Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.     

The universality of a contempt expression: A replication

Two experiments replicated Ekman and Friesen's finding of an expression that signals contempt across cultures. The subjects, from West Sumatra, Indonesia, were members of a culture that differs in a number of ways from Western cultures. In one experiment the subjects judged photographs of Japanese and American faces, both males and females, which showed many different emotions. There was very high agreement about which expressions signaled contempt in preference to anger, disgust, happiness, sadness, fear, or surprise. In a second experiment the Indonesian subjects judged expressions shown by members of their own culture, and again there was very high agreement about which expression signals contempt.This study was supported by a grant from the National Institute of Mental Health (MH 41100). Paul Ekman's work is also supported by a Research Scientist Award from the National Institute of Mental Health (MH 06092). Karl G. Heider's work was supported by a grant from the National Institute of Mental Health (MH 38221). We are grateful to Maureen O'Sullivan for her many helpful comments on this report.     

Family therapy without the family: a framework for systemic practice

This paper contrasts the basic tenets of systemic thinking with some guiding principles of the psychodynamic approach, and outlines specific techniques which family therapists can use when seeing individuals. It is argued that a useful systemic framework can be maintained if the therapist aims to keep the therapy system 'open' for relevant others to join at any time.     

Ein Protokoll aus Husserls Logikseminar vom Winter 1925

Ohne Zusammenfassung     

Perceived informativeness of verbal information

When people are asked to rate verbal material (texts, statements, and statements forming part of a text) according to informativeness, their judgments will to a large extent depend upon how much they already know about the subject, and how novel the communication is to them. This will in some cases make them stress novelty and in other cases familiarity as the most important determinants for expected or perceived informativeness. It is argued that these apparently contradictory trends are reconcilable by a propositional (subject-predicate) model of information, which presupposes an identifiablesubject of the communication (“what it is all about”), as well as something to be predicated about this subject, topic, or theme. This kind of information structure allows the communication to contain both novel and familiar elements at the same time, with informativeness being at a peak when something quite new and unexpected is told about a familiar subject, or when a new subject is made familiar (i.e., satisfactorily explained) to the person. This article was written when the author was on sabbatical leave at the University of Leicester. The study was supported by a grant from the Norwegian Research Council for Science and the Humanities.     

Spiritual issues in mental health care

Religious and spiritual issues in mental health are explored in the context of four conceptual models: the medical, the nursing, the humanistic, and the pastoral. This is done by looking at each model in terms of content, diagnostic focus, language and treatment goals, and primary qualities in the health provider.The models are illustrated by case studies gathered from a multidisciplinary setting. The discovery that each model can incorporate the religious and spiritual dimension in mental health care, but that each model does this in distinctive ways, is a key point.     

Stomatologic studies in schizophrenic patients--contributions to the problem of medical and social integration of psychiatric patients

Stomatological examination was carried out on 173 patients with schizophrenia (IKK-Nr. 295). It was observed that this group of patients showed a diminished dental and oral care in comparison to the average population of the same region. The close cooperation of dentists with the institutions for chronic patients will be as prophylactic measure in favour of the patients encouraged.     

Secobarbital and perceptual processing

An experiment which employed each of 18 subjects in four days of testing was used to examine acute secobarbital dose treatment effects on choice reaction time in a Cooper and Shepard (1973) character recognition task. Manipulations of visual stimulus degradation, character difficulty, 180 degree rotation, and mirror-image reversal were included in order to evaluate the hypothesis that the drug affects performance by disrupting early stimulus input processing. The results indicate significant increases in the effect of secobarbital on reaction time and errors under conditions of visual stimulus degradation. The effects of the drug, however, were not changed by 180 degree rotation of the target character or by the other task variables. The results were interpreted to indicate that secobarbital impairs performance primarily by placing selective stress on hypothetical early encoding activities and that later processing operations (associated with use of an internal representation of the target character) are not affected by the drug. Strengths and weaknesses of the two-stage model of visual stimulus processing are discussed and implications of the model for future drug research are indicated.     

Integrating vocational interest inventory results and expressed choices

Though many studies have examined the predictive power of expressed choices versus that of measured interests, fewer have been concerned with the relationship between the degree to which choices and interests agree and later persistence in an expressed choice. This study explored that relationship, using longitudinal data for 7706 college students and 1372 employed persons. Four levels of congruence between expressed choice and measured interests were identified. Results indicated that persistence in an expressed choice increases systematically as congruence between choice and interests increases. Implications for counselors are noted.     

Information processing abilities in twins reared apart

A battery of information processing measures and psychometric tests of specific and general cognitive abilities was administered to a sample of 105 individuals which included 34 monozygotic and 13 dizygotic reared apart twin pairs or triplets. Correlations between information processing parameters and psychometric abilities as well as twin resemblances for the information processing parameters were examined. In a principal components analysis of the information processing parameters, three components were identified which accounted for 67% of the total variation; Overall Speed of Response (OSR), Speed of Information Processing (SIP), and Speed of Spatial Processing (SSP). OSR was significantly correlated with WAIS IQ, and psychometric measures of verbal reasoning, spatial ability, and perceptual speed and accuracy. SIP was significantly correlated with WAIS IQ, measures of verbal reasoning, and one of the perceptual speed and accuracy measures. SSP was significantly correlated with measures of both spatial ability and perceptual speed and accuracy. Due to the small size of the dizygotic twin sample, no strong conclusions could be drawn regarding the magnitude of their resemblance. The correlation between component scores of reared apart monozygotic twins was significant for OSR, but not for SIP or SSP.