Fluid noncompliance and symptomatology in end-stage renal disease: cognitive and emotional variables

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.     

Binocular unmasking with vertical disparity

We recently found (Schneider, Moraglia, & Jepson, 1989) that the contrast threshold for the detection of a visual signal in a noisy background can be considerably lower when binocular cues are available then when monocular cues only are present. Here, we investigated the occurrence of binocular unmasking with vertical interocular disparities. Subjects reported about the presence of Gabor signals in fields of two-dimensional broadband Gaussian noise surrounded by a frame of uniform noise. They saw these stimuli through a stereoscope; in all cases, the right-eye noise field was vertically displaced relative to the left one in either an upward or a downward direction, by up to 67.6'. In one condition, the right-eye signal was displaced by an amount equal to that of the noise, so that no opportunities for binocular unmasking existed; in the other, it appeared in exactly corresponding locations in the two fields--here, binocular disparities could be used to unmask the signal. Enhanced signal detectability, by up to 12.7 dB, was observed in the latter case for both directions of displacement, but only for displacements of 13.52' and only when the signal's orientation was horizontal. We argue that these effects result from the summation of monocular inputs carried out by linear binocular mechanisms.     

Influence analysis of structural equation models with polytomous variables

The estimation of model parameters in structural equation models with polytomous variables can be handled by several computationally efficient procedures. However, sensitivity or influence analysis of the model is not well studied. We demonstrate that the existing influence analysis methods for contingency tables or for normal theory structural equation models cannot be applied directly to structural equation models with polytomous variables; and we develop appropriate procedures based on the local influence approach of Cook (1986). The proposed procedures are computationally efficient, the necessary bits of the proposed diagnostic measures are readily available following an usual fit of the model. We consider the influence of an individual cell frequency with respect to three cases: when all parameters in an unstructured model are of interest, when the unstructured polychoric correlations are of interest, and when the structural parameters are of interest. We also consider the sensitivity of the parameters estimates. Two examples based on real data are presented for illustration.The work described in this paper was partially supported by a Chinese University of Hong Kong Postdoctoral Fellows Scheme and a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (RGC Ref. No. CUHK4186/98P). We are indebted to P.M. Bentler and M.D. Newcomb for providing the data set, Michael Leung for his assistance, and the Editor and the referees for some very valuable comments.     

The termination phase of combined therapy

Three different kinds of termination are described and discussed. In combined therapy the group can help to resolve and clarify the meanings of moves to terminate therapy. The role of the therapist's countertransferences in this stage of the work is important to consider, and here, too, the group is an important part of the work. The author sees termination as an important part of the treatment process. In combined therapy it may be more complex but it also allows for a fuller exploration of the relevant issues.