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.

Perceived stress in HIV-infected individuals: physiological and psychological correlates.

The purpose of this study was to determine the correlation of perceived stress with selected physiological and psychological factors in an HIV-infected, predominantly African American population and to assess the multivariable effects on perceived stress. The variables that correlated significantly with perceived stress were entered into a backward stepwise regression model. Pearson's r analysis showed significant correlations between perceived stress and state and trait anxiety, depression, HIV-related symptoms, sleep quality, daytime sleepiness and fatigue. State and trait anxiety, depression and fatigue retained significance (p<0.1) in the final regression model. These factors explained approximately 80% of the variance in perceived stress. The significant interactions of multiple physiological and psychological correlates suggest that perceived stress is a complex outcome with a multifactorial etiology. Further, the model suggests that psychological factors may contribute to perceived stress in this population more than physiological factors such as HIV-related symptomatology or stage of disease.

Counteracting muscle wasting in HIV-infected individuals.

HIV-infected persons often experience a loss of lean tissue mass, which includes decreases in skeletal muscle mass. This HIV-associated wasting is significant because it has been associated with accelerated disease progression and increased morbidity. Signalling related to several circulating molecules, including tumour necrosis factor (TNF)-alpha, growth hormone, insulin-like growth factor (IGF)-1 and testosterone, has been associated with the aetiology of muscle wasting. Additionally, nutritional status related to malnutrition and specific dietary deficiencies may be involved. In an attempt to counter muscle wasting in HIV-infected persons, treatments have been suggested that target these mechanisms. Nutritional supplementation, cytokine reduction, hormone therapy and resistance exercise training are potential treatments for this condition. Resistance exercise training, which is more easily accessible to this population than other treatments, holds promise in counteracting the process of HIV wasting, as it has been successfully used to increase lean tissue mass in healthy and clinical populations. This review will explore the HIV/AIDS muscle-wasting syndrome, its aetiology, and the treatments used to counteract wasting.

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.

Physical activity and immunity in HIV-infected individuals.

The purpose of this study was to determine what relationship exists among physical activity levels and viral load and CD4+ cell count in HIV-infected individuals. Increased viral load is associated with disease progression and symptom severity. A convenience sample of 66 male and female subjects between the ages of 18 and 64 years of age (mean 39 +/- 8) was recruited from a hospital-based HIV/AIDS clinic. Components of PA were assessed for three continuous days using a mini-motion logger wrist actigraph. These components included mean PA level, and PA index and acceleration index. Pearson's correlational analysis was used to test the strength of association between PA components and viral load or CD4+ cell count. A significant inverse relationship was found between mean PA level and viral load (p=0.047). An inverse relationship was also observed between PA index and viral load (p=0.0061). Neither mean PA nor PA index scores correlated with CD4+ cell counts. Acceleration index, a measure of PA intensity, showed no correlation to viral load or CD4+ cell counts. These findings suggest that increasing levels of physical activity might have beneficial effects on viral load in HIV-infected individuals.

Disclosure of HIV infection: how do women decide to tell?

This descriptive study explores the phenomenon of disclosure of HIV infection by women. Specifically, we examined women's level of disclosure to various groups and how these disclosure decisions are made. The sample consisted of 322 HIV-infected women residing in the southern US. Participants were predominantly African-American, single women of reproductive age with yearly incomes less than $10,000. Data were collected at the first interview of a longitudinal study of reproductive decision making. Findings showed that the majority of the women had disclosed to some sex partners, close family and friends, and health care professionals. However, for a group of women, disclosure of HIV infection is a difficult issue supporting the need for health education and counseling. Qualitative data were analyzed using content analysis and revealed three major categories describing how women make disclosure decisions: full disclosure, criteria for disclosure and emotional disclosure. Quantitative analysis revealed few demographic differences among women in the three disclosure categories. These findings provide insight that can assist those working with HIV-infected women in helping them decide not only to whom they disclose, but how best to disclose.

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.

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.

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.

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).

Issues of women dually diagnosed with HIV infection and substance use problems in the Carolinas.

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have unique needs that require integration of physical and psychosocial interventions. These women may benefit from the services of psychiatric or mental health nurse practitioners who have the skills necessary to address the many psychosocial issues women face as well as provide physical treatment. Additionally, drug treatment services need to be expanded and made more comprehensive. Drug treatment programs need to be developed specifically for women, and these services need to be made accessible to poor women with substance abuse problems. Further, drug treatment programs need to provide comprehensive services that can appropriately integrate the treatment of HIV disease and substance abuse.

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.

Levels of hope in HIV-infected African-American women of reproductive age.

HIV disease continues to grow at a staggering rate among women, with women of color becoming the group most frequently affected. Previous research has supported hope as an important factor associated with better health, quality of life, recovery from illness, and increased survival in life threatening illnesses such as HIV disease. The purpose of this study was to describe levels of hope in HIV-infected, African-American women, and to examine the relationships among hope and the women's reported symptoms, stage of illness, and perceived relationship with her primary health care provider (PHCP). A descriptive, quantitative design was used. The sample consisted of 49 African-American women 18 to 45 years of age. Face-to-face structured interviews were conducted. Hope was measured using the Herth Hope Scale, and the quality of the relationship with one's PHCP was measured using the Relationship with the PHCP Scale. The level of hope in these HIV-infected women was lower than women with breast cancer and hospitalized adults with cancer. No significant differences were found in level of hope related to relationship status, income, stage of illness, or if a woman had or did not have children. Hope was positively associated with a more positive relationship with the PHCP (r = .33, P = .02). This finding underscores the importance of the quality of the PHCP's relationship with their clients.

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).

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.

Nursing management of anxiety in HIV infection.

Anxiety is a universal problem for individuals with AIDS because the disease creates uncertainty and disruptions in every aspect of their lives. Nurses have a wide variety of holistic interventions to help persons living with AIDS (PLWAs) manage anxiety. Orem's self-care theory of nursing provides a framework for assessing, diagnosing, planning, implementing, and evaluating nursing care for an HIV-infected person experiencing anxiety. This article presents an overview of anxiety, the nature of anxiety in HIV-infected individuals, and psychological, pharmacological, and holistic interventions to assist the client in self-care of anxiety.