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 Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.     

Effects of communication apprehension,familiarity of partner,and topic on selected “women's language” features

In keeping with Lakoff's (1975) notion that the use of women's language (WL) conveys uncertainty on the part of the speaker, the influence of communication apprehension, familiarity of partner, and topic on the use of selected WL forms was investigated. In dyadic conversation with a female friend or stranger, 71 female university students, who had completed the Personal Report of Communication Apprehension—Long, discussed a familiar or an unfamiliar topic. Multiple-regression analyses revealed that (1) communication apprehension was positively related to the use of question intonation, (2) familiarity of topic and partner were negatively related to the use of hedges, and (3) familiarity of topic was positively related to the use of intensifiers. There were no intercorrelations of the linguistic forms. These results challenge the notion that WL forms actually cohere to form a kind of language and suggest that the influence of social and psychological variables on the use of WL is much more complex and multifaceted than Lakoff believed.This article is based on portions of an Honour's thesis completed by the second author, and was presented at the Annual Convention of the Canadian Psychological Association held in Ottawa, Ontario, June 1990.     

Components of analogical reasoning in a mildly head injured population

This study sought to investigate the effects of mild head injury on a particular type of cognitive ability, verbal analogical reasoning. The performance of 19 individuals with head injuries was compared to a group of 30 control subjects matched for age, education, and gender on 100 verbal analogies. Solution times and error rates were modeled. Unstandardized regression weights for individual subjects were correlated with subjects’ performance on a number of standardized ability tests. Results showed that compared to the control subjects, the head injured subjects: (a) were significantly slower to solve the analogies, and were particularly slow to perform certain processes: encoding/inference and comparison; (b) tended to show greater variability in performance; and (c) had data that had a poorer componential model fit. The data suggest that analogical reasoning is affected by a head injury, and that certain information processes may be responsible for performance deficits.     

PRIMARY ENCOPRESIS: EVALUATION AND TREATMENT

Cathartic and behavioral treatment procedures for eliminating diurnal and nocturnal primary encopresis were investigated using a multiple-baseline design across four children. The dependent and independent variables measured were appropriate bowel movements, soiling accidents, independent toiletings, and cathartic use. Over 177 reliability observations (home visits) were conducted. For two of the children, treatment with cathartics and child-time remedied their soiling accidents and increased their independent toiletings in 8 to 11 weeks. While the cathartics and child-time increased the rate of appropriate bowel movements, they did not eliminate the soiling accidents with the other two children. Independent toiletings for these two children were achieved after 32 to 39 weeks of treatment when punishment procedures (positive practice, time-out, and hourly toilet sits) were incorporated and the suppositories were faded systematically.     

The role of phonemes and syllables in the perceived similarity of speech sounds for children

In two experiments, we investigated the factors that influence the perceived similarity of speech sounds at two developmental levels. Kindergartners and second graders were asked to classify nonsense words, which were related by syllable and phoneme correspondences. The results support the existence of a developmental trend toward increased attention to individual phonemic segments. Moreover, one significant factor in determining the perceived similarity of speech sounds appears to be the position of the component correspondences; attention to the beginning of utterances may have developmental priority. An unexpected finding was that the linguistic status of the unit involved in a correspondence (whether it was a syllable or a phoneme) did not seem particularly important. Apparently, the factors which contribute to the perceived similarity of speech sounds in the classification task are not identical to those which underlie performance in explicit segmentation and manipulation tasks, since in the latter sort of task, syllables are more accessible than phonemes for young children. The present task may tap a level of processing that is closer to the one entailed in word recognition and lexical access.