluster. Conclusions This research designates the sickness behavior symptom cluster as central in post-chemotherapy patients with lung cancer, offering valuable insights for clinical nurses in devising more effective symptom management strategies. Trial registration ChiCTR2300070944 (Chinese Clinical Trial Register).
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Affiliation(s)
- Liping Teng
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Zhou Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Yiting Yang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Jun Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Yajun Dong
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Min Zhu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Xie M, Wang A, Zhang Z, Wang K, Yu Y, Ma X, Lin Z, Yu Z, Ke J. Development and validation of the perceived symptom manageability scale among people living with the human immunodeficiency virus. BMC Psychol 2024; 12:172. [PMID: 38528643 DOI: 10.1186/s40359-024-01658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND "Perceived Symptom Manageability (PSM)" is essential in symptom management among people living with HIV. As a standardized assessment instrument was lacking, we developed a PSM scale for people living with human immunodeficiency virus (PSM-HIV). METHODS Data analysis was performed using the sample from HIV-designated medical institutions (N = 540). Psychometric testing, namely reliability and validity, is assessed by unidimensionality, internal consistency, exploratory and confirmatory factor analysis, and structural equation modeling. RESULTS The final version of the PSM- HIV scale contained 15 items. This scale was submitted to a principal components analysis with varimax rotation, and three factors were obtained, explained by a total variance of 63.10%. The three factors were named Cognitive-Behavioral, Affective Interaction, and Self-Attitude. The results show that the scale had high reliability, Cronbach's α of the scale ranged from 0.71 to 0.92, and the Intraclass Correlation Coefficient was 0.88. The structural equation model supports a factor model with the acceptable fit (χ2/df (CMIN/DF) = 2.50, Root Mean square Residual (RMR) = 0.03, Goodness-of-Fit Index (GFI) = 0.93, Adjusted Goodness of Fit Index (AGFI) = 0.90, Normed Fit Index (NFI) = 0.93, Incremental Fit Index (IFI) = 0.96, Comparative Fit Index (CFI) = 0.96). The average variance extracted was 0.38 ∼ 0.59, and the composite reliability was 0.70 ∼ 0.91, indicating that the convergent validity of the scale is acceptable. Subjects with different stages of the disease reached significance(χ2 = 9.02; df = 2, P<0.05), meaning moderate Known-Groups Comparison Validation. CONCLUSIONS The PSM-HIV scale is a valid instrument that measures overall attitude and belief about controlling or coping with HIV-relevant symptoms.
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Affiliation(s)
- Meilian Xie
- Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Aiping Wang
- Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Zhiyun Zhang
- Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Kerong Wang
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanping Yu
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Xiaojing Ma
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhaoxia Lin
- Department of Quality Control, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhengli Yu
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Jianxue Ke
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, China
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Duan DF, Liu M, Ma DY, Yan LJ, Huang YY, Chen Y, Jiang W, Tang X, Xiong AQ, Shi YY. Exploring Symptom Clusters in Chinese Patients with Diabetic Kidney Disease: A Network Analysis. Int J Gen Med 2024; 17:871-884. [PMID: 38468820 PMCID: PMC10926920 DOI: 10.2147/ijgm.s447921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose The research on symptom management in patients with diabetic kidney disease (DKD) has shifted from separate symptoms to symptom clusters and networks recently. This study aimed to evaluate the unpleasant symptoms of DKD patients, and to investigate how these symptom clusters could affect patients. Methods 408 DKD patients were recruited in this cross-sectional study. The symptoms of DKD patients were measured using the modified Dialysis Symptom Index. Network analysis was employed to evaluate the symptom network and the characteristics of individual nodes, while factor analysis was utilized to identify symptom clusters. Results Blurred vision was the most prevalent symptom among DKD patients. The symptoms identified as the most distressing, severe, and frequent were light headache or dizziness, arteriovenous fistula/catheterization pain, and diarrhea, respectively. Five symptom clusters were obtained from factor analysis, and the most central symptom cluster in the entire symptom network was sexual dysfunction. Conclusion This study identified five symptom clusters in Chinese DKD patients, with sexual dysfunction emerging as the most central cluster. These findings carry significant clinical implications, underscoring the necessity of assessing symptom clusters and their associations to enhance symptom management in DKD patients. Further research is essential to elucidate the underlying mechanisms of symptoms and to clarify the associations among symptoms in DKD patients across different disease trajectories or treatment modalities.
