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.     

Identifying subgroups that succeed or fail with three levels of physical activity intervention: the Activity Counseling Trial.

The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.     

When the happy victimizer says sorry: Children's understanding of apology and emotion

Previous research suggests that children gradually understand the mitigating effects of apology on damage to a transgressor's reputation. However, little is known about young children's insights into the central emotional implications of apology. In two studies, children ages 4–9 heard stories about moral transgressions in which the wrongdoers either did or did not apologize. In Study 1, children in the no‐apology condition showed the classic pattern of ‘happy victimizer’ attributions by expecting the wrongdoer to feel good about gains won via transgression. By contrast, in the apology condition, children attributed negative feelings to the transgressor and improved feelings to the victim. In Study 2, these effects were found even when the explicit emotion marker ‘sorry’ was removed from the apology exchange. Thus, young children understand some important emotional functions of apology.     

Effects of Stimulus Number and Target-to-Distractor Ratio on the Performance of Random Array Letter Cancellation Tasks

Cancellation tests are commonly used in the clinical assessment of visuospatial function, but there has been little study of task characteristics influencing performance. This study was designed to assess factors which affect cancellation performance. Sixteen healthy subjects sequentially performed four random-array letter cancellation tasks. The forms contained 50 and 100 stimuli and target:distractor (T/D) ratios of 1:4 and 1:9 with target letter “A” and randomly selected letter distractors. The primary performance measure was calculated as the number of correctly cancelled targets divided by the time to complete the task, corrected for accuracy. This measure revealed a strong effect of T/D ratio (p< .0001), with performance adversely affected by higher proportion of distractors. There was no effect of stimulus number. This suggests that T/D ratio should be considered in cancellation test design and interpretation.