The mediation effect of treatment fatigue in the association between memory and health-related quality of life in men with HIV who have sex with men.

Approximately half of all adults living with the Human Immunodeficiency Virus (HIV) experience cognitive alterations related to difficulties in treatment adherence and, therefore, to a significant decrease in quality of life. In this sense, new studies are needed to identify potential mediators related to treatment in this association, such as treatment fatigue. This fact is especially important in at specific groups of individuals with HIV, namely men with HIV who have sex with men (MSM). The objective of this study was to analyze the association between cognitive functioning, Health-Related Quality of Life (HRQoL), and treatment fatigue in MSM with HIV. A cross-sectional study was developed with a sample of 70 MSM, from the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). Participants completed questionnaires related to sociodemographic data, HRQoL, and treatment fatigue in an initial phase; in a second phase, they were administered a computerized cognitive evaluation. Our results demonstrate a significant relationship between a lower cognitive performance in the memory domain and worse HRQoL. Mediation analysis has revealed the total mediation effect of treatment fatigue, specifically, the treatment cynicism domain, on this relationship. This mediation effect remained significant after controlling the sociodemographic and clinical HIV-related variables in the model. No significant mediation effects of the rest of evaluated cognitive domains (attention, perception, reasoning, or coordination) were found in this relationship. The results of this study highlight how MSM with a significant deterioration of memory are at greater risk of developing high levels of treatment fatigue, and, therefore, a lower adherence to the same and a significant deterioration in their HRQoL.

Spanish validation of the simple lifestyle indicator questionnaire: validity and reliability analysis.

Introduction: It has been shown that lifestyle is a highly modifiable determinant having a direct effect on the health status. Therefore, short and simple questionnaires assessing the lifestyle of the general and clinical population are needed to create interventions on behavioral aspects that can improve the health status. The Simple Lifestyle Indicator Questionnaire (SLIQ) is a validated health scale in English that combines five lifestyle factors: diet, exercise, alcohol consumption, tobacco use, and stress level. The objective of this study was to validate the SLIQ questionnaire in Spanish by analyzing the scale's validity and reliability. Its discriminatory power of the scale was also examined by evaluating the differences in health outcomes according to the levels of adherence to a healthy lifestyle. Methods: The sample consisted of 745 participants with an average age of 39.94 (SD: 16.99). A transcultural adaptation process was carried out to validate the SLIQ questionnaire in the Spanish context, to determinate the structural equivalence of the Spanish version as compared to the English version, and to assess the psychometric properties of the scale. PREDIMED and IPAQ scales were used to analyze the convergent validity of the Spanish version of the SLIQ regarding to diet and exercise, and the questionnaires SF-12 and DASS-21 questionnaires were used to assess the capacity of the Spanish version of the SLIQ to discriminate health status related to different levels of reported lifestyles. Results: Regarding validity, the results indicate significant correlations between the different dimensions of the SLIQ questionnaire and those used as a reference. As for reliability, the test-retest analyses reveal a high temporal consistency for the scores obtained on the questionnaire. Finally, the differences found in anxiety, depression, and quality of life, with regard to the different levels of adherence in the SLIQ questionnaire, suggest that the questionnaire's Spanish version has adequate discriminatory power. Discussion: The obtained correlation coefficients between the SLIQ and the other standardized measures pointed out the adequate convergent validity of the instrument. Moreover, the test-retest results demonstrated the stability of the results obtained through this questionnaire. Finally, the lifestyle categories derived from the SLIQ showed a high ability to discriminate between participants' health profiles. Hence, it can be concluded that the Spanish version of the SLIQ questionnaire is a valid and reliable tool for the quick and effective assessment of lifestyle.

Assessment Strategies to Evaluate the Mediterranean Lifestyle: A Systematic Review.

