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.     

Hypothesizing and evidence-gathering: the nexus of understanding

Prior discussion of hypothesizing as a session "guideline" has not fully clarified the derivation of hypotheses. Reviewing relevant philosophy of science literature, the authors develop the notions of evidence and evidence-gathering in systemic family therapy. The authors claim evidence-gathering and hypothesizing are interdependent, reciprocal elements of scientific understanding. The structure of evidence is described along with practical and qualitative rules for collecting and using evidence. This model is applied to a case example illustrating the logic of clinical process. Implications are discussed for family therapy training and supervision.     

Musical notation for the keyboard: An examination of stimulus-response compatibility

A recent stimulus-response compatibility model was used to provide a performance evaluation of an experimental notation for the keyboard in which pitch varies horizontally in visual space. One hundred and twenty subjects performed a choice reaction time task using either the horizontal notation or a more traditional vertical notation. Half the subjects in each notation group received white noise and half received pitch-varying feedback with responses. A horizontal display advantage was revealed when rules of the model were applied to data analyses. Further, the horizontal display advantage was not dependent on the nature of the feedback. In a second experiment, performance of musicians and non-musicians was compared using the horizontal and vertical notations. Musicians' performance was uniformly better than that of non-musicians, and did not differ with notation orientation. The findings support the use of non-traditional horizontal notations for novice performance on a keyboard instrument.     

The rate of scent marking by male rats and consequent olfactory preferences of female rats

An experiment is reported designed to test the hypothesis that female rats might discriminate between males that differed in the quantity of odor deposited by scent marking. Male odor donors were selected by prior screening for high or low rates of scent marking in an open arena. Females were then tested to determine whether they showed any preference for males that marked at a high rate. It was found that female rats did discriminate, but that they preferred to remain near males selected for low rates of scent marking.     

An essentialism perspective on intercultural processes

Essentialist theories are the beliefs that there are immutable essences underlying observed differences between social groups (e.g. racial group, cultural group). This paper reviews the intergroup dynamics and intrapersonal processes associated with essentialism. It also explores the interplay between the two. By explicating the intricate relationship between these psychological processes, the current paper aims to advance our understanding of intergroup relations and identify their implications for the study of multiculturalism. We posit that although the commonly observed negative intergroup outcomes, such as prejudices and biases, can be the byproducts of basic cognitive processes associated with essentialist theories, the social power dynamics in a given society also play important roles in shaping the relationships between essentialism and intergroup outcomes. We then discuss the implications of this understanding to our increasingly multicultural world.     

The rhetorician's craft, distinctions in science, and political morality

In his response to Szasz' Secular Humanism and Scientific Psychiatry, the author considers the use of rhetorical devices in Szasz' work, Szasz' avoidance of acknowledging psychiatry's scientific distinctions, and Szaszian libertarianism versus liberalism.     

Social Integration may Moderate the Relationship between Neighborhood Vacancy and Mental Health Outcomes: Initial Evidence from Flint,Michigan

Long-term residence in neighborhoods is thought to promote the development and maintenance of supportive relationships and trust. These strong social ties may, however, be limited in communities in post-industrial cities characterized by high levels of vacant properties. This study aimed to examine the relationship between neighborhood vacancy and mental health with adjustment for length of residence and possible moderation by social (dis)integration in a sample of Flint, MI, residents. We found that short-term (but not long-term) increases in neighborhood vacancy were associated with poorer mental health, after adjustment for individual covariates. When considering neighborhood vacancy, length of residence and individual covariates, however, the only significant association detected was between higher social disintegration and lower wellbeing. This effect was direct and not mediated by other factors. In this way, it appears that the social conditions of neighborhoods may be important, particularly in places that have experienced declines in the built environment. In addition, we identified evidence that social integration moderates the relationship between neighborhood vacancy and mental health outcomes. The level of neighborhood vacancies had a weaker relationship to wellbeing among those with higher levels of social ties. But none of the independent variables in our study were able to predict social integration, highlighting some potential areas for future research. From these findings, we posit that establishing strong social connections can buffer residents against negative mental health outcomes, and health promotion efforts could usefully assist in maintaining social ties among neighbors.