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.     

The role of illness uncertainty on coping with fibromyalgia symptoms.

This study examined the role of illness uncertainty in pain coping among women with fibromyalgia (FM), a chronic pain condition of unknown origin. Fifty-one FM participants completed initial demographic and illness uncertainty questionnaires and underwent 10-12 weekly interviews regarding pain, coping difficulty, and coping efficacy. Main outcome measures included weekly levels of difficulty coping with FM symptoms and coping efficacy. Multilevel analyses indicated that pain elevations for those high in illness uncertainty predicted increases in coping difficulty. Furthermore, when participants had more difficulty coping, they reported lower levels of coping efficacy. Results were consistent with hypothesized effects. Illness uncertainty accompanied by episodic pain negatively influenced coping efficacy, an important resource in adaptation to FM.     

Perceived racism and cardiovascular reactivity and recovery to personally relevant stress.

This study evaluated cardiovascular responses (CVR) to an active speech task with blatantly discriminatory (BRC) versus neutral (NRC) stimuli and an anger recall task in a sample of Black men (N = 73; age 18 to 47). Diastolic blood pressure scores were higher for NRC versus BRC stimuli during anger recall (p = .05). Moreover, persons in the NRC group who perceived high levels of racism (vs. no racism or BRC group) during active speech showed larger increases in blood pressure across postspeech rest, anger recall, and subsequent rest (p = .03). The notable elevation in CVR in response to an ambiguous event extends current models of racism suggesting that subtle racism is a psychosocial stressor that erodes health through chronically elevated CVR.     

Reinforcement and the organisation of behaviour in golden hamsters: Differential overshadowing of a CS by different responses

Are different responses differentially associable with their consequences? An overshadowing design was used to try to answer this question for three responses previously studied in golden hamsters. In Experiment I, scrabbling was rapidly suppressed by electric shock punishment, and it overshadowed a tone which occurred between scrabbling and shock. In Experiment II, no evidence of response-shock association was obtained when open rearing was the punished response, and open rearing did not overshadow the tone. Punishment had some effect on face washing, but there was no statistically significant overshadowing with this response. These results are consistent with the idea that differences in punishment suppression among these three responses have an associative basis. They also demonstrate the usefulness of a novel paradigm for studying “preparedness” of response-reinforcer associations.     

Binocular cues in the perception of distance of a point source of light

The ability to make egocentric distance estimates of a single point source of light, seen in darkness and without the cues of changing size and luminance, was investigated in sixteen observers. The attenuation required to maintain constant luminance, when the target was viewed from different distances, was shown to follow the inverse square law providing the angle subtended by the light was less than 20 s arc. Distance changes were also simulated by means of a split mirror which produced vergence cues, or by test lenses to provide accommodation cues. Over the range 0.5 to 9.2 m distance estimates were surprisingly accurate, although there was some overestimation of near and underestimation of far distances. Most observers made good judgements when only convergence cues were varied, whereas no observers made consistently good judgements when only accommodation cues were varied. The difficulties are discussed in terms of the accommodation-convergence link. When distance was simulated by changing convergence and accommodation cues, estimates were not as good as when real distance was changed. Since good estimates were made with brief target exposures, these judgements were not based on subsequent convergence or accommodation changes. It is suggested that the metric or reference against which the apparently absolute judgements were made was the efferent demand signal associated with a 'resting' position of convergence in darkness.