The fatigue experience: persons with HIV infection

Testosterone Insufficiency in Human Immunodeficiency Virus-Infected Women: A Cross-Sectional Study

INTRODUCTION

Now that HIV infection has become a chronic disease, optimizing health status is an important goal of care for HIV-infected patients. Testosterone insufficiency (TI) can compromise health status, but little is known about the prevalence of TI and possible related factors in HIV-infected women.

AIM

To investigate the prevalence of TI among HIV-infected women attending our HIV outpatient clinic, and to study the relationship between TI and sexual function, fatigue, health status, and depression.

METHODS

56 HIV-infected women aged ≥18 years who attended the HIV outpatient clinic of the Amsterdam University Medical Center, The Netherlands, were included. Blood samples were taken for endocrinologic testing and patients filled out 6 validated questionnaires measuring sexual function, fatigue, health, and depression.

MAIN OUTCOME MEASURE

TI, the Female Sexual Function Index, the Female Sexual Distress Scale-Revised, the Multidimensional Fatigue Inventory, the Medical Outcomes Studies Short Form 36-item health survey, and the Beck Depression Inventory were assessed.

RESULTS

A relatively high prevalence of TI, 37%, was found. Plasma viral load and CD4 cell count did not differ between women with or without TI. Clinical fatigue, physical fatigue, and impaired cognitive function were significantly more prevalent in women with TI. Women with TI also tended to report decreased sexual desire, reduced physical activity, increased mental fatigue, reduced physical function, increased health distress, and clinical depression.

CONCLUSION

We recommend that in all HIV-positive women with complaints typical for TI, testosterone is measured, and that in women with TI, testosterone replacement be considered as a treatment option. However, given that complaints are also prevalent in HIV-positive women without TI, the approach to women with these complaints should include sexual and psychological evaluation. Laan ETM, Prins JM, van Lunsen RHW, et al. Testosterone Insufficiency in Human Immunodeficiency Virus-Infected Women: A Cross-Sectional Study. Sex Med 2019;7:72-79.

Fatigue in Type 2 Diabetes: Impact on Quality of Life and Predictors

Fatigue is a persistent symptom, impacting quality of life (QoL) and functional status in people with type 2 diabetes, yet the symptom of fatigue has not been fully explored. The purpose of this study was to explore the relationship between fatigue, QoL functional status and to investigate the predictors of fatigue. These possible predictors included body mass index (BMI), Hemoglobin A1C (HbA1C), sleep quality, pain, number of complications from diabetes, years since diagnosis and depression. Forty-eight individuals with type 2 diabetes (22 females, 26 males; 59.66±7.24 years of age; 10.45 ±7.38 years since diagnosis) participated in the study. Fatigue was assessed by using Multidimensional Fatigue Inventory (MFI-20). Other outcomes included: QoL (Audit of Diabetes Dependent QoL), and functional status (6 minute walk test), BMI, HbA1c, sleep (Pittsburg sleep quality index, PSQI), pain (Visual Analog Scale), number of complications, years since diagnosis, and depression (Beck's depression Inventory-2). The Pearson correlation analysis followed by multivariable linear regression model was used. Fatigue was negatively related to quality of life and functional status. Multivariable linear regression analysis revealed sleep, pain and BMI as the independent predictors of fatigue signaling the presence of physiological (sleep, pain, BMI) phenomenon that could undermine health outcomes.

Community Dwellers' Perspectives on the Experience of Feeling Very Tired

Feeling very tired is a phenomenon experienced by all humans at some point in their life. As a means of more fully understanding the human experience of feeling very tired, this concept was explored with a group of 10 community dwelling individuals who had no expressed health concerns. The Parse research method was used to answer the research question, What is the structure of the lived experience of feeling very tired? The central finding of this study is the structure: The lived experience of feeling very tired is dissipated vigor arising with monotonous disquietude amid spirited cherished engagements . The structure was conceptually integrated with the human becoming theory as: feeling very tired is powering the languaging of valuing connecting-separating. The findings are discussed in relation to human becoming and future research.

Physiological and Psychological Correlates of Fatigue in HIV Disease

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.

