Changes in health status after one year for persons at-risk for and with HIV infection

Abstract

Health status is an important component of the evaluation of patient outcome in HIV infection where disease is chronic, progressive, and debilitating. This paper compares patient self-report for 9 dimensions of health status for patients followed in ATHOS (AIDS Time-Oriented Health Outcome Study). We compared changes in functioning after 12 months for 1, 524 patients with varying HIV disease severity: 238 asymptomatic, 447 symptomatic, 441 AIDS, and 398 HIV-negative individuals who are at-risk for infection.

Declines in health status were observed for all HIV-infected persons, including also asymptomatic patients. Individuals with symptomatic disease or AIDS had significant declines (p < 0.001) in physical functioning, energy, global health, pain, and increased disease symptoms, but no significant declines in health distress, cognition, or mental health. Persons with AIDS had greater declines than those with symptomatic disease. All HIV-infected individuals reported significantly fewer hours at work and more disability days than HIV-negative patients from similar risk pools. The adverse impact that HIV infection has on the health status of HIV-positive asymptomatic individuals is striking; HIV-negative individuals are more similar to HIV-positive individuals than to the general population.     

The use of diabetes-specific perceived control and health belief measures to predict treatment choice and efficacy in a feasibility study of continuous subcutaneous insulin infusion pumps

Abstract

In the course of a feasibility study of continuous subcutaneous insulin infusion pumps, 382 insulin-requiring diabetic patients were offered a choice of CSII, intensified conventional treatment or conventional treatment. Two hundred and eighty-six (75%) patients completed newly developed diabetes-specific measures of health beliefs and attributions before any change of treatment regimen. The scales were useful predictors of patients' choice of treatment. Furthermore, they were useful in predicting efficacy of treatment in terms of glycosylated haemoglobin measures of diabetes control after one year of treatment in the study. The implications of the findings for introducing patients to new forms of treatment are discussed.     

Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments

The sleep characteristics of 37 military veterans and active-duty service members (17 with PTSD and 20 without PTSD) of recent wars were analyzed to determine if combat deployment, with its associated sleep restriction, may be an alternative explanation for the sleep complaints found among combat veterans with PTSD (as determined by PTSD Checklist Military Version scores). Over a 1-week period, sleep data were collected using sleep actigraphy and self-report. Across the entire sample, subjective and objective assessment methods of sleep were strongly correlated, although there were some notable within-group differences. Specifically, although sleep duration between groups did not differ based on actigraphy, veterans without PTSD reported sleeping 1 h and 11 min (p = .002) longer than did veterans with PTSD. In an effort to determine why individuals without PTSD might be overreporting sleep, we found that symptoms of emotional arousal (anger, anxiety, and nightmares) were significantly correlated with self-reported sleep duration, suggesting a pattern of higher autonomic arousal found in veterans with PTSD. Thus, although sleeping for 6 h, the higher levels of emotional arousal reported by veterans with PTSD may mean that they do not perceive their sleep as restful. Further research is necessary to determine if the sleep architecture of veterans with PTSD is actually different from that of combat veterans without PTSD and if such differences are actually amenable to standard behavioral treatments for this disorder.     

Memory for Faces in Children with Autism

Previous research has established that children with Autistic Disorder have deficits in aspects of social cognition and in verbal memory, but research on social memory is limited. Twenty-four autistic boys aged 7 to 12 years and normal controls matched for verbal mental age were administered parallel social and nonsocial matching and memory tasks. Results showed that the children with autism were impaired relative to the normal children on the social (face) memory task only. Furthermore, of the four experimental tasks, the social memory task had the highest and most consistent correlations with measures of social development and adaptive skills. Whereas the normal children used the special status of faces to recall them more easily than objects, the children with autism showed equal recall of objects and faces.     

Effortful control and externalizing problems in young adults

The present study evaluates the relationship between effortful control (EC) and externalizing psychopathology in young adults. EC, the capacity to delay immediate impulses in favor of long-term goals, has been robustly linked to externalizing behaviors in children and adolescents. However, such data is limited in adults, and mechanisms underlying this relationship have yet to be evaluated. We hypothesized that the effect of low EC on greater externalizing problems would be mediated by elevated psychological distress. In total 236 undergraduate students completed the EC subscale of the Adult Temperament Questionnaire, the Brief Symptom Inventory, and the Externalizing Spectrum Inventory (ESI). The ESI was found to have four factors representing Callous Aggression, Impulsive Urgency, prosocial control, and Substance Abuse. The degree to which low trait EC manifested in increased Callous Aggression, Impulsive Urgency and decreased prosocial behavior was mediated by elevated psychological distress. However, EC was not related to Substance Abuse. These data indicate that EC plays an important role in shaping psychological and social adjustment in adulthood.     

Social Identity Change During an Intergroup Merger: The Role of Status,Similarity, and Identity Threat

Conducted during the merger between two hospitals, this longitudinal study (N = 149) revealed that at both Time 1 (i.e., questionnaire completed 12 months prior to the merger) and Time 2 (completed 1 year after the merger had been implemented), employees from the low-status premerger organization generally reported lower adjustment to the merger. Whereas Time 2 identity threat predicted lower and decreased identification with the new merged organization and perceptions of a common in group identity, perceived similarities between the merging organizations at Time 2 predicted higher identification with the new merged organization and higher perceptions of a common in group identity.     

A preliminary study of sex differences in brain activation during a spatial navigation task in healthy adults

The hippocampus plays a significant role in spatial memory processing, with sex differences being prominent on various spatial tasks. This study examined sex differences in healthy adults, using functional magnetic resonance imaging (fMRI) in areas implicated in spatial processing during navigation of a virtual analogue of the Morris water-maze. There were three conditions: learning, hidden, and visible control. There were no significant differences in performance measures. However, sex differences were found in regional brain activation during learning in the right hippocampus, right parahippocampal gyrus, and the cingulate cortex. During the hidden condition, the hippocampus, parahippocampal gyrus, and cingulate cortex were activated in both men and women. Additional brain areas involved in spatial processing may be recruited in women when learning information about the environment, by utilizing external cues (landmarks) more than do men, contributing to the observed sex differences in brain activation.     

Relations between Minnesota Multiphasic Personality Inventory-A scales and Rorschach variables with the scope and severity of maltreatment among adolescents

This study examined preexisting Rorschach (Exner, 2001) and Minnesota Multiphasic Personality Inventory-A (MMPI-A; Butcher et al., 1992) profiles to determine if selected MMPI-A scales and Rorschach variables would jointly associate with the number and severity of maltreatment subtypes (physical abuse, sexual abuse, neglect, and emotional maltreatment) of 157 adolescents (ages 14-17) with documented maltreatment histories. The Maltreatment Classification System was used to systematically code the maltreatment attributes. Six Rorschach variables (MOR, PER, Afr, SumY, SumC', Human Content) were significantly correlated with the number of maltreatment subtypes, but none of the anticipated MMPI-A scales were related. MMPI-A Scale 7 and Rorschach variables Ego, MOR, and PER were jointly associated with physical abuse severity. MMPI-A Scale 0 and Rorschach variables MOR, PER, SumY, SumC', PTI, Human Content, and Texture jointly associated with sexual abuse severity. This study supports the potential for certain MMPI-A scales and Rorschach variables to reflect the impact of adolescents' maltreatment experiences in terms of the number and severity of types of maltreatment experienced. Because both instruments captured different aspects of adolescents' maltreatment experiences, clinicians should consider using both when evaluating the impact of maltreatment on adolescents.