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Tang C, Goldsamt LA, Yu S, Zhao T, Wang H. Psychological pathways to HIV-related posttraumatic stress disorder symptoms among people living with HIV in China: the mediating role of rumination. AIDS Care 2023; 35:165-169. [PMID: 35749306 DOI: 10.1080/09540121.2022.2092713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The occurrence of HIV-related posttraumatic stress disorder (PTSD) compromises the physical and mental health of people living with HIV (PLWH). This study examined the psychological pathways of HIV-related PTSD symptoms considering the influence of rumination in PLWH of China. A cross-sectional survey was conducted in Changsha, China. The data were collected using the PTSD Checklist-Civilian Version, the Ruminative Response Scale, the Multidimensional Scale of Perceived Social Support, and measures of sociodemographic and HIV-related clinic characteristics. A total of 602 PLWH were surveyed. The average score of HIV-related PTSD symptoms was (34.54 ± 13.58). The mediation model showed that perceived social stigma and physical health exhibited direct associations with PTSD symptoms (β = 0.093, -0.145, respectively), while the direct relations of family support, friend support and significant others support to PTSD symptoms were not significant. Rumination mediated the effect of perceived social stigma (β = 0.077), physical health (β = -0.150), family support (β = -0.144) and friend support (β = -0.105) on PTSD symptoms. The study findings underscore the importance of routinely assessing PTSD for PLWH, and developing trauma-focused interventions that alleviate HIV-related PTSD symptoms and reduce rumination while improving social support and physical health and reducing social stigma.
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Affiliation(s)
- Chulei Tang
- School of Nursing, Nanjing Medical University, Nanjing, People's Republic of China
- Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Lloyd A Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Simin Yu
- Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Ting Zhao
- Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
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Cunha GHD, Lima RCRDO, Lopes MVDO, Galvão MTG, Siqueira LR, Fontenele MSM. Mortality, survival and prognostic factors of people with AIDS in intensive care unit. Rev Esc Enferm USP 2021; 55:e20210121. [PMID: 34516603 DOI: 10.1590/1980-220x-reeusp-2021-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze mortality, survival and prognostic factors of patients with AIDS in Intensive Care Unit (ICU). METHOD Retrospective cohort study with a sample of 202 patients with AIDS in ICU, whose sociodemographic, epidemiological, and clinical characteristics were obtained from medical records and assessed. RESULTS Patients were mostly male (73.8%) and drug users (59.4%), with no regular health follow-up (61.4%) and no adherence to antiretrovirals (40.6%), presenting low CD4+ T lymphocyte count (94.0%) and high viral load (44.6%). The main causes of hospitalization were sepsis and respiratory and renal insufficiency. The mean duration of hospitalization was 11.9 days (p = 0.0001), with a 41.6% survival; 58.5% died in the ICU. Sepsis upon admission (p < 0.001), pressure injury (p = 0.038), sexual exposure (p = 0.002), high viral load (p = 0.00001) and prolonged hospitalization (p < 0.001) increased the risk of death. CONCLUSION Most patients had no regular health follow-up, were drug users and presented low CD4+ T lymphocyte count and high viral load. The high mortality indicated that antiretroviral adherence is essential to reduce viral resistance, opportunistic diseases, and mortality.
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Affiliation(s)
- Gilmara Holanda da Cunha
- Universidade Federal do Ceará, Departamento de Enfermagem, Programa de Pós-graduação em Enfermagem. Fortaleza, CE, Brazil
| | | | | | - Marli Teresinha Gimeniz Galvão
- Universidade Federal do Ceará, Departamento de Enfermagem, Programa de Pós-graduação em Enfermagem. Fortaleza, CE, Brazil
| | - Larissa Rodrigues Siqueira
- Universidade Federal do Ceará, Departamento de Enfermagem, Programa de Pós-graduação em Enfermagem. Fortaleza, CE, Brazil
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Graham L, Makic MBF. Nursing Considerations for Patients With HIV in Critical Care Settings. AACN Adv Crit Care 2021; 31:308-317. [PMID: 32866256 DOI: 10.4037/aacnacc2020969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized.
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Affiliation(s)
- Lucy Graham
- Lucy Graham is Director of Nursing Education Programs and Assistant Professor, Colorado Mesa University, 1100 North Ave, Grand Junction, CO 81501
| | - Mary Beth Flynn Makic
- Mary Beth Flynn Makic is Professor, University of Colorado, College of Nursing, Aurora, Colorado
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Cournoyer JM, Garms AP, Thiessen KN, Bowers MT, Johnson MD, Relf MV. Cardiovascular Disease and HIV: Pathophysiology, Treatment Considerations, and Nursing Implications. Crit Care Nurse 2018; 36:37-46. [PMID: 27694356 DOI: 10.4037/ccn2016839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
HIV infection has progressed from an acute, terminal disease to a chronic illness with cardiovascular disease as the leading cause of death among persons living with HIV. As persons living with HIV infection continue to become older, traditional risk factors for atherosclerosis compounded by the pathophysiological effects of HIV infection and antiretroviral therapy markedly increase the risk for cardiovascular disease. Further, persons living with HIV are also at high risk for cardiomyopathy. Critical care nurses must recognize the risk factors for cardiovascular disease and the pathophysiology and complex treatment options in order to manage care of these patients and facilitate multidisciplinary collaboration. Two case studies are used to highlight the treatment options and nursing considerations associated with cardiovascular disease among persons living with HIV.
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Affiliation(s)
- Justin M Cournoyer
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Aven P Garms
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Kimberly N Thiessen
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Margaret T Bowers
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Melissa D Johnson
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Michael V Relf
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing.
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