The Experience of Fatigue Across Long-Term Conditions: A Qualitative Meta-Synthesis

CONTEXT

Fatigue is a common and debilitating symptom associated with many long-term conditions and is reported to cause significant levels of distress for those individuals. There is a substantial body of literature related to the nature of fatigue; however, this has not been drawn together and compared across conditions.

OBJECTIVES

The aim of this review was to synthesize data on the nature of fatigue across long-term conditions.

METHODS

The review was designed as a qualitative meta-synthesis and followed the Joanna Briggs Institute guidelines for synthesizing qualitative research. The following databases were searched for the period January 1980 to January 2016, Ovid (Medline, Embase, CINAHL, and PsycINFO) and manual searching from the reference lists from articles identified by electronic search. Fifty-seven studies were included in the review, and findings related to the nature of fatigue were extracted and findings meta-synthesized.

RESULTS

The perceived nature of fatigue across long-term conditions was encompassed in one synthesis; the fatigue experience is without precedent, with four categories: a different fatigue to any experienced before, the intensity of fatigue is overwhelming, the trajectory of fatigue, and impact on sleep and sleep disturbance. Just over half of the participants in the included studies were diagnosed with cancer. Patterns in the experience of fatigue by condition were found for cancer-related fatigue and post-stroke fatigue where data were able to be synthesized.

CONCLUSION

Although similarities in the nature of the fatigue experienced were found across conditions, differences were also evident and could be mapped for cancer-related fatigue and post-stroke fatigue. Further qualitative research on the experience of fatigue across a wide range of chronic conditions would further contribute to understanding similarities and differences across conditions and inform both research and practice in relation to assessment and management.

Meanings of fatigue for women with Parkinson's disease

The existing knowledge of women's experiences of living with Parkinson's disease and fatigue is limited. To gain first-hand knowledge, we interviewed 11 women using a phenomenological hermeneutic interpretation. The results indicate that the familiar daily routines of women with Parkinson's disease had changed in the sense that their bodily attachment to the world had been altered. The body no longer provided smooth access to the surrounding world; rather, the body served as a barrier to daily living. In practice, understanding this barrier can be significant in recognizing how to create positive conditions that support the women's experiences and how to formulate their care in congruence with their needs.

Fatigue and Related Factors in People With Type 2 Diabetes

Purpose

The purpose of this study was to examine the presence and severity of fatigue in people with type 2 diabetes.

Methods

The Fatigue Severity Scale (FSS), Fatigue Assessment Scale (FAS), and Visual Analog Fatigue Scale (VAFS) were administered by anonymous survey of 37 individuals with and 33 individuals without diabetes to assess the presence of fatigue. Data on age, gender, weight, height, year of diagnosis, and number/type of complications were also collected. Nonparametric tests tested for differences in fatigue measures between the groups, and distribution characteristics of the FAS, FSS, and VAFS scores were examined. Spearman rank correlation coefficients examined the relationships between the variables.

Results

People with diabetes scored higher on all 3 fatigue assessment scales as compared to controls (FAS: 25.11 vs 19.94, P = .001; FSS: 4.30 vs 2.59, P = .000; VAFS: 4.64 vs 1.75, P = .000). Data were normally distributed for FSS in the group with diabetes and the group without diabetes, and scores of FAS, FSS, and VAFS showed no ceiling effects. A positive correlation was noted between fatigue measures and number of complications ( r = .482; P = .003).

Conclusions

Higher levels of fatigue were noted in people with type 2 diabetes as compared to healthy age-matched control; however, the cause and impact of these changes remain unclear. FSS is a recommended tool for measuring fatigue in this population. Further studies are needed to explore the contributing factors to fatigue in those with diabetes.

