Aerobic and resistance training improves mood state among adults living with HIV.

The purpose of this investigation was to examine the effects of combined aerobic and resistance exercise training among self-reported mood disturbances, perceived stress, frequency of self-reported symptoms, and symptom distress in a sample of HIV+ adults. For this purpose, 49 participants were randomly assigned into an exercise (EX) or control (CON) group. Those in the EX group completed 50 min of supervised aerobic and resistance training at a moderate intensity twice a week for 6 weeks. The CON group reported to the university and engaged in sedentary activities. Data were collected at baseline before randomization and 6 weeks post intervention. Measures included the symptom distress scale (SDS), perceived stress scale (PSS), profile of mood states (POMS) total score, and the POMS sub-scale for depression and fatigue. A 2 way ANOVA was used to compare between and within group interactions. The EX group showed a significant decrease in reported depression scores (p=0.03) and total POMS (p=0.003). The CON group reported no change in POMS or SDS, but showed a significant increase in PSS. These findings indicate that combination aerobic and resistance training completed at a moderate intensity at least twice a week provides additional psychological benefits independent of disease status and related symptoms.

Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS): a new autosomal dominant syndrome.

OBJECTIVE: The purpose of this study was the clinical and pathological characterisation of a new autosomal dominant gastric polyposis syndrome, gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS). METHODS: Case series were examined, documenting GAPPS in three families from Australia, the USA and Canada. The affected families were identified through referral to centralised clinical genetics centres. RESULTS: The report identifies the clinical and pathological features of this syndrome, including the predominant dysplastic fundic gland polyp histology, the exclusive involvement of the gastric body and fundus, the apparent inverse association with current Helicobacter pylori infection and the autosomal dominant mode of inheritance. CONCLUSIONS: GAPPS is a unique gastric polyposis syndrome with a significant risk of gastric adenocarcinoma. It is characterised by the autosomal dominant transmission of fundic gland polyposis, including areas of dysplasia or intestinal-type gastric adenocarcinoma, restricted to the proximal stomach, and with no evidence of colorectal or duodenal polyposis or other heritable gastrointestinal cancer syndromes.

Native and modified LDL activate extracellular signal-regulated kinases in mesangial cells.

Glycation and/or oxidation of LDL may promote diabetic nephropathy. The mitogen-activated protein kinase (MAPK) cascade, which includes extracellular signal-regulated protein kinases (ERKs), modulates cell function. Therefore, we examined the effects of LDL on ERK phosphorylation in cultured rat mesangial cells. In cells exposed to 100 microg/ml native LDL or LDL modified by glycation, and/or mild or marked (copper-mediated) oxidation, ERK activation peaked at 5 min. Five minutes of exposure to 10-100 microg/ml native or modified LDL produced a concentration-dependent (up to sevenfold) increase in ERK activity. Also, 10 microg/ml native LDL and mildly modified LDL (glycated and/or mildly oxidized) produced significantly greater ERK activation than that induced by copper-oxidized LDL +/- glycation (P < 0.05). Pretreatment of cells with Src kinase and MAPK kinase inhibitors blocked ERK activation by 50-80% (P < 0.05). Native and mildly modified LDL, which are recognized by the native LDL receptor, induced a transient spike of intracellular calcium. Copper-oxidized (+/- glycation) LDL, recognized by the scavenger receptor, induced a sustained rise in intracellular calcium. The intracellular calcium chelator (EGTA/AM) further increased ERK activation by native and mildly modified LDL (P < 0.05). These findings demonstrate that native and modified LDL activate ERKs 1 and 2, an early mitogenic signal, in mesangial cells and provide evidence for a potential link between modified LDL and the development of glomerular injury in diabetes.

Rapid detection and presumptive identification of Clostridium difficile by p-cresol production on a selective medium.

A modification of a selective medium for Clostridium difficile is described. The ability of Cl difficile to produce p-cresol from p-hydroxy phenyl acetic acid provides a means for the rapid, sensitive detection and presumptive identification of this species in faecal cultures.

