Psychosocial predictors of quality of life among South Africa adolescents receiving antiretroviral therapy.

PURPOSE: Minimal research has been conducted to understand how fatigue influences quality of life (QOL) among adolescents living with HIV. The purpose of the study was to examine the relationship between fatigue, sleep disturbance, depression, anxiety, pain and QOL among adolescents receiving antiretroviral therapy (ART). METHODS: Using a cross-sectional survey design, we studied 134 South African adolescents receiving an ART at community clinics. RESULTS: Participants in general reported low levels of fatigue, insomnia, distress and pain and non-problematic levels of QOL. In the regression model, the linear combination of these variables explained 49% of the variance in QOL, a large effect size. Insomnia, anxiety, and depression significantly predicted QOL but surprisingly fatigue and pain did not. CONCLUSIONS: Many members of the sample experienced non-clinical levels of sleep disturbance, fatigue and psychosocial distress. Similarly, QOL was within the normal range. These findings are surprising as the commonly held assumption is that adolescents living with HIV, especially those of poorer socio-economic backgrounds, would experience lower QOL than the norm. Even though scores on the instruments measuring these variables fell in the non-clinical range, they were still robustly predictive of poor QOL. Future research may address the relationship between self-reported adherence and QOL, possibly by examining the role of viral load as a mediating variable. Further research may also focus on non-adherent adolescents to understand the ways in which fatigue and other factors such as school functioning and social interaction influence QOL.

Fatigue among South African adolescents living with HIV: Is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue?

Evidence suggests that HIV-infected adolescents experience elevated levels of fatigue that impacts their functioning at school and other important aspects of their lives. Yet, fatigue has not been measured amongst this population group. In this cross-sectional, mixed-methods study we explored the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) amongst 134 South African adolescents (11-18 years old) receiving antiretroviral therapy (ART) in the Western Cape. Using the Likert scoring method for the CFQ, the mean total score was 14.89 (SD=3.83) and about a quarter (n=33, 24.63%) of adolescents scored ≥ 18, indicating problematic levels of fatigue. The CFQ demonstrated good internal consistency with a Cronbach's alpha of 0.83 (0.84, with item 11 deleted), which is comparable to other validation studies. On the first iteration of the principal component analysis (PCA) with a Varimax rotation, three factors accounted for 59.15% of the variance. However, the third factor consisted of one item only which we chose to remove from the analysis. On the second iteration of the PCA, a two factor solution was retained that accounted for 54.24% of the variance. The first factor, 'Physical fatigue', represented the first eight items on the scale. The second factor 'Mental fatigue' represented items nine and ten. The CFQ also demonstrated modest content and construct validity. The CFQ is a short, easy-to-use and cost-effective measure of fatigue, and demonstrates reliability and validity amongst a South African sample of adolescents. Given the high rate of fatigue amongst our participants, we recommend that future interventions be developed to reduce fatigue among HIV-infected adolescents, which may ultimately lead to improvements in school performance and social functioning. Future research may include test-retest reliability of the CFQ in order to show stability over time.

' But i'm still tired': the experience of fatigue among South African adolescents receiving antiretroviral therapy.

In adults with HIV, fatigue is a common and disabling symptom associated with suboptimal adherence to antiretroviral therapy (ART), poor health and well-being, reduced economic productivity, and increased health care resource use. Fatigue among adolescents with HIV is relatively unexplored. We recruited 14 adolescents with HIV receiving ART in South Africa whom we interviewed about fatigue. We used thematic analysis to analyse the data. Participants reported difficulties in maintaining concentration at school and resorting to self-care strategies such as napping during school hours. Adolescents also described actively avoiding activities thought to lead to fatigue and spoke of being socially excluded by their peers. The findings demonstrate that adolescents experienced symptoms consistent with a definition of fatigue, which had implications for their academic and social lives.

The resistance spectrum shown by a fenvalerate-resistant strain of blue tick (Boophilus decoloratus) to a range of ixodicides.

A strain of Boophilus decoloratus, resistant to fenvalerate, was subjected to larval immersion, adult immersion and stall tests using the following classes of ixodicides: organochlorines, organophosphates, a diamidide and pyrethroids. A susceptible reference strain of B. decoloratus was used for comparative purposes. The results indicated a high level of resistance to DDT and camphechlor, slight tolerance to dioxathion, chlorfenvinphos and pirimiphos ethyl, full susceptibility to bromophos ethyl and amitraz, but marked resistance to cyhalothrin, cypemethrin, deltamethrin and flumethrin. This marked resistance in the strain therefore appears to be widespread within the pyrethroid group of chemicals and may have developed as a result of organochlorine cross-resistance.

Resistance by the blue tick (Boophilus decoloratus) to the synthetic pyrethroid, fenvalerate.

The Shaw larval test, in conjunction with adult tick immersion and stall tests, was utilized to confirm that a field strain of B. decoloratus, from Natal, is highly resistant to the ixodicide fenvalerate (Factor of resistance 4,744). This resistance developed over a reported 18 months of usage for cattle dipping.

Malignant fibrous histiocytoma of the parotid gland associated with polycythemia.

Although malignant fibrous histiocytoma (MFH) is thought to be the most common soft tissue tumor of late adult life, it is extremely uncommon in the parotid gland. A case of MFH in the parotid is reported, associated with polycythemia, which remitted following surgical extirpation of the tumor.