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. 相似文献
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. 相似文献
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. 相似文献
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. 相似文献
To anyone vaguely aware of Feyerabend, the title of this paper would appear as an oxymoron. For Feyerabend, it is often thought, science is an anarchic practice with no discernible structure. Against this trend, I elaborate the groundwork that Feyerabend has provided for the beginnings of an approach to organizing scientific research. Specifically, I argue that Feyerabend’s pluralism, once suitably modified, provides a plausible account of how to organize science. These modifications come from C.S. Peirce’s account of the economics of theory pursuit, which has since been corroborated by empirical findings in the social sciences. I go on to contrast this approach with the conception of a ‘well-ordered science’ as outlined by Kitcher (Science, truth, and democracy, Oxford University Press, New York, 2001), Cartwright (Philos Sci 73(5):981–990, 2006), which rests on the assumption that we can predict the content of future research. I show how Feyerabend has already given us reasons to think that this model is much more limited than it is usually understood. I conclude by showing how models of resource allocation, specifically those of Kitcher (J Philos 87:5–22, 1990), Strevens (J Philos 100(2):55–79, 2003) and Weisberg and Muldoon (Philos Sci 76(2):225–252, 2009), unwittingly make use of this problematic assumption. I conclude by outlining a proposed model of resource allocation where funding is determined by lottery and briefly examining the extent to which it is compatible with the position defended in this paper.
This paper examines college students' attributions about suicide as a function of gender and context (athletic vs. relationship failure). Results indicated that male athletes who suicided were considered more emotionally well-adjusted compared to males who suicided because of a relationship failure and all females. Male and female athletes who suicided were seen as more competent and less distressed compared to those who suffered a failed relationship. Females were also seen as more distressed compared to males. These results are discussed in terms of a positive bias toward athletes in our society as well as gender stereotypes. Implications of these findings as well as methodological limitations are discussed. 相似文献
The current study was designed to gain a better understanding of the nature of the relationship between substance use and sexual risk taking within a community sample of women (N = 1,004). Using confirmatory factor analysis, the authors examined the factor structure of sexual risk behaviors and substance use to determine whether they are best conceptualized as domains underlying a single, higher order, risk-taking propensity. A 2 higher order factor model (sexual risk behavior and substance use) provided the best fit to the data, suggesting that these 2 general risk domains are correlated but independent factors. Sensation seeking had large general direct effects on the 2 risk domains and large indirect effects on the 4 first-order factors and the individual indicators. Negative affect had smaller, yet still significant, effects. Impulsivity and anxiety were unrelated to sexual health risk domains. 相似文献