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Affiliation(s)
- Di-Fei Duan
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Min Liu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Deng-Yan Ma
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lin-Jia Yan
- The Nethersole School of Nursing Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Yue-Yang Huang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yi Chen
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Wei Jiang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Xi Tang
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - An-Qi Xiong
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan Province, People’s Republic of China
| | - Yun-Ying Shi
- Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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Zhou Q, Yang L, Wan Y, Li X, Zhu Z, Wang J, Huang J, Shen F, Tan Q, Dong L, Ni Q, Zhang S, Fu Y. Gender differences in symptom burden among people living with HIV/AIDS receiving antiretroviral therapy in Yunnan, China. AIDS Care 2024:1-11. [PMID: 38176025 DOI: 10.1080/09540121.2023.2300978] [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: 08/29/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024]
Abstract
ABSTRACTLittle is known about gender differences in the symptom burden of people living with HIV/AIDS (PLWHA) on antiretroviral therapy in China. This study was conducted based on a biopsychosocial-medical model to describe gender differences in symptom burden among 1035 PLWHA in Yunnan Province, China. After propensity score matching, 798 PLWHA were included in this analysis. Feeling stressed, poor sleep, and memory loss were the most burdensome symptoms among men, while feeling stressed, memory loss, and dizziness were the most burdensome symptoms among women. Among men PLWHA, factors associated with symptom burden were being of the ethnic minority, CD4 count ≥ 500 cells/mm3, physical functioning, and social support. Among women PLWHA, factors associated with symptom burden were being an inpatient, physical functioning, psychological functioning, and social support. Our findings suggest that healthcare providers need to take into account gender differences when developing optimal prevention, treatment, and care programs that provide individualized care to reduce patients' symptom burden.
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Affiliation(s)
- Qiao Zhou
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Liying Yang
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Yu Wan
- Cardiothoracic surgery, The Second People's Hospital of Yibin, Yibin, People's Republic of China
| | - Xucheng Li
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Jianhua Wang
- Department of Oncology, The First Affiliated Hospital of Dali University, Dali, People's Republic of China
| | - Jibiao Huang
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Fang Shen
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Qiu Tan
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Liting Dong
- Thyroid and breast surgery, The First Affiliated Hospital of Air Force Medical University, Xian, People's Republic of China
| | - Qinmin Ni
- School of Health Science and Technology, West Yunnan University of Applied Technology, Dali, People's Republic of China
| | - Shixiao Zhang
- School of Nursing, Dali University, Dali, People's Republic of China
| | - Yanfen Fu
- School of Nursing, Dali University, Dali, People's Republic of China
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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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Fang J, Wong CL, Liu CQ, Huang HY, Qi YS, Xu LL, Wang MX, Lin Y. Identifying central symptom clusters and correlates in children with acute leukemia undergoing chemotherapy: a network analysis. Front Oncol 2023; 13:1236129. [PMID: 37671049 PMCID: PMC10475730 DOI: 10.3389/fonc.2023.1236129] [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: 06/09/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
Background Previous studies have examined symptom clusters in children with acute leukemia, yet a knowledge gap persists regarding central symptom clusters and their influencing factors. By identifying these central clusters and associated factors, healthcare providers can enhance their understanding and effective management of symptoms. Our study seeks to address this gap by identifying symptom clusters, exploring central clusters, and investigating the demographic and health-related factors associated with these clusters in children with acute leukemia undergoing chemotherapy. Methods A total of 586 children with acute leukemia from January 2021 to April 2023 were recruited from China. They were investigated using Memorial Symptom Assessment Scale 10-18 during chemotherapy. The principal component analysis was used to identify the symptom clusters. An association network was conducted 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 each symptom cluster. Results Five clusters were identified, including oral and skin cluster, somatic cluster, self-image disorder cluster, gastrointestinal cluster and psychological cluster. Gastrointestinal cluster was the most central symptom cluster. Age, sex, clinical classification, number of having chemotherapy and education degree and marital status of the primary caregiver are associated with the severity of these five symptom clusters. Conclusion Our study highlights the importance of evaluating symptom clusters in children with acute leukemia during chemotherapy. Specifically, addressing gastrointestinal symptoms is crucial for effective symptom management and overall care.
