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.     

The long-term evaluation of a behavioral treatment program for child molesters

Recidivism data derived from various sources over a follow-up period of 1–11 yr, provided the basis for appraising the effectiveness of a comprehensive cognitive-behavioral treatment program for familial and nonfamilial child molesters. Unofficial records held by police and Children's Aid Societies proved to be the best data for estimating recidivism. These data revealed increases in recidivism with longer follow-up periods, but there were consistent advantages for the treated over the untreated patients. Men who had sexually abused the daughters of other people demonstrated the clearest treatment benefits. The younger offenders and those who had engaged in genital-genital contact with their victims were more likely to reoffend even if they were treated. Contrary to the expectations of behavior therapists, indices of deviant sexual preferences did not predict outcome.     

Selective impairment of phonation: A case study

A 47-year-old right-handed man underwent craniotomy for clipping of an aneurism at the trifurcation of the left middle cerebral artery. Subsequently, he suffered a left hemisphere CVA after which his speech and language resembled that of Broca's aphasia with accompanying apraxia of speech. Medical, behavioral, and acoustical data amassed over a period of several months indicated numerous contraindications to traditional diagnoses of Broca's aphasia, apraxia of speech, and dysarthria. Ultimately, it was determined that the patient had a selective impairement of phonation or laryngeal apraxia. This was illustrated dramatically when he was taught to use an electrolarynx which allowed him to bypass his disrupted phonatory system. Speaking with the electrolarynx, the patient communicated normally. Any semblance of Broca's aphasia disappeared. Supralaryngeal articulation was normal; apraxia of speech behaviors were absent. This case report indicates that dissociation of oral and laryngeal gestures due to brain injury is possible. Mechanisms underlying such a dissociation for this case are reviewed. The possibility of discrete center lesions in the frontal motor association area causing different types of apraxia of speech is discussed.     

Job experiences over time, multiple roles, and women's mental health: a longitudinal study.

Are changes over time in the quality of a woman's job associated with changes in her psychological distress? Do family roles moderate these relationships? We addressed these questions using longitudinal data from a 2-year 3-wave study of a stratified random sample of 403 employed women who varied in occupation, race, partnership, and parental status. After estimating individual rates of change for each woman on each of the predictors and the outcome, we modeled the relationships between family role occupancy and change in job-role quality on the one hand, and change in psychological distress on the other. Among single women and women without children, as job-role quality declined, levels of psychological distress increased. Among partnered women and women with children, change in job-role quality was unrelated to change in psychological distress.     

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.