Spirituality and psychosocial factors in persons living with HIV.

AIM OF THE STUDY: This pilot study was designed to examine the relationships among spirituality and psychosocial factors in a sample of 52 adult males living with human immunodeficiency virus (HIV) disease and to determine the most reliable spirituality measure for a proposed longitudinal study. BACKGROUND: HIV disease is among the most devastating of illnesses, having multiple and profound effects upon all aspects of the biopsychosocial and spiritual being. Although research has suggested relationships among various psychosocial and spiritual factors, symptomatology and physical health, much more research is needed to document their potential influences on immune function, as well as health status, disease progression, and quality of life among persons with HIV disease. METHODS: This descriptive correlational study explored the relationships of spirituality and psychosocial measures. Spirituality was measured in terms of spiritual perspective, well-being and health using three tools: the Spiritual Perspective Scale, the Spiritual Well-Being Scale, and the Spiritual Health Inventory. Five psychosocial instruments were used to measure aspects of stress and coping: the Mishel Uncertainty in Illness Scale, Dealing with Illness Scale, Social Provisions Scale, Impact of Events Scale, and Functional Assessment of HIV Infection Scale. The sample was recruited as part of an ongoing funded study. The procedures from the larger study were well-defined and followed in this pilot study. Correlational analyses were done to determine the relationship between spirituality and the psychosocial measures. FINDINGS: The findings indicate that spirituality as measured by the existential well-being (EWB) subscale of the Spiritual Well-Being Scale was positively related to quality of life, social support, effective coping strategies and negatively related to perceived stress, uncertainty, psychological distress and emotional-focused coping. The other spirituality measures had less significant or non significant relationships with the psychological measures. CONCLUSIONS: The study findings support the inclusion of spirituality as a variable for consideration when examining the psychosocial factors and the quality of life of persons living with HIV disease. The spiritual measure that best captures these relationships is the EWB subscale of the Spiritual Well-Being Scale.

Family responses to disclosure of self-as-lesbian.

Disclosure or nondisclosure of self-as-lesbian to family is a difficult task. Eleven lesbians aged 25-47 years old described their experiences of disclosure or nondisclosure to family. The primary source of data collection was focus groups. Family disclosure was preceded by recognition of self-as-lesbian. Five story patterns of lesbians and their families related to disclosure or nondisclosure were derived from text analysis. The participants also described missing sociocultural landmarks and symbols for lesbian lives. Implications are included for lesbians who are contemplating disclosure and their health care providers.

Mendelian diseases among Roman Jews: implications for the origins of disease alleles.

The Roman Jewish community has been historically continuous in Rome since pre-Christian times and may have been progenitor to the Ashkenazi Jewish community. Despite a history of endogamy over the past 2000 yr, the historical record suggests that there was admixture with Ashkenazi and Sephardic Jews during the Middle Ages. To determine whether Roman and Ashkenazi Jews shared common signature mutations, we tested a group of 107 Roman Jews, representing 176 haploid sets of chromosomes. No mutations were found for Bloom syndrome, BRCA1, BRCA2, Canavan disease, Fanconi anemia complementation group C, or Tay-Sachs disease. Two unrelated individuals were positive for the 3849 + 10C->T cystic fibrosis mutation; one carried the N370S Gaucher disease mutation, and one carried the connexin 26 167delT mutation. Each of these was shown to be associated with the same haplotype of tightly linked microsatellite markers as that found among Ashkenazi Jews. In addition, 14 individuals had mutations in the familial Mediterranean fever gene and three unrelated individuals carried the factor XI type III mutation previously observed exclusively among Ashkenazi Jews. These findings suggest that the Gaucher, connexin 26, and familial Mediterranean fever mutations are over 2000 yr old, that the cystic fibrosis 3849 + 10kb C->T and factor XI type III mutations had a common origin in Ashkenazi and Roman Jews, and that other mutations prevalent among Ashkenazi Jews are of more recent origin.

A common breakpoint on 11q23 in carriers of the constitutional t(11;22) translocation.