HIV Disease Impact on Mothers: What They Miss During Their Children's Developmental Years

Adjusting to chronic illness is very complicated for families with children, as they are already faced with the challenge of development and childrearing. In this study, qualitative interviews were conducted with HIV positive mothers on a number of issues related to being an HIV positive mother raising young children. One topic of the interview was whether or not they felt that HIV had caused them to miss activities with their children while the children were growing up, what types of activities they had missed, the age of the child for each example, and how HIV had led to missing these activities. Interviews were conducted in 2008 with a random sample of 57 mothers being followed in a longitudinal assessment study. All study participants were English or Spanish speaking. Mean age was 44.1 (SD = 5.6) years; 47% were Latina; 35% African American; 11% White; and 7% other race. About 60% of the mothers disclosed that their HIV status had caused them to miss out on activities with their children while their children were growing up, ranging from daily care activities to major school and extra-curricular activities. Some mothers missed significant amounts of time with their children due to hospitalizations. In some cases mothers felt forced into a choice between mothering ability and their own health, including adherence to medications. Implications for the mothers and the children are discussed.

Sources of emotional distress associated with diarrhea among late middle-age and older HIV-infected adults

CONTEXT

Although the experience of physical symptoms can adversely influence emotional well-being, the specific emotional reactions experienced in response to specific symptoms are not well understood.

OBJECTIVES

To examine the emotional impact of diarrhea among HIV+ late middle-age and older adults (i.e., age 50 years and older).

METHODS

In-depth interviews were conducted with 100 participants, of whom 29 had experienced diarrhea and spoke about the emotional impact it had had on them.

RESULTS

Three principal themes emerged: 1) I don't control the diarrhea, the diarrhea controls me; 2) I feel ashamed, dirty, and tainted; and 3) I fear what the diarrhea is doing to me and what it means. Their inability to control when and where their diarrhea would occur was a great source of emotional distress for participants. Almost all feared the possibility of fecal incontinence while out in public and the humiliation it would bring. To avoid this, many greatly restricted their time outside the home or where they would go to ensure access to a restroom. Others felt shame and perpetually "dirty" even when not dealing with a bout of diarrhea. Many also worried about the effect the diarrhea would have on their health and whether it signaled progression to end-stage disease.

CONCLUSION

The data strongly support the need to aggressively manage diarrhea in HIV-infected adults, as the social and emotional consequences can be profound. When it cannot be effectively controlled, physicians and social service agencies should address the isolation by providing home-based opportunities for social support and interaction.

Fatigue in patients with diabetes: a review

OBJECTIVE

Fatigue is a common and distressing complaint among people with diabetes and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject.

METHODS

A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue.

RESULTS

Diabetes presents many potential pathways for fatigue, but focused studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigue's nonspecific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement, or diagnostic criteria. Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, although one that did provided some meaningful finding that symptom-focused education improved self-management practices, Hb(A1c) levels, quality of life, and symptom distress.

CONCLUSION

There is a need to standardize the definition, measurement, and diagnostic criteria of fatigue in diabetes. We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena (physiological, psychological, and lifestyle) associated with fatigue in diabetes.

HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV

OBJECTIVES

Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences.

METHODS

HIV-patients (N=168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities.

RESULTS

Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems. Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fatigue (p<.01). Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders. Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p=.05). Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p<.01).

CONCLUSIONS

Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.

An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis

AIM

To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning.

BACKGROUND

Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing.

METHOD

A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire.

RESULTS

Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status.

CONCLUSION

The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing.

RELEVANCE TO CLINICAL PRACTICE

Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

Is gene therapy a good therapeutic approach for HIV-positive patients?

Despite advances and options available in gene therapy for HIV-1 infection, its application in the clinical setting has been challenging. Although published data from HIV-1 clinical trials show safety and proof of principle for gene therapy, positive clinical outcomes for infected patients have yet to be demonstrated. The cause for this slow progress may arise from the fact that HIV is a complex multi-organ system infection. There is uncertainty regarding the types of cells to target by gene therapy and there are issues regarding insufficient transduction of cells and long-term expression. This paper discusses state-of-the-art molecular approaches against HIV-1 and the application of these treatments in current and ongoing clinical trials.

The experience of physical symptoms among women living with HIV

As the number of women living with HIV and AIDS increases, so does survival time for individuals living with this chronic condition. Symptom existence, intensity, and bothersomeness greatly affect quality of life in women living with HIV and AIDS. Symptoms experienced by women living with HIV include symptoms related to HIV infection itself, those related to opportunistic infections, and those related to medications and treatments. Symptoms experienced by women include those common to both genders and those specific to females. The presence and intensity of symptoms varies with progression of the disease and with deteriorating status of HIV disease indicators. While research is limited on this topic, some research on the general symptom experience of women and on symptoms specific to or common among women has been done. Extended life expectancy among women with HIV increases the importance of nursing care focused on symptom assessment and symptom management. This article reviews research on symptoms commonly experienced by women living with HIV and presents implications for the care of women experiencing distressing symptoms.

