ABSTRACT
The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: "health-related quality of life", "HQRoL", "HIV", "AIDS", "advanced HIV disease" and "low CD4 cells". Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case-control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.
RESUMEN: El objetivo del estudio fue evaluar los efectos de la enfermedad avanzada de sida (EAS) en la calidad de vida relacionada con la salud (CVRS) en personas que viven con el VIH (PVVIH), los cambios experimentados en la CVRS en los últimos 25 años y las diferencias entre países. Realizamos una revisión sistemática y metaanálisis. La búsqueda se llevó a cabo en PubMed y Web of Science utilizando los términos: "calidad de vida relacionada con la salud", "CVRS", "VIH", "SIDA", "enfermedad avanzada por VIH" y "células CD4 bajas". Los criterios de inclusión de los estudios fueron: población adulta; iniciado después de 1996 y publicado antes de julio de 2021; ensayos clínicos, estudios transversales, de cohorte y de casos y controles; estudios que analizan la relación entre EAS y CVRS; idioma inglés o español. Se calcularon diferencias de medias estandarizadas (d+) para estimar el tamaño del efecto para los metaanálisis. Los efectos promedios se calcularon utilizando un modelo de efectos aleatorios, y el análisis de moderadores utilizando modelos de efectos mixtos. El metaanálisis incluyó 38 estudios. Los resultados indicaron que la CVRS es peor en pacientes con EAS en comparación con aquellos sin EAS. Los principales dominios de CVRS afectados son la percepción de salud general y su preocupación, y la función física y de salud y los síntomas asociados. Encontramos un impacto moderado por edad y género en algunos dominios de CVRS. No encontramos diferencias en cuanto a las desigualdades socioeconómicas, país de residencia o período de tiempo analizado. En conclusión, la enfermedad avanzada por VIH tiene un impacto negativo en la salud y el bienestar en las personas con VIH. Nuestros resultados muestran que, a pesar de todos los avances en los tratamientos antirretrovirales en los últimos 25 años, el EAS persiste como una fuente de extrema vulnerabilidad, independientemente de dónde vivan las personas con VIH.
Subject(s)
HIV Infections , Quality of Life , Humans , HIV Infections/psychology , HIV Infections/drug therapy , CD4 Lymphocyte Count , Male , Female , AdultABSTRACT
OBJECTIVES: To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved. MATERIAL AND METHODS: An anonymous survey (n=202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care. RESULTS: The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P=.005). The items that scored highest were "team availability", "information received" and "assistance for facing the disease", followed by "pain control", "peaceful death", "assistance for patient-family communication", "grief support" and "quality of life". CONCLUSIONS: Based on the relatives' assessment, the hospital PCU teams help increase the quality of care at the end of life.
ABSTRACT
OBJECTIVE: The objective of this study is to evaluate third-trimester fetal liver biometry, to predict birth weight and cord markers at birth in diabetic pregnancies. STUDY DESIGN: Fetal liver biometry (liver diameters, area and volume) was obtained between 32 and 34 weeks. A blood sample was obtained from cord after birth. Receiver operating characteristic (ROC) curve models were evaluated for 75th and 90th birth weight percentile. Univariate and multivariate models were used. RESULT: All the hepatic diameters, area and sectional volume demonstrated significant differences in both birth weight percentile ⩾75 and ⩾90. All ROC curves showed significant values. A significant association was observed for all measurements with birth weight. In multivariate model, liver area volume gave significant values for predicting birth weight. Cord leptin, c-peptide and ferritin were related to fetal hepatic size. CONCLUSION: The hepatic changes in gestational diabetes were valid to predict birth weight and metabolic changes at birth.
Subject(s)
Birth Weight , Diabetes, Gestational/epidemiology , Fetal Blood/chemistry , Fetal Weight , Fetus/diagnostic imaging , Liver/anatomy & histology , Adult , Biomarkers/analysis , Biomarkers/blood , Biometry/methods , C-Peptide/analysis , Female , Humans , Leptin/analysis , Linear Models , Liver/diagnostic imaging , Multivariate Analysis , Organ Size , Predictive Value of Tests , Pregnancy , Pregnancy Trimester, Third , Prospective Studies , ROC Curve , Spain/epidemiology , Ultrasonography, PrenatalABSTRACT
OBJETIVO: Conocer la satisfacción de familiares de pacientes fallecidos con la atención recibida en una unidad de cuidados paliativos (UCP) y comparar con los casos donde no intervino el equipo con atención psicológica específica. MATERIAL Y MÉTODOS: Administración de encuesta anónima (n=202) a familiares (tasa de respuesta = 42,1%). Se evaluaron 9 cuestiones relacionadas con el proceso de morir y la valoración global de la atención. RESULTADOS: La satisfacción global fue alta (9,22). La valoración del equipo completo fue 9,40 y sin la psicóloga, 8,40 (p = 0,005). Los ítems mejor valorados fueron «disponibilidad del equipo», «información recibida» y «ayuda para enfrentar la enfermedad», seguidos de «control del dolor», «muerte en paz», «ayuda para la comunicación entre paciente-familia», «apoyo en el duelo» y «calidad de vida». CONCLUSIONES: Según la valoración de los familiares, los equipos de las UCP hospitalarias contribuyen a incrementar la calidad de la atención al final de la vida
OBJECTIVES: To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved. MATERIAL AND METHODS: An anonymous survey (n = 202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care. RESULTS: The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P = .005). The items that scored highest were "team availability", "information received" and "assistance for facing the disease", followed by "pain control", "peaceful death", "assistance for patient-family communication", "grief support" and "quality of life". CONCLUSIONS: Based on the relatives' assessment, the hospital PCU teams help increase the quality of care at the end of life
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Hospice Care/psychology , Personal Satisfaction , Quality of Life , Professional-Family Relations , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
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