[Sleep Quality, Depression, Anxiety, and Self-Esteem in People Living With HIV/AIDS (PLWHA)].

BACKGROUND: HIV has become a chronic disease. Therefore, the mental health and sleep quality of people living with HIV/AIDS (PLWHA) have become increasingly important issues of concern. PURPOSE: To explore the sleep quality, depression, anxiety, and self-esteem of PLWHA and the correlation between sleep quality and various related mental-health factors. METHODS: A cross-sectional, descriptive, correlational study was conducted at a medical center in southern Taiwan in 2013-2014. Data on the sleep quality, depression, anxiety, and self-esteem of 146 PLWHA cases were collected using a structural questionnaire (the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, Zung's Self-Administered Anxiety Scale, and Rosenberg Self-Esteem Scale). RESULTS: Three-fifths (60.3%) of the cases had poor sleep quality, 50% were inclined toward depression, and 36.3% were inclined toward anxiety, indicating that sleep quality, depression, and anxiety levels in these cases were worse than the general population. Moreover, significant correlations were identified between poor sleep quality and the variables of depression (r = .40, p < .001) and anxiety (r = .53, p < .001). Multiple variate analysis revealed that older age, subjective feelings that HIV significantly influenced personal life, anxiety, and depression were all significant predictors of sleep quality. No significant correlations were found between CD4 (cluster of differentiation 4) lymphocyte count, HIV viral load, or receiving antiretroviral therapy and the variables of sleep quality, depression, anxiety, or self-esteem. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: About half of the PLWHA cases in the present study exhibited poor sleep quality and tendencies toward depression and anxiety. Moreover, sleep quality and mental health factors were found to be not correlated with CD4 lymphocyte count, HIV viral load, or receiving antiretroviral therapy. Therefore, early evaluation of the sleep quality and mental health of people living with HIV/AIDS is recommended in order to provide holistic care.

Stress, needs, and quality of life of people living with human immunodeficiency virus/AIDS in Taiwan.

Human immunodeficiency virus (HIV)/AIDS is a manageable infectious disease by the effectiveness of highly active antiretroviral therapy. AIDS-related stigma and conflict may create distress and deteriorate quality of life (QoL) of people living with HIV/AIDS (PLWHA). This cross-sectional, descriptive, correlational study using structural questionnaires aimed to explore the stress, needs, QoL, and associated factors of PLWHA in Taiwan. A total of 200 PLWHA participating in this study needed most on treatment of HIV and prevention of AIDS, and health maintenance. They had worse QoL in physical, psychological, and social domains (all p < 0.001) than the general population. Stress was the most significant predictor (ß = -0.25 to -0.54, p < 0.01) for all four domains of QoL. Needs was not significantly associated with QoL. The QoL of PLWHA can be explained by demographics, self-perception on health, needs, and stress for 25.3-40.7% of variances. No association existed between CD4(+) counts and QoL in Taiwanese PLWHA. It is important to recognize the perception of PLWHA on their health status, which is significantly associated with their QoL, besides monitoring their physical indicators of health (CD4(+) counts). To recognize the stress and needs that PLWHA experience and to develop intervention programs targeting strategies on HIV disclosure, prevention and health maintenance are crucial for PLWHA's QoL.

[Case management: a concept analysis].

While the case management approach has been increasingly applied to healthcare worldwide in recent years, significant differences in application exist among discrete medical systems. This paper applies a methodology outlined by Walker and Avant to analyze the case management concept. This methodology is designed to assist medical staff to understand a concept in order to better achieve concept goals. The case management approach works to leverage organizational strategies to resolve case-specific circumstances and issues in order to accomplish organizational goals. Defining attributes of case management include: (1) highly complex cases; (2) the use of multidisciplinary professional teams to resolve case problems in the most cost-effective manner; (3) the use of case managers to manage the effective integration and operation of the multidisciplinary team; and (4) helping cases improve and make effective use of medical system resources.

High prevalence of anal human papillomavirus infection and associated risky behaviors in men infected with human immunodeficiency virus in Taiwan.

A cross-sectional study was conducted to investigate the prevalence, types, and risk factors associated with anal HPV infection among HIV-infected men in outpatient clinics at an AIDS designated hospital in Taiwan. Anal swabs were collect and PCR (polymerase chain reaction) was used to analyze the types of anal HPV infection. HPV DNA was detected in 74.2% of the 198 participants, including high-risk types (40.4%), low-risk types (18.2%) and multiple-types (6%). The most common types were HPV 16 (13.1%), 6 (10.4%), 11 (7.1%) and 18 (6.1%). The significant risk factor for being infected with any type or a high-risk type of HPV was having sexual partners (>3) in the preceding 6 months. Low-risk type of anal HPV infection was associated with a history of anal lesions. Our findings support the need for regular follow-up of all HIV/HPV coinfected patients and their partners to allow early detection of anal intraepithelial neoplasia.

[Evidence-based nursing care for cancer patients with opioid-induced constipation].

About one-third of cancer patients who receive opioid drugs to control pain experience constipation. While clinical healthcare personnel often deal with constipation problems by adopting professional suggestions, effective evidence-based solutions remain lacking. Thus, cancer patient constipation problems are often not effectively solved. In this article, 2009 American National Comprehensive Cancer Network guidelines for palliative care in cancer were modified as the basis of evidence-based nursing research. Constipation assessments should first be conducted before the initiation of opioid drug treatment to relieve pain in cancer patients. Before the patient develops opioid-induced constipation, preventive action should be conducted, such as using drug combinations (e.g., sennoside and docusate). Non-pharmaceutical interventions include exercising, maintaining a high-fiber diet, conducting abdominal massage and having correct bowel habits. If the patient is already experiencing constipation, bisacodyl (ducolax) may be used. However, if no improvement is observed, pharmaceutical treatments (e.g., a lactulose-sennoside combination) may be administered. If stool impaction occurs during the testing process, digital and glycerine should be implemented to remove stool impaction. Eliminating stool impaction enhances medication effectiveness. Nurses should advise doctors regarding preventive measures related to commencing treatment with opioid drugs. Further, nurses must evaluate degree of constipation and educate patients on following non-pharmaceutical strategies to alleviate constipation to improve quality of life.