Fatigue among HIV-infected patients in the era of highly active antiretroviral therapy

OBJECTIVE

To describe the prevalence of operationally defined fatigue in an ethnically diverse HIV-infected population in south London, and to examine the association of fatigue with demographic characteristics, stage of disease, antiretroviral therapy and psychological factors.

METHODS

A descriptive comparative cross-sectional study of HIV-infected patients attending a London HIV clinic over a 5-month period in 2002 was performed. Demographic and clinical data were obtained from the local database. Participants completed four self-administered questionnaires-the Chalder Fatigue Scale (CFS), a measure of physical and mental fatigue; the General Health Questionnaire (GHQ-12) to detect anxiety and depression; the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to measure functional status, and the Illness Perception Questionnaire (IPQ). Fatigue 'cases' were defined as those scoring at least 4 on the CFS. Multivariate logistic regression was used to identify factors associated with the presence of fatigue.

RESULTS

Two hundred and five patients were approached and 148 (72%) agreed to participate. Overall, 65% of patients were defined as fatigued. Significant psychological distress on the GHQ-12, functional impairment on the SF-36 and a higher CD4 count were all independently associated with the presence of fatigue. There was no association with use of antiretroviral therapy or demographic characteristics.

CONCLUSIONS

The presence of fatigue in HIV-infected patients is most strongly associated with psychological factors and not with more advanced HIV disease or the use of highly active antiretroviral therapy. This highlights the importance of investigation and management of underlying depression and anxiety in patients presenting with fatigue.

Bioimpedance analysis and HIV-related fatigue

Although various physiological and psychological causes of fatigue in HIV-positive persons have been proposed, it is still not well understood. Bioimpedance analysis has proved to be an easily used, non-invasive measurement of body composition and cellular integrity. This study, looking at whether body composition as measured by bioimpedance analysis is associated with fatigue, is part of a pilot study looking for physiological and psychological biomarkers that could be factors in the fatigue experienced by HIV-positive people. Twenty-nine men and eleven women were measured for height, weight, and bioimpedance analysis. Correlations were examined between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, extracellular mass, and phase angle. Because of the fat redistribution that has occurred with some people taking protease inhibitors, we also examined differences in weight, body mass index, body cell mass, fat-free mass, and fatigue intensity between those taking and those not taking protease inhibitors. There was no association between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, or phase angle, nor were there differences between those taking and those not taking protease inhibitors. However, it was noted that both the phase angle and the ratio of extracellular mass to body cell mass (extracellular mass:body cell mass) were below their respective normal ranges, indicating that the participants were somewhat compromised nutritionally and with regard to cell membrane integrity. Although fatigue was not shown to be related to body composition measurement in this study, further work is needed on the causes of fatigue, because its effects on the lives of HIV-positive people can be devastating.

The meaning of fatigue for women with multiple sclerosis

AIM

This paper reports the findings of a study that aimed to elucidate the meaning of fatigue for women with multiple sclerosis (MS).

BACKGROUND

Living with chronic illness can involve giving up usual activities. MS is a chronic autoimmune disease of the central nervous system. Fatigue is a common experience among people with MS; however, little is known about the meaning of fatigue experienced by women with this condition.

METHOD

Ten women with MS were interviewed about their experience of fatigue. A phenomenological hermeneutic method influenced by Ricoeur was used to interpret the transcribed interviews.

FINDINGS

The findings were presented in two major themes with five subthemes; experiencing the body as a barrier and experiencing a different absence. Fatigue seemed to give rise to an experience of being absent and divided into two parts. This also led to a feeling of not being able to participate in the surrounding world. The feeling of being an outsider and lacking the ability as a healthy person is interpreted as a form of suffering. Although the fatigue had a great impact on the women's daily life, the women still hoped for some relief. Fatigue seemed to imply that instead of working as an implement to manage in the world the body has become an enemy of survival.