The Mediterranean Lifestyle (MLS) has been related to better health and quality of life. However, there is no consensus on how to assess this lifestyle. The main objective of this work was to systematically review the methodology used in different studies on the evaluation of the MLS. The specific objectives were (1) to analyze the MLS components evaluated in previous studies, (2) to explore the assessment instruments available for the analysis of the MLS, and (3) to identify the psychometric properties of these instruments. The search was carried out using the PubMed, Scopus, Web of Science, and ScienceDirect databases with the purpose of identifying those published articles in which the MLS was assessed. The review included 26 studies linked to the assessment of the MLS. Of these studies, only four exclusively used a tool to analyze MLS components globally. These studies included two questionnaires and three different indexes. None of them, however, evaluated all of the recognized MLS components, and food preparation was the least frequently evaluated component. Given the clear importance of analyzing MLS adherence and the lack of consensus in previous research, an evaluation tool needs to be created to comprehensively assess all of the MLS dimensions by means of appropriate psychometric properties.

Impact of COVID-19 Pandemic on Academic Stress and Perceived Classroom Climate in Spanish University Students.

The COVID-19 pandemic has caused several changes in society, especially in the educational context, where several learning methodologies and social interactions have been modified significantly. This fact could have had a negative impact on academic stress levels of students and the classroom climate, especially in the university context. The main aim of the present study was to identify changes in academic stress and the perceived classroom climate caused by COVID-19 in a sample of Spanish university students. Academic stress was evaluated trough the Stressor Academic Scale (SAS) and perceived classroom climate employing the Perceived Classroom Responsibility Climate (PCRC) questionnaire. A longitudinal study was conducted. 135 students (97 females and 38 males) from the Gastronomy (n = 31) and Criminology (n = 104) degrees were evaluated before and after the COVID-19 lockdown in Spain. Academic stress levels and perceived classroom climate were analyzed before (Time 1) and after (Time 2) the lockdown declaration. An increase in academic stress was found, especially in the categories regarding Teachers' Methodological Deficiencies, Academic Over-Burden and Beliefs About Performances. Females and final year students suffered higher levels of academic stress. No differences were found between Time 1 and 2 in perceived classroom climate. The obtained results point out a significant increase of academic stress in university students due to the COVID-19 pandemic in Spain. The implemented educational changes and the uncertainty that resulted from the pandemic could have a significant negative impact on mental health in this population, resulting in higher levels of academic stress, especially in females and final year students. Future studies should analyze the strategies that students are employing to cope with these educational challenges and intervention strategies to promote them in the context of higher education.

Gut hormones profile after an Ivor Lewis gastro-esophagectomy and its relationship to delayed gastric emptying.

Delayed gastric emptying (DGE) is common after an Ivor Lewis gastro-esophagectomy (ILGO). The risk of a dilated conduit is the much-feared anastomotic leak. Therefore, prompt management of DGE is required. However, the pathophysiology of DGE is unclear. We proposed that post-ILGO patients with/without DGE have different gut hormone profiles (GHP). Consecutive patients undergoing an ILGO from 1 December 2017 to 31 November 2019 were recruited. Blood sampling was conducted on either day 4, 5, or 6 with baseline sample taken prior to a 193-kcal meal and after every 30 minutes for 2 hours. If patients received pyloric dilatation, a repeat profile was performed post-dilatation and were designated as had DGE. Analyses were conducted on the following groups: patient without dilatation (non-dilated) versus dilatation (dilated); and pre-dilatation versus post-dilatation. Gut hormone profiles analyzed were glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY) using radioimmunoassay. Of 65 patients, 24 (36.9%) had dilatation and 41 (63.1%) did not. For the non-dilated and dilated groups, there were no differences in day 4, 5, or 6 GLP-1 (P = 0.499) (95% confidence interval for non-dilated [2822.64, 4416.40] and dilated [2519.91, 3162.32]). However, PYY levels were raised in the non-dilated group (P = 0.021) (95% confidence interval for non-dilated [1620.38, 3005.75] and dilated [821.53, 1606.18]). Additionally, after pyloric dilatation, paired analysis showed no differences in GLP-1, but PYY levels were different at all time points and had an exaggerated post-prandial response. We conclude that DGE is associated with an obtunded PYY response. However, the exact nature of the association is not yet established.

Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life.

INTRODUCTION: The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. METHODS: The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample's mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. RESULTS: The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. DISCUSSION: Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.

Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men.

Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption.

Personal and Lifestyle Determinants of HIV Transmission Risk in Spanish University Students.

