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 Structure of Creativity in Primary Education: An Empirical Confirmation of the Amusement Park Theory

In this study, we explored the structure of pupils’ creativity in primary education following the Amusement Park Theory, by investigating undiscovered linkages between the domains of writing, mathematics, and drawing. More specifically, we examined: (a) whether some domains and general thematic areas are more closely related to each other than to others, (b) whether literacy and mathematical ability are specific underlying traits of creativity in writing and mathematics, respectively, and (c) whether intelligence and divergent thinking are related to creativity in all domains. The sample consisted of 331 Dutch 4th grade pupils. For each research question, a model was analyzed using structural equation modeling. We found creativity in mathematics and creativity in writing to be most similar, followed by creativity in mathematics and creativity in drawing, with creativity in writing and creativity in drawing being least similar. Additionally, we found evidence for several underlying traits (i.e., literacy ability and mathematical ability) and initial requirements of creativity (i.e., intelligence and divergent thinking), none of which were important for creativity in only one domain, and of which only intelligence was important for creativity in all domains. Herewith, our study provides insights regarding the complexity of the structure of creativity in primary education.     

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.     

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.