CONCLUSION

This study highlights the importance for nurses of understanding how women with MS experience fatigue, which is a prerequisite for communication based on a shared understanding. This awareness would enhance nurses' opportunities to alleviate suffering. More research is needed to investigate what kinds of interventions can help these women to manage their everyday lives and to maintain a sense of normality despite their fatigue and illness. Such interventions should be subject to empirical evaluation research.

The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era

The use of highly active antiretroviral therapy (HAART) has served to significantly reduce the mortality of HIV-infected persons. However, this treatment is associated with a host of adverse effects: fatigue, nausea, pain, anxiety and depression. Rather than utilise traditional pharmacological treatments for these effects, many HIV/AIDS patients are utilising adjunct therapies to maintain their quality of life while they undergo treatment. Exercise has consistently been listed as one of the most popular self-care therapies and a small number of studies have been conducted to examine the impact of exercise on the most common self-reported symptoms of HIV and AIDS and the adverse effects of treatment. Although the results are generally positive, there are clear limitations to this work. The existing studies have utilised small samples and experienced high rates of attrition. In addition, the majority of the studies were conducted prior to the widespread use of HAART, which limits the ability to generalise these data. As a result, data from other chronic disease and healthy samples are used to suggest that exercise has the potential to be a beneficial treatment across the range of symptoms and adverse effects experienced by HIV-infected individuals. However, additional research is required with this population to demonstrate these effects.

Symptom Management in HIV-Infected Patients

Symptom management has always been a focus of nursing care. Assessing and managing symptoms is an important component of HIV nursing practice. When effective, interventions to relieve symptoms may improve quality of life (QoL), potentially increase adherence to highly active antiretroviral therapy, and improve other outcomes such as functional status. Common underrecognized and/or undertreated symptoms that may influence the QoL of persons living with HIV include fatigue, pain, anxiety/depression, and sleep disturbances. These symptoms may also contribute to the difficulty of adhering to HAART When evaluating a patient's symptoms, the nurse attempts to understand the symptom experience from the patient's perspective because symptoms are subjective experiences. Together, the nurse and patient work to determine feasible interventions. Symptom management plans are evaluated frequently. Fundamentally, symptom management aims to decrease the frequency, intensity, and distress of symptoms, with the ultimate goal of improving QoL.

Causal attributions for fatigue among late middle-aged and older adults with HIV infection

Fatigue, a symptom with many possible causes, is highly prevalent among persons with HIV/AIDS. The causal attributions HIV+ individuals make for their fatigue are important because they largely guide the coping responses they use to manage it. In a study to better understand the symptom appraisal process among 100 HIV+ older adults (50+), 49 participants discussed in depth their experience with fatigue. Many participants felt confused, at least initially, about the source of their fatigue, although most offered their HIV disease as a possible cause. However, many who did so also believed it was caused in part by other, generally less threatening causes, such as age, overexertion, or excess weight. HIV medications and other symptoms or comorbidities were also frequently cited as causes of fatigue. Health care professionals and HIV+ peers often helped to shape or reinforce participants' attributions for their fatigue.

Strategies for coping with fatigue among HIV-positive individuals fifty years and older

Fatigue, a common symptom among persons living with HIV/AIDS, is often underreported and undertreated. However, given fatigue's pervasive effects on well-being and functioning, the identification of its physiologic and psychological causes and strategies to alleviate it are important to patients' quality of life. As part of a study to understand better how HIV-positive middle-aged and older adults (50+) manage common symptoms, 49 participants discussed in depth their experience with fatigue. Most engaged in both self-care activities and sought the assistance of a health care professional. Frequent strategies included dietary changes, vitamins, modification of routines, rest, exercise, and prescribed medications for anemia, Vitamin B(12) deficiency, or testosterone deficiency. Complementary and alternative medicine (e.g., acupuncture, massage, herbal remedies, special juices) was also commonly used. Participants often used multiple strategies to alleviate their fatigue, possibly because of their tendency to attribute it to multiple causes. These HIV-positive older adults were also apt to view fatigue as an indirect indicator of their overall health status and immune functioning. This may explain why many of the coping strategies they used could be considered approaches to improving their overall health status as a means to increasing their energy levels. Health care professionals can play an important role in helping HIV-positive individuals manage their fatigue. The majority of participants tried to implement the coping suggestions offered by health care professionals, as well as those from family, friends, and support group members.