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Affiliation(s)
- Jia Fang
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Cho-Lee Wong
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chun-Qin Liu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Hai-Ying Huang
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yi-Shu Qi
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Li-Ling Xu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Mei-Xiang Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
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11
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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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12
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Jing F, Zhu Z, Qiu J, Tang L, Xu L, Xing W, Hu Y. Contemporaneous symptom networks and correlates during endocrine therapy among breast cancer patients: A network analysis. Front Oncol 2023; 13:1081786. [PMID: 37064124 PMCID: PMC10103712 DOI: 10.3389/fonc.2023.1081786] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Background Endocrine therapy-related symptoms are associated with early discontinuation and quality of life among breast cancer survivors. Although previous studies have examined these symptoms and clinical covariates, little is known about the interactions among different symptoms and correlates. This study aimed to explore the complex relationship of endocrine therapy-related symptoms and to identify the core symptoms among breast cancer patients. Methods This is a secondary data analysis conducted based on a multicenter cross-sectional study of 613 breast cancer patients in China. All participants completed the 19-item Chinese version of the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES). Multivariate linear regression analysis was performed to identify significant factors. A contemporaneous network with 15 frequently occurring symptoms was constructed after controlling for age, payment, use of aromatase inhibitors, and history of surgery. Network comparison tests were used to assess differences in network structure across demographic and treatment characteristics. Results All 613 participants were female, with an average age of 49 years (SD = 9.4). The average duration of endocrine therapy was 3.6 years (SD = 2.3) and the average symptom score was 18.99 (SD = 11.43). Irritability (n = 512, 83.52%) and mood swings (n = 498, 81.24%) were the most prevalent symptoms. Lost interest in sex (mean = 1.95, SD = 1.39) and joint pain (mean = 1.57, SD = 1.18) were the most severe symptoms. The edges in the clusters of emotional symptoms ("irritability-mood swings"), vasomotor symptoms ("hot flashes-cold sweats-night sweats"), vaginal symptoms ("vaginal discharge-vaginal itching"), sexual symptoms ("pain or discomfort with intercourse-lost interest in sex-vaginal dryness"), and neurological symptoms ("headaches-dizziness") were the thickest in the network. There were no significant differences in network structure (P = 0.088), and global strength (P = 0.330) across treatment types (selective estrogen receptor modulators vs. aromatase inhibitors). Based on an evaluation of the centrality indices, irritability and mood swings appeared to be structurally important nodes after adjusting for the clinical covariates and after performing subgroup comparisons. Conclusion Endocrine therapy-related symptoms are frequently reported issues among breast cancer patients. Our findings demonstrated that developing targeted interventions focused on emotional symptoms may relieve the overall symptom burden for breast cancer patients during endocrine therapy.
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Affiliation(s)
- Feng Jing
- School of Nursing, Fudan University, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Jiajia Qiu
- Department of Nursing Administration, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Lichen Tang
- Department of Breast Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Lei Xu
- School of Nursing, Fudan University, Shanghai, China
| | - Weijie Xing
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
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13
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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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14
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Han S, Zhang Y, Yang X, Li K, Zhang L, Shao Y, Ma J, Hu Y, Zhu Z, Zhang Y, Wang Z. Exploring core mental health symptoms among persons living with HIV: A network analysis. Front Psychiatry 2023; 14:1081867. [PMID: 36741117 PMCID: PMC9895861 DOI: 10.3389/fpsyt.2023.1081867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
CONTEXT Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships. OBJECTIVE This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH. METHODS From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters. RESULTS Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (rS = 0.59, rC = 0.61, rB = 0.06), followed by feeling discouraged about the future (rS = 0.51, rC = 0.57, rB = 0.04) and feelings of worthlessness (rS = 0.54, rC = 0.53, rB = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (rS = 1, rC = 1, rB = 0.43). CONCLUSION Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Yizhu Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Ke Li
- Department of Emergency, Peking University First Hospital, Beijing, China
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Ying Shao
- Department of Infection, Beijing Youan Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jianhong Ma
- Department of Infection, Beijing Youan Hospital Affiliated With Capital Medical University, Beijing, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Yukun Zhang
- School of Nursing, Fudan University, Shanghai, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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15
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Xie M, Wang A, Wang K, Yu Y, Lin Z. Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study. BMC Geriatr 2022; 22:728. [PMID: 36058926 PMCID: PMC9442943 DOI: 10.1186/s12877-022-03411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Debate has persisted regarding whether PLWH with longer HIV durations have lower levels of prevalence and severity of symptoms compared with their newly diagnosed counterparts. Whether and how the HIV duration impact the symptom distress among middle-aged and older PLWH has not been explored clearly. Methods The patients with HIV-infected aged more than 40 years old were included from seven designated medical institutions of seven regions in China. Outcome was the score of symptom distress. We used the multiple regression model to calculate adjusted Coefficient of Regression (β) with 95% CI in this study. Results Among 210 participants (mean age 50.8 years; 71.0% male; 68.1% at asymptomatic stage) in the study, the median number of symptoms was 5. Of all symptoms reported, the most distressed symptoms were sleep disturbance (33.33%), followed by memory loss (31.90%), fatigue (26.67%), slow reactions (22.86%), and vision blur (21.90%). All participants were divided into four groups according to HIV duration, and the median of total score of symptom ditress among all participants was 0.1(0.0,0.9). Difference of total scores and clusters’ scores of symptom distress among four HIV duration groups were statistically significant. 51 participants with 6–10 years HIV duration were more likely to be higher level of education, at asymptomatic stage and have higher CD4 + T cell count. After adjustment for gender, age, race, education, marital status, employment, family income, region, stage of disease and CD4 + T cell count, the score of symptom distress among participants with 6–10 years HIV duration had was higher with the extension of HIV duration. Specially in physical symptoms and psychological symptoms,participants with 6–10 years HIV duration reported the persisting worse burdensome. Conclusions HIV duration with 6–10 yearsmay be a key period that the medical team needs to pay special attention to among middle-aged and elderly PLWH. There is a need to provide medical and psychosocial services targeting middle-aged and elderly PLWH according to their changing symptom distress. Trial registration Clinicaltrials.gov: ChiCTR2100046225. Registered 11 May 2021.