Structural chromosomal rearrangements occur commonly in the general population. Individuals that carry a balanced translocation are at risk of having unbalanced offspring; therefore, the frequency of translocations in couples with recurrent spontaneous abortions is higher than that in the general population. The constitutional t(11;22) translocation is the most common recurrent non-Robertsonian translocation in humans and may serve as a model to determine the mechanism that causes recurrent meiotic translocations. We previously localized the t(11;22) translocation breakpoint to a region on 22q11 within a low-copy repeat, termed "LCR22." To define the breakpoint on 11q23 and to ascertain whether this region shares homology with LCR22 sequences, we performed haplotype analysis on patients with der(22) syndrome. We found that the breakpoint on 11q23 occurred between two genetic markers, D11S1340 and APOC3-tetra, both being present within a single bacterial-artificial-chromosome clone. To determine whether the breakpoint occurred within the same region among a larger set of carriers, we performed FISH mapping studies. The breakpoints were all within the same clone, suggesting that this region may harbor sequences that are prone to breakage. We narrowed the breakpoint interval, in both derivative chromosomes from two unrelated carriers, to a 190-bp, AT-rich repeat, which indicates that this repeat may mediate recombination events on chromosome 11. Interestingly, the LCR22s harbor AT-rich repeats, suggesting that this sequence motif may mediate recombination events in nonhomologous chromosomes during meiosis.

Der(22) syndrome and velo-cardio-facial syndrome/DiGeorge syndrome share a 1.5-Mb region of overlap on chromosome 22q11.

Derivative 22 (der[22]) syndrome is a rare disorder associated with multiple congenital anomalies, including profound mental retardation, preauricular skin tags or pits, and conotruncal heart defects. It can occur in offspring of carriers of the constitutional t(11;22)(q23;q11) translocation, owing to a 3:1 meiotic malsegregation event resulting in partial trisomy of chromosomes 11 and 22. The trisomic region on chromosome 22 overlaps the region hemizygously deleted in another congenital anomaly disorder, velo-cardio-facial syndrome/DiGeorge syndrome (VCFS/DGS). Most patients with VCFS/DGS have a similar 3-Mb deletion, whereas some have a nested distal deletion endpoint resulting in a 1.5-Mb deletion, and a few rare patients have unique deletions. To define the interval on 22q11 containing the t(11;22) breakpoint, haplotype analysis and FISH mapping were performed for five patients with der(22) syndrome. Analysis of all the patients was consistent with 3:1 meiotic malsegregation in the t(11;22) carrier parent. FISH-mapping studies showed that the t(11;22) breakpoint occurred in the same interval as the 1.5-Mb distal deletion breakpoint for VCFS. The deletion breakpoint of one VCFS patient with an unbalanced t(18;22) translocation also occurred in the same region. Hamster-human somatic hybrid cell lines from a patient with der(22) syndrome and a patient with VCFS showed that the breakpoints occurred in an interval containing low-copy repeats, distal to RANBP1 and proximal to ZNF74. The presence of low-copy repetitive sequences may confer susceptibility to chromosome rearrangements. A 1.5-Mb region of overlap on 22q11 in both syndromes suggests the presence of dosage-dependent genes in this interval.

Transforming academic nursing: from balance through integration to coherence.

Academic institutions continue to be challenged to enhance their productivity in the face of diminishing resources. Escalating demands on full-time faculty must come from a fundamental transformation in the focus and, hence, design of that work. This article presents a model of a mission transformed from the current representation of the tripartite activities involved with teaching, research, and service to a new representation of the inherent holism of that work. This transformation moves the academy's mission to a single, integrative focus on knowledge work. When the essence of the academy's unique mission is expressed as knowledge work, the unity of knowledge development, dissemination, and application can be actualized in the work lives of a community of scholars. A fuller realization of the inherently holistic nature of this knowledge work is seen as a transformation to coherence at the levels of university, unit, and scholar. Coherence within the academic lives of individuals, the collective community of scholars, and the broader organization is the essential feature for the long-term success of the institution and the career of a scholar.

Neurologic mechanisms in psychoneuroimmunology.

Synthesizing the neurologic mechanisms of psychoneuroimmunology (PNI) into a schematic model serves as a basis to enhance understanding of the complex interactions within the PNI framework. The examination of current research in physiology, neurotransmission, hormonal mechanisms, immunologic function and stress allows for the creation of a neurological model to depict hypothetical interactions of these systems. This model of neurological mechanisms in PNI can serve as the basis for integrating PNI in nursing practice. It is hoped that the model will serve as a bridge to understanding the neuroscience component of PNI and stimulate further research.

Revision of HIV center medical staging scale.

HIV-related symptomatology represents both an indirect measure of immune functioning and a clinically significant indicator of disease progression. The most widely used classification system for HIV-related symptomatology is the Center for Disease Control (CDC) system. Although the CDC scale has widely recognized clinical utility, it provides only nominal-level measurement, which may be problematic for both clinicians and researchers. This article describes the revision and validation of the HIV Center Medical Staging Scale (rHCMSS), and ordinal-level physical illness scale that provides a means of independently measuring the progression of HIV-disease symptomatology and immunological decline. Concurrent use of the rHCMSS, the CDC classification system, and T-lymphocyte and viral load data will provide a more comprehensive indication of HIV-disease progression for clinical and research purposes.