The influence of symptoms on quality of life among HIV-infected women

Symptoms serve as intervention foci for patients and health care providers. Research has established a relationship between symptoms and quality of life for persons living with HIV/AIDS. This article reports symptom prevalence and intensity data that include gynecological and cognitive symptoms self-reported by HIV-infected women (N = 118). Using a cross-sectional, descriptive design, data were obtained using the Center for Epidemiological Studies-Depression Scale (CES-D), Medical Outcomes Study Short Form-36 (MOS SF-36), and the revised Sign and Symptom Check-List for Persons Living with HIV/AIDS (SSC-HIV). Prevalent symptoms were depression (83%), muscle aches (84%), weakness (80%), and painful joints (71%). Symptoms with the highest mean intensity, however, were headaches, rash, insomnia, vaginal itching, and shortness of breath at rest. Symptoms also significantly predicted role functioning. This study contributes to our understanding the nature of symptoms and the influence of symptoms on role and physical functioning among HIV-infected women.

Interleukin-1beta elevation during the postpartum period

During the postpartum period, women frequently report increased fatigue, which, if severe, may interfere with maternal-child bonding, delay a new mother's return to her activities of daily living, and contribute to depression. Several studies have sought to determine psychosocial contributions to fatigue during the postpartum period, but few evaluate any physiological changes that may contribute to fatigue during this time. The following study was designed to test whether the potent, pro-inflammatory cytokine interleukin-1beta (IL-1beta), known to be a physiological mediator of fatigue in several clinical and experimental conditions, is elevated in women during the postpartum period and whether it might be related to symptoms of fatigue. Levels of fatigue and the urinary excretion of IL-1beta were measured in 26 women over 4 weeks postpartum. Correlations between fatigue and activation of the inflammatory response were investigated. Results demonstrated a significant elevation in IL-1beta during the postpartum period compared to control participants (p < .05) and a significant, although delayed, correlation between IL-1beta elevation and fatigue (p < .05). These results suggest that activation of the inflammatory response, as reflected by elevation in urinary IL-1beta, occurs in association with postpartum fatigue. Studies to explore further this association and to identify specific mechanisms of action are needed.

The experience of fatigue for people living with hepatitis C

Hepatitis C affects approximately 3% of the world population, with fatigue being acknowledged as the cardinal symptom. Despite growing recognition that hepatitis C fatigue impacts in a negative manner on quality of life, at the time of this study no empirical information existed regarding the nature of this fatigue or the way in which it affects a person's life. Such information is needed to enable nurses to engage in appropriate sensitive symptom management which is the core nursing activity with this population, as to date there is no vaccine or widely effective pharmacological therapy. The aim of the study was to ascertain the nature of hepatitis C fatigue. A qualitative approach using a grounded theory approach was employed. Theoretical sampling generated 28 participants for in-depth interview. Data analysis consisted of three coding processes, each type of coding having its own purpose and method. Ethical approval was obtained, both from the principal author's academic institution and the participating health care institution. Hepatitis C fatigue emerged as being multidimensional in nature, with both acute and chronic versions existing. The hepatology community is beginning to acknowledge the significant prevalence of hepatitis C fatigue. This study provides a valuable insight into its nature. This information can serve as resource for practitioners in their development of interventions to enable the hepatitis C virus population live with fatigue in a proactive manner.

Embedded assumptions in qualitative studies of fatigue

Qualitative researchers have long recognized that fatigue is a common concern among those with chronic illness; however, the insights derived from this body of inquiry have not been synthesized into a coherent body of clinical knowledge that could provide direction for nursing practice. Using a synthesis approach of meta-study, the authors identify four predominant assumptions embedded in qualitative studies that have influenced the way researchers have interpreted and made sense of their findings about fatigue in chronic illness over the past two decades. They argue that these assumptions may have inhibited the development of more dynamic, comprehensive understandings of fatigue. They conclude that addressing some of the methodological issues within this body of research might lead to a more accurate portrayal of the complexity, fluidity, and contextual nature of the fatigue experienced in chronic illness.