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Affiliation(s)
- Meilian Xie
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Kerong Wang
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanping Yu
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhaoxia Lin
- Department of Quality Control, Beijing Ditan Hospital Capital Medical University, Beijing, China
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16
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Xie M, Wang A, Lin Z. Prevalence of Gynecological Related Symptoms and Quality of Life in Women Living with HIV/AIDS: a Secondary Analysis from an Online, Cross-Sectional Survey in China. Int J Womens Health 2022; 14:1425-1433. [PMID: 36199912 PMCID: PMC9527813 DOI: 10.2147/ijwh.s369781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/18/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Our study aims to completely understand the experience of gynecological related symptoms (GRS) and the association between GRS and quality of life (QOL) among HIV-infected women in China. Design A cross-sectional, multicenter survey. Setting The HIV/AIDS designated medical institutions of seven regions in China. Participants One hundred and fifty-three women with HIV infection. Primary and Secondary Outcome Measures Primary outcome measures included the score of GRS and QOL from analysis sample. Results Among 153 participants, 60.13% were asymptomatic, and 39.87% were symptomatic according to their self-report data. In the symptomatic group, 47.54% reported only one symptom, 18.03% reported 2 symptoms, others reported more than 3 symptoms. The most common symptoms were vaginal discharge (25.49%), followed by irregular period (18.95%), bad cramps (13.07%), vaginal odor (11.11%), and vaginal itching (10.46%). The mean score of QOL was 86.82 ± 15.53. The symptomatic group had higher score than the asymptomatic group on each domain of QOL. GRS were negatively correlated with QOL after adjustment for confounding factors. Correlation matrix of GRS and six domains of QOL demonstrated significant negative correlation with each domain of QOL, especially the most strongly negative correlation with physical function of participants. But the association between GRS and environmental domain was weaker. Conclusion These findings present the multidimensionality of common gynecologic related symptoms and highlight the clinically meaningful associations between GRS and quality of life among women with HIV infection in China. There is an urgent need to take measures to increase vaginal care and education in advance, delivered by trusted health professionals.
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Affiliation(s)
- Meilian Xie
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Aiping Wang
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Correspondence: Aiping Wang, Department of Public Service, the First affiliated Hospital of China Medical University, Shenyang, People’s Republic of China, Email
| | - Zhaoxia Lin
- Infection Center, Beijing Ditan Hospital Capital Medical University, Beijing, People’s Republic of China
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17
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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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18
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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: 11] [Impact Index Per Article: 5.5] [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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19
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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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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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21
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Yang Z, Zhu Z, Lizarondo L, Xing W, Han S, Hu H, Hu Y, Wu B. Experience of chronic noncommunicable disease in people living with HIV: a systematic review and meta-aggregation of qualitative studies. BMC Public Health 2021; 21:1651. [PMID: 34507576 PMCID: PMC8431942 DOI: 10.1186/s12889-021-11698-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/29/2021] [Indexed: 12/17/2022] Open
Abstract
Background An increasing number of people living with HIV (PLWH) have had chronic noncommunicable diseases (NCDs) over the last 5 years. However, robust evidence regarding the perception and challenges of having NCDs among PLWH is limited. Therefore, this study aimed to synthesize qualitative evidence regarding the experiences of PLWH with NCDs. Methods We used a meta-aggregation approach to synthesize qualitative studies. Peer-reviewed and gray literature published in English and Chinese from 1996 to November 2020 was searched using electronic databases. Two reviewers independently appraised the methodological quality and extracted data from the included studies. The Joanna Briggs Institute (JBI) meta-aggregation approach was used to synthesize the findings. Results In total, 10,594 studies were identified in the initial database search. Fourteen eligible studies were included in the meta-synthesis. Among these studies, nine synthesized findings regarding the following topics were identified: fragmented healthcare systems, care continuity, manifestations of multiple conditions, financial hardship, stigma and discrimination, polypharmacy burden and adherence, reciprocal relationships between HIV and NCDs, and coping strategies. Conclusions In recent years, attempts have been made to institutionalize NCD preventive and control services in HIV long-term care. However, considering the growing problem of HIV and NCD comorbidity globally, integrated primary health care systems are needed to address the problems of PLWH with NCDs. Healthcare professionals should help PLWH develop strategies to better monitor their polypharmacy burden and adherence, stigma and discrimination, financial hardship, and manifestations of multiple conditions to achieve high levels of care continuity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11698-5.
