Abstract
Background: Few studies of HIV+ individuals in China have examined the associations between HIV-related stress with sleep disturbance and fatigue, which are common complaints among people living with HIV/AIDS (PLWHA). We carried out this study to examine the relationships among perceived stress, sleep disturbance, and fatigue in PLWHA in China. Methods: A mixed methods study design was used during data collection in Shanghai, China, from December 2009 to March 2010. Qualitative in-depth interviews were conducted with 19 HIV+ females. Additionally, crosssectional audio computer-assisted self-interviews (ACASI) were conducted to collect quantitative data from a convenience sample of 107 HIV+ patients (84% were male) including the following scales: 1) Perceived Stress Scale for PLWHA, 2) General Sleep Disturbance Scale, and 3) Fatigue Scale. Results: The major themes that emerged from the in-depth interviews were around life stress with HIV, sleep disturbance, and fatigue. Participants presented varying amounts of stress around worrying about whether to disclose their diagnosis and whether they might transmit the disease to their family. In addition, in the cross-sectional data, 40% of the participants reported clinically significant sleep disturbances (GSDS > 3) with an average of 3 nights of disturbed sleep in the past week (M=2.87, SD=1.21) and moderate fatigue severity (M=5.24, SD=2.27). In mediation analyses, the data suggests that the relationship between perceived stress and fatigue was largely (53%) mediated through sleep disturbance. Conclusions: Chinese PLWHA described how stress had caused them to become sleepless and fatigued. The quantitative data also demonstrated significant levels of sleep disturbance and fatigue, where were due to perceived stress with HIV disease. A systematic self-management intervention to decrease perceived stress should be designed and implemented in mental health resource-limited settings such as China in order to reduce sleep disturbance and fatigue.
Highlights
Measles is a highly contagious children infectious disease
The measles clinic case-definition is any person with a fever and macula popular rash and cough/coryza/conjunctivitis, confirmed case of measles had laboratory evidence of infection that included positive serology for measles immunoglobulin M (IgM), or a 4-fold rise in serum immunoglobulin G (IgG) from the acute to convalescent samples [5]
The National Notifiable Diseases Reporting System (NNDRS) reports the basic epidemiological data including name, age, sex, date of the disease onset and the residency on all clinically and laboratory diagnosed cases by posting a card to the Center for Disease Control from 1950 to 2000, with telephone posting a card together from 2001 to 2004, with internet since 2005. This system was strengthened in Guangxi for its establishing the Three Network System which is composed of administrative responsibility, information delivery and rescue network systems [6] to deal with public health emergency event which more likely is infectious disease outbreak since 2001
Summary
The comparison of measles outbreak once every three years before 1966 without introduction of measles vaccine to outbreak every two to three years after measles vaccine available in the urban area though the incidence is lower since 1966 (Figure 2). During the second campaign period, the incidence of under 1 year old is the slowest decreased compared with the incidence of the ages else This indicated that for the schedule of the first dose of measles vaccine is 8 months in China needs more years to control to get the cases down for younger children less than 8 month (Table 8). The new born registrations has been increased from 530,000 in 2001 to 737,000 in 2006, the coverage for newborn in routine immunization increased from 78% in 2001 to 97% in 2006 These achievements surely plays an important role in the decrease in measles incidence, the percentage of incidence decreased was the same no matter 1-4 years or 5-9 and 1014, even the percentage decreased over 5 was little bigger than under 5 years old group (Table 10) which showed the campaign still is the key important for the measles control in Guangxi in the high risk county campaign
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