Grey glasses: sadness in young women.

Sadness as a developmental phenomenon in young women was discovered in a study designed to identify developmental transitions and the relationship of these transitions to mental health. Sadness is conceptualized as a pervasive feeling of disillusionment and unhappiness that influences the meaning of life events and decision-making. Field research and interpretive analysis techniques were used to observe, describe and analyse the life experiences of 25 volunteer participants. For most women in the study, sadness was found to be time-limited and perhaps had beneficial effects. Some women, however, were unable to resolve sadness and became depressed. Sadness can be an antecedent to depression. Sadness that is recognized and validated may facilitate reshaping of a woman's expectations, a form of cognitive restructuring. The transitional nature of sadness has important implications for women's mental health.

Psychometric validation of the revised Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) quality of life instrument.

The revised Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) quality of life (QoL) instrument has been updated and expanded to provide more complete and accurate coverage of human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related QoL. Factor analysis and the Rasch measurement model were used to determine a new subscale structure for the FAHI. The content of these subscales, including physical well-being (ten items, alpha = 0.91), function and global well-being (13 items, alpha = 0.86), emotional well-being/living with HIV (10 items, alpha = 0.82), social well-being (eight items, alpha = 0.73), and cognitive functioning (three items; alpha = 0.75), reflect both general illness- and HIV/AIDS-specific QoL concerns: a total QoL score can also be calculated for the FAHI (44 items, alpha = 0.91). Psychometric evaluation revealed good internal consistency reliability for the FAHI and its subscales. In addition, construct validity, known groups validity and sensitivity to change were demonstrated by significant associations between the FAHI and additional indicators of functional status, psychological symptoms, stress and illness severity. In summary, the FAHI is a psychometrically sound instrument that captures multiple important dimensions of HIV/AIDS-related QoL. It is brief, easy to administer and score, has been translated into nine languages other than English and is appropriate for use in clinical trials and clinical practice.

Development and validation of the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) quality of life instrument.

The Functional Assessment of Human Immuno-deficiency Virus (HIV) Infection (FAHI) quality of life instrument was developed using a combination of conceptual and empirical strategies. The core, general health-related quality of life instrument is the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. The FACT-G was selected to enable comparison of data across two similar, life-threatening conditions and because of its desirable psychometric properties. Initial data on both the relevance (applicability) of the FACT-G to the HIV population and the generation and testing of questions for an HIV-specific subscale were encouraging. Consequently, the FACT-G and a 9-item HIV-specific subscale were combined and tested in 196 patients in three categories: an English-speaking stress management sample from Chicago, illinois (n = 110); an English-speaking urban, mixed race sample from Chicago (n = 71); and a Spanish-speaking urban sample from Chicago and San Juan, Puerto Rico (n = 64). With the exception of the Social Well-being subscale, the subscales of the FACT-G demonstrated good internal consistency reliability across all three samples (alpha range = 0.72-0.88). Total FAHI scores produced consistently high alpha coefficients (0.89-0.91). Concurrent validity data included moderately strong associations with other measures of similar concepts and an ability to distinguish groups of patients by activity level and disease severity. Sensitivity to change in mood disturbance and responsiveness to a stress management intervention were also evident. The 9-item HIV-specific subscale demonstrated relatively low alpha coefficients (range = 0.53-0.71) and marginal sensitivity to change, leading to supplementation of content with an additional 11 items, creating a 20-item HIV-specific subscale that is currently being tested. Clinical trial and clinical practice investigators are encouraged to use the FACT-G in its current (version 3) form when evaluating group differences and within-group change over time. It should prove particularly useful when comparing clinical trial and clinical practice data for cancer vs. HIV-infected patients and in the evaluation of treatments for HIV disease and HIV-related malignancy. The supplemental 20 questions comprising the revised HIV-specific subscale are undergoing further testing, and may ultimately enhance the value of this measurement system.

The influence of stress management training in HIV disease.

A pretest-posttest design (with a 6-week wait-list control and a 6-month comparison group) was used to compare the effectiveness of a 6-week stress management training program with standard outpatient care for 45 men with HIV disease. Outcomes included stress levels, coping patterns, quality of life, psychological distress, illness-related uncertainty, and CD4+ T-lymphocyte levels. At 6 weeks, intervention was associated with increases in the emotional well-being dimension of quality of life. After 6 months, the intervention group had a relative decline in HIV-related intrusive thinking, indicating that stress management training may have buffered illness-related psychological distress over time.