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Affiliation(s)
- Zhongfang Yang
- Fudan University School of Nursing, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - 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.
| | - Lucylynn Lizarondo
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - 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
| | - Shuyu Han
- Fudan University School of Nursing, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - 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, New York, USA
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22
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Liu X, Cao J, Zhu Z, Zhao X, Zhou J, Deng Q, Zhang L, Wang H. Nutritional risk and nutritional status in hospitalized older adults living with HIV in Shenzhen, China: a cross-sectional study. BMC Infect Dis 2021; 21:618. [PMID: 34187374 PMCID: PMC8244224 DOI: 10.1186/s12879-021-06322-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutrition is a crucial factor that can impact morbidity and mortality in older people living with HIV (PLWH). Studies on nutritional risk and nutritional status in all age groups in PLWH have been conducted. However, few studies have focused on nutritional risk in older PLWH. This study aimed to describe the nutritional risk and nutritional status in older PLWH, and explore factors associated with nutritional risk and undernutrition status. METHODS We conducted a cross-sectional study. We recruited participants aged 50 years or older from the Third People's Hospital of Shenzhen from January 2016 to May 2019. Nutritional risk and nutritional status were evaluated by the Nutritional Risk Screening 2002 (NRS 2002) tool, body mass index (BMI), albumin level, and prealbumin level on the first day of admission. Logistic regression models were used to identify the factors associated with undernutrition based on the BMI, albumin, and prealbumin criteria. RESULTS A total of 196 older PLWH were included in the analysis. We found that 36% of hospitalized older PLWH had nutritional risk, and 12-56% of them had undernutrition based on the BMI, albumin, and prealbumin criteria. An increased nutritional risk score was associated with older age (β = 0.265 CI [0.021, 0.096], P = 0.002), a higher viral load (β = - 0.186 CI [- 0.620, - 0.037], P = 0.028), a lower BMI (β = - 0.287 CI [- 0.217, - 0.058], P = 0.001), and a lower albumin level (β = - 0.324 CI [- 8.896, - 1.230], P = 0.010). The CD4 count was associated with the prevalence of undernutrition based on the albumin criterion (OR = 15.637 CI [2.742, 89.178], P = 0.002). CONCLUSION Our study indicated that nutritional screening, assessment, and management should be routinely performed in hospitalized older PLWH. HIV-specific measures should be used to assess nutritional risk, and albumin, BMI, and other assessments should be used in combination to identify undernutrition in older PLWH.
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Affiliation(s)
- Xiaoning Liu
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jing Cao
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - 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.
| | - Xia Zhao
- Peking Union Medical College Hospital, Beijing, China
| | - Jing Zhou
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qiuxia Deng
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Liyuan Zhang
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hui Wang
- The Third People's Hospital of Shenzhen, Shenzhen, China.
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23
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Zhu Z, Wen H, Yang Z, Han S, Fu Y, Zhang L, Hu Y, Wu B. Evolving symptom networks in relation to HIV-positive duration among people living with HIV: A network analysis. Int J Infect Dis 2021; 108:503-509. [PMID: 34098098 DOI: 10.1016/j.ijid.2021.05.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To explore and visualize the relationships among multiple symptoms in people living with HIV (PLWH) and compare centrality indices and the density of symptom networks among groups of individuals with different HIV-positive durations. METHODS We conducted a secondary analysis of data from the HIV-related Symptoms Monitoring Survey conducted in China. Networks were constructed among 27 symptoms. Centrality properties, including strength and closeness, and network density were used to describe relationships among symptoms in 5 different HIV-positive duration groups. RESULTS The findings showed that PLWH with longer HIV-positive durations did not have more severe symptoms; instead, their symptom networks were denser than those of their newly HIV-diagnosed counterparts (F = 27.073, P < 0.001). Fatigue was the most severe and central symptom in PLWH with an HIV-positive duration <10 years (rS = 7.79-10.09, rB = 18-44, rC = 0.01). Confusion was the most central symptom across the 3 centrality indices (rS = 11.81, rB = 14.00, rC = 0.02) in PLWH who had HIV-positive durations >10 years. CONCLUSION This study demonstrates a need to include an assessment of PLWH symptom networks as an essential component of HIV care. We recommended evaluating cognitive function and cognitive training as essential components of HIV care for long-term survivors, even in younger populations (aged ≤50 years).
