What is known from the existing literature about how sleep is measured in HIV care? A scoping review.

The HIV care landscape has significantly altered over the past 30 years with advances in HIV medical treatment. Despite these medical advances, people living with HIV experience a significant number of issues that affect their health-related quality of life, including sleep. Although poor sleep quality is common, there remains a lack of understanding of how to identify sleep issues in order to improve outcomes for people living with HIV. A scoping review of three databases as well as the grey literature yielded 2932 articles, of which 60 met the inclusion criteria. The following themes were identified: range of methods used to assess sleep, self-reported sleep measures and objective measures of sleep. The review found that a number of different measures of sleep were used within the research, the most commonly used being the Pittsburgh Sleep Quality Index. Due to the variety of approaches being used to measure sleep (n=18) there was a lack of consistency in what aspects of sleep were being explored, and in many cases why the measure of sleep was chosen. Furthermore, there was a lack of meaningful clinical recommendations as to how these findings could be used to improve outcomes for people living with HIV.

Resurrecting the 'fourth 90': towards a definition of health-related quality of life in HIV care.

Medical advancements in the treatment of HIV continue to return ever more impressive medical results; increasing life expectancy and reducing negative symptoms (either disease-related or medically-induced). Physical wellness, however, is only one of the many facets of human life. It has been 5 years since Lazarus et al proposed we should be looking towards a fourth 90-good health-related quality of life (QoL)-yet little has been done to take up this task within a coherent approach. We suggest that one of the barriers to this is a lack of definition about what we mean by 'good health-related quality of life' (HRQoL) for people living with HIV. This article considers existing definitions of this, and related terms, and the difficulties in finding a universal definition. It goes on to suggest a way to a conceptual HRQoL in people living with HIV based on the biopsychosocial model. It is proposed that by doing it this way, practitioners can assess HRQoL in a comprehensive way, and focus on the things that matter to the individual.

What are the current factors that impact on health-related quality of life for women living with HIV?

Since the start of the HIV epidemic, care has often had a strong focus on quality of life. In the early days, this was in part due to the limited treatment options available for people living with HIV, alongside the strong humanistic desire of those working in the specialty to provide optimum care. Advances in HIV treatments have led to care having more of a medical focus, with national and international targets concentrating on the prevention of new infections. Despite medical progress, the impact of being diagnosed and living with HIV has a significant impact on many people, across all aspects of their life. Factors that impact on health-related quality of life for women living with HIV are often poorly understood and under-explored in healthcare settings.

The relationships between psychological mindedness, parental bonding and adult attachment.

OBJECTIVES: The aims of this study were to clarify the relationship between psychological mindedness and attachment relationships in childhood and adulthood. DESIGN: This analogue study examined associations between psychological mindedness and attachment using a cross-sectional design. METHOD: Participants completed questionnaire measures of psychological mindedness, parental bonding, and adulthood attachment relationships. RESULTS: As hypothesized, psychological mindedness was strongly, negatively correlated with attachment avoidance in adulthood. Psychological mindedness was also positively correlated with perceived maternal care in childhood, and negatively correlated with perceived paternal over-protection. However, a regression analysis found that attachment avoidance in adulthood was a more significant predictor of psychological mindedness than parental bonding experiences in childhood. CONCLUSIONS: Further research is needed to replicate associations between attachment and psychological mindedness in clinical samples and to explore additional constructs which influence psychological mindedness. PRACTITIONER POINTS: High attachment avoidance may be a potential risk factor for poor psychological mindedness. Helping individuals to develop more secure attachments in their adult relationships may improve their psychological mindedness.

An exploratory study to clarify the cluster of symptoms predictive of chemotherapy-related nausea using random forest modeling.

CONTEXT: Chemotherapy-related nausea is experienced by most cancer patients receiving chemotherapy. Although vomiting is managed well with current antiemetics, nausea is difficult to manage and little is understood about its development. OBJECTIVES: The aim was to determine whether nausea exists as part of a symptom cluster and evaluate the symptom cluster's impact on patients' quality of life, psychological distress, and nutritional status. METHODS: A prospective observational design over two cycles of chemotherapy was used. Patients completed the Memorial Symptom Assessment Scale, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-General, and Patient-Generated Subjective Global Assessment before chemotherapy and at the end of the first and second cycles of treatment. Random forest modeling, a state-of-the-art prediction method, was used to analyze the data. RESULTS: One hundred four patients participated in the study. Nausea was found to be a dynamic experience, changing over time. "Core" symptoms, predictive of the presence of nausea, were identified and included appetite loss, feeling bloated, vomiting, taste changes, and lack of energy. Although nausea alone did have an impact on patient outcomes, the impact was significantly higher in relation to physical and functional quality of life and nutritional status in those patients who had more than two symptoms from the nausea cluster. CONCLUSION: This exploratory study, using an innovative analytical approach, has shown that nausea is a complex symptom affected by the presence and/or severity of other concurrent symptoms (the symptom cluster). The findings have implications for the measurement of nausea and also to target people for interventions to manage nausea and its cluster of symptoms.