Self-care for fatigue in patients With HIV

PURPOSE/OBJECTIVES

To identify when fatigue is reported as a problem by people who are HIV positive, what the perception of fatigue is, and which self-care behaviors are used and with what efficacy.

DESIGN

Multisite descriptive study.

SETTING

University-based AIDS clinics, community-based organizations, and homecare agencies located in cities across the United States, in Norway, and through a university Web site.

SAMPLE

Convenience sample of 422 self-identified people who are HIV positive.

MAIN RESEARCH VARIABLES

Symptom description, symptom relief, symptom help, and self-care strategies.

FINDINGS

The sixth most reported symptom in this study, fatigue, was treated with a variety of self-designed strategies. In only three instances was consultation with a healthcare provider (i.e., physician) or an injection (medication not defined) mentioned. The most frequently used interventions were supplements, vitamins, and nutrition followed by sleep and rest; exercise; adjusting activities, approaches, and thoughts; distraction; and complementary and alternative therapies. In addition to self-designed strategies, the media and friends and family were sources of information.

CONCLUSIONS

Fatigue was reported less frequently in this study than in other HIV-, AIDS-, or cancer-related studies. This may be an artifact of the study design. The use of informal networks for assistance, let alone the prevalence of unrelieved fatigue, indicates the need for more attention to this problem among people with AIDS.

IMPLICATIONS FOR NURSING

Careful assessment of the pattern of fatigue and its onset, duration, intervention, and resolution is required if the varied types of fatigue are to be identified and treated successfully.

Poststroke fatigue: a 2-year follow-up study of stroke patients in Sweden

BACKGROUND AND PURPOSE

Fatigue is common among stroke patients. This study determined the prevalence of fatigue among long-term survivors after stroke and what impact fatigue had on various aspects of daily life and on survival.

METHODS

This study was based on Riks-Stroke, a hospital-based national register for quality assessment of acute stroke events in Sweden. During the first 6 months of 1997, 8194 patients were registered in Riks-Stroke, and 5189 were still alive 2 years after the stroke. They were followed up by a mail questionnaire, to which 4023 (79%) responded. Patients who reported that they always felt depressed were excluded.

RESULTS

To the question, "Do you feel tired?" 366 (10.0%) of the patients answered that they always felt tired, and an additional 1070 (29.2%) were often tired. Patients who always felt tired were on average older than the rest of the study population (74.5 versus 71.5 years, P<0.001); therefore, all subsequent analyses were age adjusted. Fatigue was an independent predictor for having to move into an institutional setting after stroke. Fatigue was also an independent predictor for being dependent in primary activities of daily living functions. Three years after stroke, patients with fatigue also had a higher case fatality rate.

CONCLUSIONS

Fatigue is frequent and often severe, even late after stroke. It is associated with profound deterioration of several aspects of everyday life and with higher case fatality, but it usually receives little attention by healthcare professionals. Intervention studies are needed.

The effectiveness of self-management training for individuals with HIV/AIDS

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned to the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

Correlates of quality of life in symptomatic HIV patients living in Hong Kong

This cross-sectional study assessed quality of life (QOL), coping styles, mood and uncertainty in illness in a non-random sample of 46 (out of 91 eligible) symptomatic HIV patients living in Hong Kong. QOL was moderate and the main concerns were related to the environmental aspects of QOL, spirituality and social relationships. Considerable mood disturbance was demonstrated in the sample, especially with regards to depression, fatigue and tension/anxiety. High levels of uncertainty in illness were also reported. A median split of the uncertainty score demonstrated that high uncertainty was related to lower levels of overall QOL (p = 0.04), higher psychological dysfunction (p = 0.05), worse adjustment with the environment (p < 0.001) and higher mood disturbance (p = 0.008). The sample predominantly used internal coping, which also correlated well with higher QOL scores. Through regression analysis it was shown that QOL could be predicted with the combined effects of uncertainty in illness and fatigue (adjusted R2 = 0.51, p < 0.001). Findings indicate that efforts should be directed towards improving QOL issues in the Chinese HIV patients and interventions could be introduced to alleviate those factors that were found to affect QOL. It is suggested that such interventions may include group or individual psychological therapies, management of fatigue and teaching patients more effective coping techniques.