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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
| | - Huan Wen
- Fudan University School of Public Health, Shanghai, China
| | - Zhongfang Yang
- Fudan University School of Nursing, Shanghai, China; Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Shuyu Han
- Fudan University School of Nursing, Shanghai, China
| | - Yanfen Fu
- Dali University School of Nursing, Dali, Yunnan Province, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, 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
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24
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Zhu Z, Guo M, Dong T, Han S, Hu Y, Wu B. Assessing psychological symptom networks related to HIV-positive duration among people living with HIV: a network analysis. AIDS Care 2021; 34:725-733. [PMID: 34043459 DOI: 10.1080/09540121.2021.1929815] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to explore and visualize relationships among multiple psychological symptoms among people living with HIV (PLWH) with different HIV-positive durations and to compare centrality indices and densities of psychological symptom networks. We used subsets of data collected from five designated HIV/AIDS hospitals in China. Networks were constructed among 16 psychological symptoms. Centrality properties, including strength and closeness, were adopted to describe relationships among symptoms. The results showed that PLWH with longer HIV-positive durations had denser emotional networks, which indicated that they had more emotional neuroticism than their newly diagnosed counterparts. Sadness, self-abasement, and self-loathing were the most central psychological symptoms across different HIV-positive durations. Our study suggests the need to provide psychosocial support services targeting PLWH according to changing symptom severity and neuroticism trajectories. Interventions should focus on increasing empathy for PLWH and enhancing the ability to consider the situation from different perspectives to avoid the development of neuroticism in long-term survivors.
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Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, People's Republic of China
| | - Mengdi Guo
- School of Government and Public Affairs, Communication University of China, Beijing, People's Republic of China
| | - Tingyue Dong
- Beijing Administration Institute, Beijing, People's Republic of China
| | - Shuyu Han
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, People's Republic of China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, People's Republic of China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York University, New York City, New York, USA
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25
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Adeola J, Badejo OA, Ahonkhai A, Okonkwo P, Aboh Akande P, Evans CT, McHugh M, Pierce L, Ahmed I, Jolayemi T, Ladi Akinyemi B, Onwuatuelo I, Murphy R, Kyriacou D, Musa J, Agaba P. Effect of Baseline Symptom Manifestations on Retention in Care and Treatment among HIV-Infected Patients in Nigeria. J Int Assoc Provid AIDS Care 2021; 19:2325958220903575. [PMID: 32027211 PMCID: PMC7005974 DOI: 10.1177/2325958220903575] [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] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Symptom management is an important component of HIV care. But symptom patterns and how they affect engagement with HIV care and treatment services have not been adequately explored in the era of increased HIV treatment scale-up. We investigated the relationship between symptom patterns among people living with HIV (PLHIV) and 12 months retention in care, within the context of other clinical and demographic characteristics. METHODS Retrospective cohort analysis of 5114 PLHIV receiving care within a large HIV treatment program in Nigeria. We assessed the prevalence and burden of baseline symptoms reported during routine clinic visits from January 2015 to December 2017. Multivariable regression was used to identify relationships between 12-month retention and symptom dimensions (prevalence and burden) while controlling for demographic and other clinical variables. RESULTS Increasing symptom burden was associated with higher likelihood of retention at 12 months (adjusted odds ratio [aOR] = 1.19 [95% confidence interval, CI: 1.09-1.29]; P < .001) as was the reporting of skin rashes/itching symptom (aOR = 2.59 [95% CI: 1.65-4.09]; P < .001). Likelihood of retention reduced with increasing World Health Organization (WHO) Clinical staging, with CD4 ≥500 cells/mL and self-reported heterosexual mode of HIV transmission. Conclusions: Symptom dimensions and standardized clinical/immunological measures both predicted retention in care, but effects differed in magnitude and direction. Standardized clinical/immunological measures in HIV care (eg, WHO clinical staging and CD4 count categories) can mask important differences in how PLHIVs experience symptoms and, therefore, their engagement with HIV care and treatment. Symptom management strategies are required alongside antiretroviral treatment to improve outcomes among PLHIV, including retention in care.
