Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to predict adherence to highly active antiretroviral therapy (HAART) medication regimens among HIV-positive men and women

Psychosocial and behavioral factors may be strong predictors of adherence to medications in a wide variety of diseases. Newly emerging antiretroviral medications for HIV have been shown to be effective but require near perfect adherence to offer clinically significant benefits. There is currently great interest in deriving patient factors that may predict optimal medication adherence in HIV-positive persons. In this study, we examined the association of psychosocial and behavioral characteristics using the Millon Behavioral Medicine Diagnostic (MBMD; Millon, Antoni, Millon, Meagher, & Grossman, 2001) and adherence to highly active antiretroviral therapy (HAART) among 117 HIV-positive individuals on HAART regimens. Specific indexes of the MBMD were associated with HAART adherence as assessed through patient interview, at baseline assessment, and at 3-month follow-up at a point after which participants had received medication adherence training. As hypothesized, the Medication Abuse scale of the MBMD was uniquely associated with overall adherence at baseline assessment and also predictive of adherence at 3-month follow-up. Additional MBMD scales were also related to overall adherence as well as specific adherence behaviors such as missed doses, following specific instructions, and overmedicating, although the Medication Abuse scale emerged as the most consistent predictor of adherence in the study. These results suggest that the MBMD can be used to predict adherence to HAART medication in a sample of HIV-positive men and women and may subsequently be used to identify those in need of adherence counseling at the point when medications are initiated.     

WHAT SHOULD WE TREAT AS AN END IN ITSELF?

One formulation of the Categorical Imperative tells us to treat humanity as an end in itself. It has become common to think that ‘humanity’ (die Menschheit) here refers to some minimal power of rationality that is necessarily possessed by any rational agent, but I argue that this common reading is misguided. Instead, ‘humanity’ refers to a good will, the will of a being who is committed to moral principles. This good will reading of ‘humanity’ is not only suggested by passages in which Kant specifically discusses humanity, but also is more consistent with the main ideas of Kant's ethics.     

Aboriginal Practitioners Offer Culturally Safe and Responsive CBT: Response to Commentaries

We appreciate the valuable commentaries that have been provided for our paper “Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal practitioners trained in CBT.” The international authors identify how CBT, with adaptations by culturally responsive practitioners can be of value for non‐Western and Indigenous peoples. The commentary by Australian psychologists Dudgeon and Kelly questions the value of CBT for Indigenous Australians, terming it a “Western therapy” that is “culturally unresponsive” and “culturally blind.” They also critique the methodology of the study. We argue that CBT can be adapted by culturally competent practitioners to be culturally safe in Australia, as elsewhere. Cultural safety is mostly a function of the therapist, not the therapy. In the Bennett‐Levy et al. (2014) study, CBT was delivered in a culturally responsive way by Aboriginal counsellors within their own communities. CBT is a particularly adaptable and versatile therapy, and embodies principles of empowerment and self‐determination that are central to Indigenous social and emotional well‐being. We are concerned that CBT, which has strong empirical support and has been adapted elsewhere for a range of cultures, including Indigenous cultures, may be being denied to Indigenous Australian clients. There is considerable opportunity to evaluate the effectiveness and versatility of CBT, and variations of its mode of delivery, for all Australians.     

Emotional scenes elicit more pronounced self-reported emotional experience and greater EPN and LPP modulation when compared to emotional faces

Emotional faces and scenes carry a wealth of overlapping and distinct perceptual information. Despite widespread use in the investigation of emotional perception, expressive face and evocative scene stimuli are rarely assessed in the same experiment. Here, we evaluated self-reports of arousal and pleasantness, as well as early and late event-related potentials (e.g., N170, early posterior negativity [EPN], late positive potential [LPP]) as subjects viewed neutral and emotional faces and scenes, including contents representing anger, fear, and joy. Results demonstrate that emotional scenes were rated as more evocative than emotional faces, as only scenes produced elevated self-reports of arousal. In addition, viewing scenes resulted in more extreme ratings of pleasantness (and unpleasantness) than did faces. EEG results indicate that both expressive faces and emotional scenes evoke enhanced negativity in the N170 component, while the EPN and LPP components show significantly enhanced modulation only by scene, relative to face stimuli. These data suggest that viewing emotional scenes results in a more pronounced emotional experience that is associated with reliable modulation of visual event-related potentials that are implicated in emotional circuits in the brain.     

Newborn Screening: Education,Consent, and the Residual Blood Spot. The Position of the National Society of Genetic Counselors

Newborn screening (NBS) is a minimally invasive lifesaving test. There is currently no federal mandate for NBS, thus states determine their own screening panel based on the recommendations of the Secretary’s Advisory Committee on Heritable Disorders in Newborn and Children (SACHDNC), which was recently re-chartered as the Discretionary Advisory Committee on Heritable Disorders in Newborns and Children (DACHDNC). After NBS is completed, a couple of residual blood spots remain. While some states allow these spots to be used for public health and scientific research purposes, parents are not always informed about these additional uses. This paper addresses the National Society of Genetic Counselors’ (NSGC’s) position about NBS and blood spot storage/use and the rationale for these positions. The National Society of Genetic Counselors strongly supports newborn screening for the uniform screening panel of conditions recommended by the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children. NSGC also supports storage and use of blood spot samples by newborn screening laboratories and transparent policies that govern these activities.