Psychoneuroimmunology: an emerging framework for nursing research.

Psychoneuroimmunology (PNI) is concerned with the mechanisms of bidirectional communication between the neuroendocrine and immune systems. Investigators in other disciplines have used this framework to guide the examination of possible relationships between behavioural factors and the progression of immunologically mediated illnesses and to evaluate the role of immune products in central nervous system disturbances. Nurse scientists have an opportunity to make unique contributions to the growing field of PNI. Unlike basic science research, which has as its goal the generation of fundamental knowledge concerning biological or behavioural processes, nursing research is driven by the need to promote excellence in nursing science as a guide for nursing practice. Although a few nurse scientists have conducted PNI research to date, additional studies are needed to generate new knowledge concerning mind-body interactions in health and illness and to develop strategies that promote mental and physical well-being in persons at risk for immune dysfunction. This paper highlights the few recently conducted nursing studies grounded in a PNI framework to illustrate the utility of PNI in advancing nursing science.

Immunological and virological markers of HIV-disease progression.

This review, based upon scientific literature, evaluates a number of immunological and virological markers for their usefulness as prognostic indicators for progression of HIV disease. The most widely studied marker, the CD4 positive T lymphocyte count, is perhaps the best single indicator of stage of illness. Serum factors such as neopterin and beta-2 microglobulin, alone and in combination with CD4 cell counts, have been shown to have good predictive value. Measurement of viral burden by quantification of viral RNA levels in plasma and immune cells also holds promise for following disease progression. It is recommended that a combination of these factors be monitored in evaluating stage of illness and responses to therapy in HIV-infected persons.

Use of decimal assay for additivity to demonstrate synergy in pair combinations of econazole, nikkomycin Z, and ibuprofen against Candida albicans in vitro.

Interactions between six compounds (econazole, miconazole, amphotericin B, nystatin, nikkomycin Z, and ibuprofen) were investigated for their antifungal activities against Candida albicans by using pair combinations in an in vitro decimal assay for additivity based on disk diffusion. Additive interactions were observed between miconazole and econazole, amphotericin B and nystatin, and amphotericin B and ibuprofen, while an antagonistic interaction was observed between econazole and amphotericin B. Synergistic interactions were recorded for the combinations of econazole and ibuprofen, econazole and nikkomycin Z, and ibuprofen and nikkomycin Z.

Correlates of stress in HIV disease.

A group of 53 men with HIV disease participated in this correlational study of the relationships among psychological distress, quality of life, uncertainty, coping patterns, stress, and CD4+ T-lymphocyte levels. Meaningful correlations (r > .40, p < .01) indicated that higher levels of negative-impact stressful experiences were associated with more frequent use of emotion-focused coping; both higher levels of negative stress and more frequent use of emotion-focused coping were associated with lower quality of life, higher psychological distress, and more uncertainty; lower quality of life was associated with higher psychological distress and more uncertainty; and lower CD4+ counts were associated with higher levels of positive-impact stressful experiences.

Stress and coping in the context of psychoneuroimmunology: a holistic framework for nursing practice and research.

Nurses who specialize in mental health routinely deal with stress and coping as priority issues. Yet there has been no consensus on an overriding framework for organizing and interpreting knowledge concerning the influences of stress on health and well-being. In addition, stress-management interventions have often been piecemeal. This article surveys traditional and emerging conceptualizations of stress and stress management, with a special focus on the transactional model and psychoneuroimmunology as complementary integrative frameworks. The authors recommend a comprehensive approach for stress management that includes behavioral, cognitive, and combination strategies for active coping as well as cognitive-behavioral techniques for relaxation.

Research priorities for psychosocial aspects of nursing care in HIV disease.

The complex biopsychosocial aspects of nursing care for persons infected with the human immunodeficiency virus (HIV) present formidable challenges for nursing research. Suggestions for clinical nursing research related to physiological aspects of HIV care recently were addressed by Zeller, Swanson, and Cohen (1993). The authors highlight the research priorities related to psychosocial aspects of nursing care in HIV disease, as identified for the 1990-1994 National Nursing Research Agenda by the National Center for Nursing Research (NCNR) (1990). The authors conclude that the NCNR's 1990 recommendations remain relevant priorities for research concerning the psychosocial aspects of nursing care for persons with HIV disease.