Measurement of fatigue in HIV-positive adults: reliability and validity of the Global Fatigue Index

Fatigue is among the most common and distressing symptoms in patients with HIV/AIDS. Little is known about the clinical assessment of fatigue, especially in patients using highly active antiretroviral regimens. The purpose of this study was to evaluate the psychometric properties of the Global Fatigue Index (GFI) in a community-based sample of 209 patients with HIV/AIDS. The GFI is a measure that quantifies five dimensions of fatigue from the Multidimensional Assessment of Fatigue instrument into one score. To assess construct validity, the study included measures of depression, perceived stress, activities of daily living (ADLs), health behaviors, and clinical markers. Cronbach's alpha was calculated for internal consistency reliability, and factor analysis and bivariate correlations were conducted. The GFI was found to be easily self-administered, reliable, and a valid measure of overall fatigue burden in an HIV population. This instrument may be used by clinicians and researchers for assessing fatigue.

The effectiveness of self-management training for individuals with HIV/AIDS

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

Concept analysis: chronic fatigue

This concept analysis attempts to clarify and analyse the concept 'chronic fatigue' and does so by utilizing the framework outlined by Walker and Avant (1995). The aim is to use this work to underpin future research into the care of patients suffering from chronic obstructive pulmonary disease (COPD). The literature revealed no universal definition of fatigue and a confusion exists between fatigue and chronic fatigue. Three concept analyses are considered to assist clarification. Everyday meanings are sought as well as meanings revealed in poetry. A continuum from tired to exhausted is identified and definitions offered. Defining attributes are decided upon which will be used as an operational definition in later research. Constructed cases are created; antecedents and consequences are devised from the literature; scales, tests and descriptions of general appearance which appear within the literature are considered as empirical referents. However, whilst assisting with the understanding of the concept and future research, the complexity of this subject is still evident.

Functional aerobic impairment in adolescents seropositive for HIV: a quasiexperimental analysis

OBJECTIVE

To determine the degree to which cardiorespiratory insufficiency limits physical performance in adolescents seropositive for human immunodeficiency virus (HIV).

DESIGN

Quasiexperimental, case series design.

SETTING

Rehabilitation physiology laboratory.

PARTICIPANTS

Seventeen adolescents (12 women, 5 men; age, 18 +/- 2 yr; weight, 74.7 +/- 19.3 kg; height, 170 +/- 9 cm) with HIV infection (viral load, 22,043 +/- 55,869 copies/mL; CD4 count, 499 +/- 210/mL) who were free of comorbid conditions limiting treadmill performance.

MAIN OUTCOME MEASURES

Spirometric measurements of oxygen uptake and anaerobic threshold obtained from a peak exercise treadmill test using the modified Bruce protocol.

RESULTS

Measured peak oxygen consumption (VO2) was 42% +/- 19% lower than expected (p < .025), suggesting a significant functional aerobic impairment (FAI) or peak VO2 less than 73% of expected values. Peak VO2 was only slightly higher (p < .05) than the oxygen uptake requirements for the most intense activities of daily living (ADL). Anaerobic threshold was only slightly higher (p < .05) than minimum ADL intensities.

CONCLUSIONS

Cardiorespiratory insufficiency and FAI limited the ability to perform even low levels of physical activity in these adolescents with mild HIV seropositivity. Disability identified by quantification of FAI may affect implementation of the American with Disabilities Act and public health policy.

Understanding cytokines. Part II: Implications for nursing research and practice

Cytokines are small signaling proteins released from a variety of cells that influence virtually every aspect of growth and development and every host response to infection, injury, and inflammation. Because of their widespread and potent effects across the life span, cytokines without a doubt influence nursing research and practice. From physiological and adaptive effects of cytokines to cytokine-induced diseases, nurses and nursing care are involved. Part II of this review highlights a few of the many examples of cytokines functioning in response to infection and inflammation, during the processes of reproduction, and in a variety of pathophysiological states. Implications for nursing research and practice are emphasized.