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Affiliation(s)
- Juliet Adeola
- APIN Public Health Initiatives, Abuja, Nigeria.,Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Okikiolu Abimbola Badejo
- APIN Public Health Initiatives, Abuja, Nigeria.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Aimalohi Ahonkhai
- Vanderbilt University, Division of Infectious Diseases, Nashville, TN, USA
| | | | | | - Charlesnika Tyon Evans
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Megan McHugh
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Leslie Pierce
- Vanderbilt University, Division of Infectious Diseases, Nashville, TN, USA
| | - Isah Ahmed
- APIN Public Health Initiatives, Abuja, Nigeria
| | | | | | | | - Robert Murphy
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Demetrious Kyriacou
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Jonah Musa
- Jos University Teaching Hospital, APIN Center, Plateau State, Nigeria
| | - Patricia Agaba
- Jos University Teaching Hospital, APIN Center, Plateau State, Nigeria
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26
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Han S, Pei Y, Wang L, Hu Y, Qi X, Zhao R, Zhang L, Sun W, Zhu Z, Wu B. The Development of a Personalized Symptom Management Mobile Health Application for Persons Living with HIV in China. J Pers Med 2021; 11:346. [PMID: 33922984 PMCID: PMC8146530 DOI: 10.3390/jpm11050346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/31/2022] Open
Abstract
Persons living with HIV (PLWH) continuously experience symptom burdens. Their symptom prevalence and severity are also quite different. Mobile health (mHealth) applications (apps) offer exceptional opportunities for using personalized interventions when and where PLWH are needed. This study aimed to demonstrate the development process of the symptom management (SM) app and the structure and content of it. Our research team systematically searched for evidence-based resources and summarized up-to-date evidence for symptom management and health education. Our multidisciplinary research team that included physicians, nurses, software engineers, and nursing professors, evaluated the structure and content of the drafted app. Both quantitative data and qualitative results were collected at a group discussion meeting. Quantitative data were scores of sufficient evidence, situational suitability, practicability, cost-effectiveness, and understandability (ranged from one to four) for 119 items of the app contents, including the health tracking module, the self-assessment module, coping strategies for 18 symptoms (80 items), medication management, complementary therapy, diet management, exercise, relaxation techniques, and the obtaining support module. The SM app was comprised of eight modules and provided several personalized symptom management functions, including assessing symptoms and receiving different symptom management strategies, tracking health indicators, and communicating with medical staff. The SM app was a promising and flexible tool for HIV symptom management. It provided PLWH with personalized symptom management strategies and facilitated the case management for medical staff. Future studies are needed to further test the app's usability among PLWH users and its effects on symptom management.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Peking University, Beijing 100191, China;
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA; (Y.P.); (X.Q.)
| | - Lina Wang
- School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou 313000, China;
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai 200032, China; (R.Z.); (Z.Z.)
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai 200032, China
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA; (Y.P.); (X.Q.)
| | - Rui Zhao
- School of Nursing, Fudan University, Shanghai 200032, China; (R.Z.); (Z.Z.)
- Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai 201508, China; (L.Z.); (W.S.)
| | - Wenxiu Sun
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai 201508, China; (L.Z.); (W.S.)
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai 200032, China; (R.Z.); (Z.Z.)
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai 200032, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA; (Y.P.); (X.Q.)
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27
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Huang F, Chen WT, Shiu CS, Sun W, Radaza A, Toma L, Luu BV, Ah-Yune J. Physical symptoms and sleep disturbances activate coping strategies among HIV-infected Asian Americans: a pathway analysis. AIDS Care 2021; 33:1201-1208. [PMID: 33487002 DOI: 10.1080/09540121.2021.1874270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
How to activate adaptive coping strategies has an important and practical meaning for the quality of life of people living with HIV (PLHIV); however, few studies have focused on the effects of sleep disturbances and HIV-related physical symptoms on coping strategies. The specific relationships among coping strategies, sleep disturbances and HIV-related physical symptoms were unknown. We performed a path analysis to examine the proposed model of relationships among sleep disturbances, physical symptoms, and coping strategies. A convenience sample of 69 HIV-positive Asian Americans in San Francisco, Los Angeles, and New York City were recruited and data were collected on demographics, sleep disturbances, HIV-related physical symptoms, and coping strategies. Sleep disturbances directly affect maladaptive coping (β = 0.34), and physical symptoms directly affect adaptive coping (β = 0.30) and maladaptive coping (β = 0.24). Interventions designed to decrease sleep disturbances and physical symptoms should be developed to enhance adaptive coping and reduce maladaptive coping among Asian Americans with HIV.
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Affiliation(s)
- Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, People's Republic of China.,School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Cheng-Shi Shiu
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.,Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Wenxiu Sun
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China
| | - Abigail Radaza
- Research, Evaluation, and Development, APAIT, Los Angeles, CA, USA
| | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
| | - Binh Vinh Luu
- Chinese-American Planning Council, Inc., New York, CA, USA
| | - Judy Ah-Yune
- Chinese-American Planning Council, Inc., New York, CA, USA
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28
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Han S, Hu Y, Relf MV, Mulawa MI, Lu H, Zhang L, Zhu Z, Luo J, Pei Y, Wu B. Effects of Nurse-Delivered Cognitive Behavioral Intervention on Depression and Anxiety for Persons Living With HIV in China: A Clinical Controlled Trial. J Assoc Nurses AIDS Care 2021; 32:79-93. [PMID: 33177434 DOI: 10.1097/jnc.0000000000000213] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Depression and anxiety, which may influence antiretroviral therapy (ART) medication adherence, are prevalent among persons living with HIV (PLWH) in China. This parallel two-arm clinical controlled trial aimed to examine the effects of a nurse-delivered cognitive behavioral intervention (CBI) on depression, anxiety, and ART medication adherence in Chinese PLWH. Using in-person and online recruitment, 140 PLWH ages 18 years and older who were undergoing ART and had a Patient Health Questionnaire-4 score of ≥2 were assigned to the 10-week-long CBI group or the routine follow-up group according to their preference. Outcomes were measured at baseline, postintervention, and 6-month follow-up. Results showed significant intervention effects on depression maintained until the 6-month follow-up. Although anxiety and ART medication adherence did not show robust effects between conditions, amelioration trends for these outcomes were also found. Our study demonstrated that the nurse-delivered CBI could help Chinese PLWH ameliorate depression.