The increase in human immunodeficiency virus (HIV) transmission cases poses a serious public health concern. Although several previous studies have been conducted with the aim of identifying the risk factors for HIV transmission, the number of cases has been increasing, especially in youth. The present study is aimed at the identification of personal and lifestyle determinants of HIV transmission risk in a sample of 335 Spanish university students selected by convenience sampling from a public university located in Alicante (Spain). Sociodemographic factors, lifestyles, and variables of HIV risk of transmission were evaluated. Group differences on risk of HIV transmission were evaluated between participants depending on their sociodemographic characteristics (age, sex, relationship status, employment status, economic status, and sexual orientation) and lifestyle (diet, physical exercise, smoking, alcohol consumption, and stress). Linear regression models were conducted in order to identify those personal and lifestyle variables related to HIV transmission risk. The obtained results indicate that, generally, being older, in a relationship, and employed were factors related to a high risk of HIV transmission. Regarding lifestyle, poor diet, lower intensity of physical exercise, higher alcohol intake, and smoking were fundamentally associated with a higher risk of HIV transmission, through lower use of condoms and higher frequency of risky sexual behaviors. Hence, participants who develop an unhealthy lifestyle exhibit twice the probability of being at a high risk of HIV transmission, especially regarding these previously indicated behaviors. The present study points out the relevance of sociodemographic characteristics and lifestyles of university students in their proneness to developing risky behaviors for HIV infection. Future studies should be developed with larger, randomized, and more representative samples, in order to obtain significant information for the development of effective preventive strategies oriented toward the increase in the adherence to healthy lifestyles and HIV prevention.

The Medical Outcome Study-HIV Health Survey: A systematic review and reliability generalization meta-analysis.

The Medical Outcome Study-HIV Health Survey (MOS-HIV) is one of the most used questionnaires for the evaluation of the health-related quality of life (HRQoL) in people living with HIV (PLWHIV) in both medical settings and research studies. This study aimed to estimate the average reliability of the MOS-HIV scores and to evaluate the characteristics of the studies that could explain the variability between reliability estimates. Furthermore, the study aimed to estimate the induction rate of the reliability of the MOS-HIV. A systematic review of the previous literature, including studies that reported α and/or test-retest coefficients with the data at hand for the total score of the MOS-HIV and the subscales, was conducted. Fifty studies (52 samples; N = 14,132) were included in the reliability generalization meta-analysis. The average α coefficient for the total score of MOS-HIV was .91 and above .80 for all of the subscales, except for role functioning, which had an average coefficient of .76. Different study dimensions were related to the heterogeneity of reliability between studies. Reliability induction was found to be 76.1%. The results obtained in the present study indicate that the MOS-HIV is a reliable instrument for HRQoL evaluation in PLWHIV, for clinical and research purposes. In the clinical practice of health services, nurses could employ this gold standard for reliable evaluations of HRQoL in PLWHIV.

The Role of Mental Health Conditions in the Diagnosis of Neurocognitive Impairment in People Living with HIV.

The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study on HIV subjects, ≥18 years old, on stable antiretroviral treatment and with HIV viral load <50 copies/mL was carried out. Patients with known comorbidities, substances abuse, anxiety or depression were excluded. UMHC were evaluated by the Millon Clinical Multiaxial Inventory-III and NCI by Frascati criteria. The association between NCI and sociodemographic, clinical HIV variables and mental health conditions was analyzed. Further, the relationship between mental health conditions scores and NCI diagnosis was evaluated. Eighty patients were included, 37.5% had at least one undiagnosed mental health condition, and 26.3% had NCI. The most frequent mental health conditions were: anxiety (21.3%); bipolar disorder (11.3%); and substance dependence (8.8%). Only longer time since HIV diagnosis (p = 0.030) and at least one mental health condition diagnosis (p = 0.002) showed an association with NCI. Participants with NCI presented higher scores in anxiety, alcohol dependence and post-traumatic stress. Undiagnosed mental health conditions are frequent in PLWHIV. These disorders cannot be identified by HIV clinicians or basic screening questionnaires, and they are not usually self-reported by patients. UMHC could act as confounders in the evaluation of NCI.