Appraisal in the diagnostic laboratory of three commercially available anaerobic cabinets.

Three commercially available anaerobic cabinets are described and their performance in relation to one another and to a standard anaerobic jar technique are reported upon from a clinical laboratory.

Gas chromatographic identification of Clostridium difficile and detection of cytotoxin from a modified selective medium.

A modification of an existing selective medium for Clostridium difficile is described. Inclusion in the medium of DL nor-leucine and p-hydroxyphenylacetic acid enables identification of C difficile to be made directly from primary isolation plates by gas chromatographic detection of caproic acid and p-cresol. Plugs of agar withdrawn from the selective medium also allow the detection of cytotoxin production in vitro.

Rapid diagnosis of anaerobic infections by gas-liquid chromatography of clinical material.

Gas-liquid chromatographic analysis of samples of pus provides a rapid and reliable means for the presumptive differentiation of anaerobic from aerobic infections.

Depression in HIV-infected patients: allopathic, complementary, and alternative treatments.

OBJECTIVES: The purpose of this review article is to synthesize the current knowledge related to depression and HIV disease. METHODS: The research literature was critically evaluated for several selected therapies that are prescribed for HIV-infected persons to treat depression. These therapies included pharmacotherapy, psychotherapy, alternative, and complementary therapies. RESULTS: Several therapies are currently available for the treatment of depression in HIV disease. When prescribing treatments, clinicians should be aware of problems associated with diagnoses, drug-drug interactions, and the benefits of some of the new therapies that are now available. Treatment regimes should be carefully designed to meet the individual needs of the patient and will optimally include a combination of approaches including psychotherapy, pharmacotherapy, education, and/or complementary therapies. CONCLUSIONS: Although HIV is now a treatable disease, the prevalence of depression in the HIV population remains high and should be continually addressed.

Restructuring life to face the future: the perspective of men after a positive response to protease inhibitor therapy.

This article describes a qualitative study that explores the psychosocial changes and care delivery issues experienced by men with AIDS who were facing end-stage disease but then had dramatic physical improvement as a result of protease inhibitor therapy. In-depth interviews were conducted with 11 men with HIV/AIDS drawn from a community-based AIDS service organization in a large metropolitan area in the Southeast. Using Collaizi's model of content analysis, three broad categories, protease inhibitors as a reprieve, changed roles and relationships, and need for advocacy and support, emerged from the data. From the three broad categories, seven more specific themes were identified: guarded optimism, buying time, change in relationships, work versus disability, access to medications, access to HIV/AIDS competent health care, and focused support services. Collectively, the phenomenon resulting from these men's experiences and concerns can be described as efforts to restructure life to face a future they did not expect. These findings support the need for developing formal, structured interventions to help persons living with AIDS (PLWA) to restructure their lives as new antiretroviral therapies promote improvements in health.

HIV-infected women's experiences and beliefs related to AZT therapy during pregnancy.

To explore women's experiences and beliefs concerning zidovudine (AZT) therapy during pregnancy, short-answer and open-ended questions were asked of 322 human immunodeficiency virus (HIV)-infected women at increased risk for pregnancy. Specifically, we examined what women believed they had been told concerning AZT therapy during pregnancy by health care professionals and peers, experiences with taking AZT, how effective they believed AZT therapy to be, and if they would take AZT if they became pregnant. Women in the study were predominately African American (88%), single (79%), with a mean age of 32 years, and had annual incomes less than $10,000 (64%). Although 81.4% of the women had been told to take antiretrovirals, only 69.1% of the women were actually taking HIV-related medicines. Almost three-fourths of the women (70.8%) reported being told that taking AZT during pregnancy would reduce perinatal transmission. Women reported the most frequent reason for their stopping AZT was its side effects. When women who were not presently taking AZT were asked what would make them consider taking it, they most frequently said they would begin AZT if their health deteriorated or based on the advice of health care professionals. A small group of women said nothing would make them take AZT-type medications. More than one-half of the women said they felt AZT was effective in preventing perinatal HIV transmission. However, almost 20% of the women reported believing that their health care provider would not be positive about their taking AZT during pregnancy. Significant relationships were found between intent to take AZT if becoming pregnant and specific AZT-related beliefs and experiences.

