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.     

The Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.     

Characteristics of adolescents at risk for compulsive overeating on a brief screening test

As part of a large survey of addictive behavior in high school students, 43% of a sample of 278 (26% of the males, 57% of the females) scored above the cutoff point set by Overeaters Anonymous on their scale for assessing compulsive overeating. While this at-risk group did not report poorer general adjustment, health, or school achievement than did the students not at risk, they did significantly more often perceive their life quality and relationship with the person closest to them as less positive. The at-risk subsample indicated the defensive effectiveness of overeating in their significantly more frequent report of dissociative experiences while eating, and less severe ratings of insecurity, worrying, and daydreaming. One of the most salient findings was the at-risk students' more frequent report of addictive problems in their parents (overeating, alcohol and drug use, and gambling).     

Focused search of semantic cases in question answering

Three experiments tested the hypothesis that people can execute focused searches of semantic cases when answering questions about complex facts, such as “the teacher watered the peas, the corn, and the lettuce with the hose.” In Experiment 1, answer time varied mainly with the number of concepts in the relevant or focused case, supporting the hypothesis. Experiment 2 indicated that the irrelevant case undergoes some processing. Experiment 3 confirmed that search in Experiments 1 and 2 focused on semantic cases rather than on taxonomic categories. It is proposed that focused memory search has a high probability of retrieving the relevant case and a low probability of retrieving the irrelevant case. In the latter event, the irrelevant concepts receive full processing.     

Stability/Instability of Cognitive Strategies Across Tasks Determine Whether Stress Will Affect Judgmental Processes'

Previous research indicates that individuals employ various cognitive heuristics and decision modes in making decisions and judgmental tasks that do not follow an expected value model. It further indicates that several cognitive faculties are affected by stress. The purpose of this study was twofold: first, to examine whether individual differences exist in the use of cognitive heuristics and risk-assessment decision modes; second, to examine whether stress would affect the use of these cognitive strategies. Three versions of a questionnaire measuring the representativeness and availability heuristics, and risk-seeking and risk-aversion decision modes were administered to three different groups of subjects. Consistent individual differences were only observed in the subscales measuring risk-seeking and risk-aversion modes, but not in the use of the heuristics. In a different group of subjects, exposure to noise and task overload stress increased the use of the representativeness heuristic, but did not alter the use of risk-seeking and risk-aversion decision modes. These results indicate that the existence of individual differences in cognitive strategies may determine, in part, whether stress will modify judgmental processes.     

Job experiences over time, multiple roles, and women's mental health: a longitudinal study.

Are changes over time in the quality of a woman's job associated with changes in her psychological distress? Do family roles moderate these relationships? We addressed these questions using longitudinal data from a 2-year 3-wave study of a stratified random sample of 403 employed women who varied in occupation, race, partnership, and parental status. After estimating individual rates of change for each woman on each of the predictors and the outcome, we modeled the relationships between family role occupancy and change in job-role quality on the one hand, and change in psychological distress on the other. Among single women and women without children, as job-role quality declined, levels of psychological distress increased. Among partnered women and women with children, change in job-role quality was unrelated to change in psychological distress.