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.     

Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnosed patients with juvenile rheumatoid arthritis.

Adherence to medications for chronic pediatric diseases decreases overtime. This randomized controlled trial evaluated a clinic-based, nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis. Thirty-four participants completed the study (mean age = 8.44 years, SD = 3.96), including 19 in the experimental group and 15 in the standard-treatment (education) control group. There were significant group and Group x Time effects for adherence (assessed with an electronic monitor over a 13-month period) favoring the experimental group. In contrast, the groups did not differ significantly in disease activity or functional limitations. Factors that may have prevented detection of differences in these health parameters are dicussed.     

Acceptance of Labels for Behavioral Response-Reduction Procedures and the Users of Those Procedures

The Psychological Record - The acceptability of labels for behavioral response-reduction procedures and the users of those procedures was evaluated. Introductory psychology students read a lesson...     

PROBLEM SOLVING TO PREVENT WORK INJURIES IN SUPPORTED EMPLOYMENT

A problem-solving strategy was used to teach three groups of 3 individuals in supported employment how to prevent work-related injuries. The problem-solving strategy was taught in two training phases. The first training phase involved the use of cue cards, and the second involved the withdrawal of the cue cards. Interviews and staged generalization assessments in the participants' natural work environments were conducted before, during, and up to 12 weeks after training. In these assessments, situations were presented that were either similar or dissimilar to situations presented in training. Results of both the interviews and staged assessments indicated that the participants' newly acquired problem-solving skills generalized to similar and dissimilar situations.     

Response competition: a major source of interference in a tactile identification task.

Two experiments investigated the ability of subjects to identify a moving, tactile stimulus. In both experiments, the subjects were presented with a target to their left index fingerpad and a nontarget (also moving) to their left middle fingerpad. Subjects were instructed to attend only to the target location and to respond "1" if the stimulus moved either to the left or up the finger, and to respond "2" if the stimulus moved either right or down the finger. The results showed that accuracy was better and reaction times were faster when the target and nontarget moved in the same direction than when they moved in different directions. When the target and nontarget moved in different directions, accuracy was significantly better and reaction times were significantly faster when the two stimuli had the same assigned response than when they had different responses. The results provide support for the conclusion that movement information is processed across adjacent fingers to the level of incipient response activation, even when subjects attempt to focus their attention on one location on the skin.     

Sentence encoding and implicitly activated memories

Some words have fewer direct associates than others, and, when words varying in set size are studied in a list-learning task, those with smaller sets are more likely to be recalled. This set-size effect is found in cued recall when the words are studied in the absence of related words, but not when studied in the presence of related words. Related words provide context and theoretically inhibit irrelevant associates. The present research determined that set-size effects are found when words are encoded in sentence contexts. In contrast to list-learning experiments, the results of three experiments found such effects even when lexically related words were present in the sentences. Other findings indicated that target-set-size effects were determined by the proximity of related words in the sentence and the nature of the test cue. The results are discussed in relation to a model for explaining set-size effects and to selective findings from the sentence-comprehension literature.