Systematic pain records and their impact on pain control. A pilot study.

This study examined the impact of a systematic nursing pain assessment tool (PAT) and pain flow sheet (PFS) on pain management. A control group (N = 23) was compared with a treatment group (N = 20) of hospitalized patients on a medical oncology unit. In the control group, "routine" charting of pain was done in the nurses' narrative notes. Patients in the treatment group underwent standardized pain assessment and documentation using a PAT and PFS. The treatment group reported significantly lower average pain intensity ratings (chi 2 = 5.019, p = 0.02) on day three of follow-up. In addition, a greater number of patients in the treatment group (85%) reported decreased pain intensity from day one to day three as compared with the control group (57%). This study supports other research and recommendations in the literature that use of systematic pain records can improve pain management.

Protease inhibitors: a new weapon and a new strategy against HIV.

Until recently, reverse transcriptase inhibitors have been the mainstay for treating HIV infection. Now, three protease inhibitors have been approved. Early evidence suggests that triple therapy delays the progression of HIV infection. An understanding of these new drugs and treatment strategies is imperative for clinicians. This article (1) reviews HIV's structure and replication process, (2) discusses currently approved reverse transcriptase and protease inhibitors, (3) describes the antiretroviral drugs' modes of action, (4) discusses important nursing implications for monitoring clients on these drugs, and (5) presents current scientific evidence regarding the effectiveness of combination therapy strategies.

Extrapunitive and intropunitive anger of HIV caregivers: nursing implications.

The purpose of this qualitative study was to investigate the anger of individuals who have provided direct patient care to loved ones who are living with or who have died from AIDS. The sample consisted of eight individuals who are currently involved in an AIDS service organization in northeast Tennessee. Data were collected using semistructured taped interviews. At the beginning of the study, two group interviews were conducted. Subsequently, each of the participants was interviewed privately. Extrapunitive and intropunitive anger were predominant themes in each of the interviews. Participants also reported ways of coping with their anger. Nurses can suggest these strategies to other caregivers who are experiencing anger. Recommendations for additional nursing interventions are offered.

Effects of individualized acupuncture on sleep quality in HIV disease.

Although it may begin at any point, sleep disturbance often appears early in HIV disease and contributes to decreased quality of life during the course of the illness. Relatively few studies have explored the complex nature of poor sleep quality in HIV disease or tested interventions to improve sleep quality. The purpose of this study was threefold: explore the nature of sleep quality in HIV disease, test the relationship between pain and sleep quality, and test the effectiveness of acupuncture delivered in a group setting for improving sleep quality in those who are HIV infected. A pretest, posttest, preexperimental design was used to test the effects of acupuncture on sleep quality. Participating in the study were 21 HIV-infected men and women between the ages of 29 and 50 years who reported sleep disturbance three or more times per week and who scored greater than 5 on the Pittsburgh Sleep Quality Index. The Wrist Actigraph was used to measure sleep activity, and the Current Sleep Quality Index was used to measure sleep quality for 2 nights before and after a 5-week acupuncture intervention (10 treatments). Acupuncture was individualized to address insomnia and other symptoms reported by the participants. Sleep activity and sleep quality significantly improved following 5 weeks of individualized acupuncture delivered in a group setting.

Knowledge and risk behaviors of people seeking HIV antibody testing at a community site.

People seeking HIV antibody testing at a community-based AIDS service organization (N = 342) were asked to complete a self-report questionnaire to determine knowledge of HIV transmission, source(s) of HIV-related knowledge, and recent risk behaviors. The overall knowledge level of risk for transmitting HIV associated with 16 related behaviors was relatively high. Yet, 69% of the participants reported engaging in unsafe sex during the previous six months. Poorly informed subjects tended to overestimate their level of knowledge. In a multiple regression analysis, knowledge, age, and gender were the only significantly predictors of engaging in unsafe sex in this cohort. Nurses must be on the forefront in developing (1) strategies to reach people at high risk for HIV infection and HIV transmission, (2) culturally relevant and sensitive education, and (3) interventions that will enable people to make appropriate choices concerning high-risk behaviors.

