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.     

Differential effects of prime-probe duration on positive and negative location priming: Evidence for opponent facilitatory and inhibitory influences in priming tasks

A series of four spatial localization experiments is reported that examined the effects of display duration and presentation mode on positive and negative priming using an attended-repetition and an ignored-repetition paradigm, respectively. Experiment 1 showed larger positive priming with response-dependent than with 150 ms display durations while negative priming remained unaffected. Experiments 2-4 were performed to further elucidate the effects of prime-probe durations. Data suggest largely independent effects of prime and probe duration on priming effects. Manipulation of prime duration affected facilitation due to repetition of the prime distractor location as well as inhibitory effects associated with ignored repetition. Furthermore, anticipated probe duration modulated the effectiveness of inhibition of return. Findings are discussed within a framework proposing two major components of priming effects—a stimulus-driven or automatic component, and a strategic component related to the participant's expectations towards the probe.     

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.     

Auditory Long term Memory: Repetition Priming of Voice Recognition

Two experiments examined repetition priming in the recognition of famous voices. In Experiment 1, reaction times for fame decisions to famous voice samples were shorter than in an unprimed condition, when voices were primed by a different voice sample of the same person having been presented in an earlier phase of the experiment. No effect of voice repetition was observed for non-famous voices. In Experiment 2, it was investigated whether this priming effect is voice-specific or whether it is related to post-perceptual processes in person recognition. Recognizing a famous voice was again primed by having earlier heard a different voice sample of that person. Although an earlier exposure to that person's name did not cause any priming, there was some indication of priming following an earlier exposure to that person's face. Finally, earlier exposure to the identical voice sample (as compared to a different voice sample from the same person) caused a considerable bias towards responding 'famous'-i.e. performance benefits for famous but costs for nonfamous voices. The findings suggestthat (1) repetition priming invoice recognition primarily involves the activation of perceptual representations of voices, and (2) it is important to determine the conditions in which priming causes bias effects that need to be disentangled from performance benefits.