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Affiliation(s)
- Shuyu Han
- Shuyu Han, MSN, RN, is a Doctoral Candidate, School of Nursing, Fudan University, Shanghai, China. Yan Hu, PhD, RN, FAAN, is a Professor and Dean, School of Nursing, Fudan University, Shanghai, China, and is the Director of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China. Michael V. Relf, PhD, RN, AACRN, ANEF, FAAN, is the Editor-in-Chief of JANAC and Associate Dean for Global and Community Health Affairs, Duke University, School of Nursing, Durham, North Carolina, USA. Marta I. Mulawa, PhD, MHS, is the Assistant Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA. Hongzhou Lu, PhD, is the President, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China. Lin Zhang, BSN, RN, is a Vice Director of Nursing, Shanghai Public Health Clinical Nursing, Fudan University, Shanghai, China. Zheng Zhu, PhD, RN, is a Faculty Member, School of Nursing, Fudan University, Shanghai, China, and is a Core Researcher of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China. Jianfeng Luo, PhD, is a Professor, School of Public Health, Fudan University, Shanghai, China. Yaolin Pei, PhD, is a Post-doctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA. Bei Wu, PhD, is the Dean's Professor in Global Health, the Director for Global Health and Aging Research, and the Director for Research, Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York, USA
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29
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Dong N, Chen WT, Lu H, Zhu Z, Hu Y, Bao M. Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study. Appl Nurs Res 2020; 54:151283. [PMID: 32425335 PMCID: PMC7229465 DOI: 10.1016/j.apnr.2020.151283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) are a vulnerable group who experience multiple physiological and psychological symptoms. A better understanding of unmet symptom management needs will allow researchers to design interventions that are more reflective of deficits in care and more effective at improving patient care. Few studies have focused on unmet needs for symptom management in PLWHA particularly in China. Factors influencing Chinese PLWHA symptom management needs are rarely discussed. AIM The purpose of this study was to investigate the unmet needs for symptom management of PLWHA and how their symptom burden, HIV perceived stigma, and self-management capacity contributes to HIV-related self-management practices in Shanghai, China. DESIGN Study participants were recruited from the outpatient and inpatient HIV/AIDS wards in an infectious hospital in Shanghai, China. Self-administered questionnaires were implemented and medical charts were reviewed. RESULTS A total of 367 participants was recruited from April to September 2017. The results show that 53.1% (195 of 367) of participants presented at least one unmet symptom management need and that symptom burden, as well as perceived stigma, reduced self-management capacity, and no employment significantly affected unmet symptom management needs. CONCLUSION The findings indicate that there is room for improvement in symptom management for Chinese PLWHA. Culturally appropriate interventions focusing on improving symptom burden, decreasing HIV perceived stigma, and enhancing self-management capacity can enhance symptom management in this population.
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Affiliation(s)
- Ning Dong
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei-Ti Chen
- School of Nursing, University of California, Los Angeles, CA, United States
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Molecular network-based intervention brings us closer to ending the HIV pandemic. Front Med 2020; 14:136-148. [PMID: 32206964 DOI: 10.1007/s11684-020-0756-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/13/2020] [Indexed: 01/08/2023]
Abstract
Precise identification of HIV transmission among populations is a key step in public health responses. However, the HIV transmission network is usually difficult to determine. HIV molecular networks can be determined by phylogenetic approach, genetic distance-based approach, and a combination of both approaches. These approaches are increasingly used to identify transmission networks among populations, reconstruct the history of HIV spread, monitor the dynamics of HIV transmission, guide targeted intervention on key subpopulations, and assess the effects of interventions. Simulation and retrospective studies have demonstrated that these molecular network-based interventions are more cost-effective than random or traditional interventions. However, we still need to address several challenges to improve the practice of molecular network-guided targeting interventions to finally end the HIV epidemic. The data remain limited or difficult to obtain, and more automatic real-time tools are required. In addition, molecular and social networks must be combined, and technical parameters and ethnic issues warrant further studies.
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