Health care providers' influence on HIV-infected women's beliefs and intentions related to AZT therapy.

This study examined how women's relationship with their primary health care provider (PHP) and their perceptions about how effective their PHPs believe zidovudine (AZT) to be in decreasing perinatal transmission related to women's AZT beliefs and intentions. It used a cross-sectional design to collect data from 59 HIV-infected African American women. Almost half the women (45%) had given birth since HIV diagnosis. Most of the babies born to HIV-infected mothers (87%) were seronegative. Data analysis with Pearson's r indicated that the quality of the women's relationship with their PHP was positively correlated to how important the PHP would be in decision making related to AZT therapy. Significant positive correlation was observed between women's perceptions about how effective their PHPs believed AZT to be in decreasing perinatal HIV transmission and the women's own beliefs about AZT, their intent to take AZT if pregnant, and intent to give AZT to a newborn.

Hope and coping in HIV-infected African-American women of reproductive age.

African-American women of reproductive age, particularly those living in the southern United States, represent a disproportionate number of women with HIV/AIDS. Often women who become infected with HIV in the South must cope not only with the disease, but with economic stresses and racial stigma, as well. Faced with these changes, these women experience increased distress and loss of hope. The purpose of this study was to examine levels of hope in a group of HIV-infected African-American women and to identify coping strategies that were associated with women maintaining a sense of hope for the future. A descriptive design was used to test the relationships between hope and coping strategies used by HIV-infected African-American women. Reported levels of hope were significantly lower for study participants than for women with breast cancer or for hospitalized adults with cancer who were receiving chemotherapy. Statistically significant positive relationships were observed between hope and the total coping score (r = .37, p = .009) hope and managing the illness (r = .47, p = .001) and between hope and spiritual activities (r = .40, p = .004). A statistically significant negative relationship was observed between hope and avoidance coping (r = -.35, p = .009).

Adult sickle cell patients' perceptions of nurses' caring behaviors.

Sickle cell disease (SCD) is a life-long, acutely painful, chronic illness. This study was conducted to explore differences in perceptions of nurses' caring behaviors between adults with SCD and adults with general medical conditions and the differences in perceptions of nurses' caring behaviors between men with SCD and women with SCD. Watson's (1988) Theory of Human Caring provided the conceptual framework. In this descriptive, correlational design, convenience sampling was used to obtain 29 adults with SCD and 34 adults with other medical conditions. The mean age for adults with SCD was 35.8, and on average they reported four hospitalizations per year. The mean age for the general medical patients was 48.9, and they averaged two hospitalizations per year. Instruments used in this study were a demographic data form and the Caring Behavior Assessment, modified for use in this study. The instruments were distributed through support groups using the snowball technique. Data were analyzed using descriptive statistics and independent t-tests. Participants with SCD reported lower satisfaction with nurses' caring behaviors than those with other medical conditions (t = 2.19, p = .03). Women with SCD reported lower satisfaction with nurses' caring behaviors than men with SCD (t = 2.91, p = .01).

Social service and case management needs of HIV-infected persons upon release from prison/jail.

This study sought to identify social service needs of HIV-infected persons at the time of release from prison/jail and to describe their case management experiences after release from prison/jail. Sixteen men and women who were infected with HIV, each with a history of incarceration, participated in one of three focus group sessions. Study participants consisted of 11 men and five women. The majority of the participants were African-American (81%), single (50%), and currently unemployed (69%). Qualitative analysis of the focus group transcripts revealed a total of 483 comments regarding a need for social or health services. These comments were further grouped into 13 categories of services or service-related issues that represented the range of the responses. Although participants described positive experiences with specific case managers, their overall evaluation of case management was negative. Identified social services needs and the descriptions of their experiences with case management provides insight as to how case management services can be improved for this population.