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.     

A model of stage of change to recommend colonoscopy among urban primary care physicians.

Theory is little used in the prediction of physician cancer screening stage of change. Structural equation modeling was used to evaluate the theoretical predictors of stage of change to recommend colonoscopy among 235 urban physicians. Constructs from the theory of planned behavior, social-cognitive theory, and the transtheoretical model were systematically tested. As predicted, contextual factors, such as the physicians' ages, their race-ethnicities, patient race-ethnicity, and office-related barriers to preventive care were associated with stage of change through self-efficacy, normative beliefs, and negative behavioral beliefs. The findings demonstrate the relevance of these models to studying the behavior of physicians and support the development of interventions that are tailored to normative beliefs and specific physician cognitions for colonoscopy recommendation.     

A BLACK FEMINIST MODEL OF RAPE MYTH ACCEPTANCE

A Black feminist model was used to investigate rape myth acceptance between African American antirape activists and a comparison group of nonactivists using Cross's (1991) racial identity model and Downing and Roush's (1985) feminist identity model. As predicted, activists rejected rape myths more than nonactivists; the earlier stages of both models were associated with rape myth acceptance; the later stages were associated with rape myth rejection; and activists evidenced more sociopolitical maturity (race and gender consciousness) than nonactivists. The findings suggest that researchers may need to investigate to what degree rape myth acceptance serves an overarching system of social domination where racism and sexism overlap.     

COMPARISON OF STAFF TRAINING STRATEGIES TO PROMOTE GENERALIZED TEACHING SKILLS

Two studies compared the effectiveness of different strategies for promoting generalization of staff skills in teaching self-care routines to clients with developmental disabilities. In Study 1, 9 direct-care staff members of group homes were trained sequentially through four conditions: (a) the provision of written instructions, (b) performance-based training using a single client program exemplar and simulated clients (single case training), (c) performance-based training using actual developmentally delayed clients as trainees (common stimuli training), and (d) performance-based training using multiple client program exemplars with simulated clients (general case training). The results indicated that staff members did not reach all generalization criteria until general case training was provided. Because staff members had been trained sequentially through several conditions in Study 1, a second study controlled for potential sequence effects. In Study 2, 7 staff members were trained using only the general case strategy after baseline. All staff members reached generalization criteria with only general case training, replicating the findings of Study 1. Together, the two studies demonstrated that the general case training strategy was more effective at promoting generalized training effects across clients, settings, and client programs than other commonly used staff training approaches.     

TEACHING CHILD-CARE SKILLS TO MOTHERS WITH DEVELOPMENTAL DISABILITIES

The present study identified and remediated child-care skill deficits in parents with developmental disabilities to reduce their risk of child neglect. Eleven mothers with developmental disabilities who were considered by social service and child welfare agencies to be providing neglectful child care were found in baseline to have several important child-care skill deficits (e.g., bathing, diaper rash treatment, cleaning baby bottles) compared to nonhandicapped mothers. Parent training (consisting of verbal instructions, pictorial manuals, modeling, feedback, and reinforcement) resulted in rapid acquisition and maintenance of child-care skills in all mothers. Mean percentage correct scores increased from 58% in baseline to 90% in training and 91% in follow-up (M = 31 weeks). The latter two scores compare favorably to the mean score (87%) of 20 nonhandicapped mothers on the same skills. Where observable, parent training was associated with corresponding benefits to the children (e.g., elimination of diaper rash and cradle cap, increased weight gain, successful toilet training). These results indicate that parent training may be a viable option to the removal of the child from the home when parenting skill deficits place the child's well-being in jeopardy.     

Religiosity, schizotypal thinking, and schizophrenia

The relationship between religiosity and the incidence of schizotypal thinking was investigated in a normal sample and in acute and chronic schizophrenic samples. The Rust Inventory of Schizotypal Cognitions was administered to measure schizotypal thinking, and two religiosity measures were developed. Religiosity had a significantly negative relationship with schizotypal thinking in normal subjects, while in schizophrenic patients the relationship was positive and significantly different. It is suggested that the process of existential growth of awareness in the normal development of religious belief, which is thought to be associated with schizotypal thinking, may have proceeded differently in persons suffering from schizophrenia.     

The influence of alcohol and loud music on analytic and holistic processing

The influence of alcohol and loud music on analytic versus holistic processing was examined in classification, concept learning, and embedded figures tasks. In the classification task, loud music reduced analytic responding by individuals who had consumed alcohol and increased analytic responding by individuals who had received placebo drinks. Alcohol also decreased the speed with which individuals were able to generate analytic responses in the classification task and decreased analytic performance on the embedded figures test. Alcohol slowed the rate of learning in the concept-learning task but did not lead to less analytic responding in that task. The results are consistent with the idea that alcohol slows the rate of information processing, particularly in tasks requiring visual analysis of stimuli.     

Once more on the equilibrium-point hypothesis (lambda model) for motor control

The equilibrium control hypothesis (lambda model) is considered with special reference to the following concepts: (a) the length-force invariant characteristic (IC) of the muscle together with central and reflex systems subserving its activity; (b) the tonic stretch reflex threshold (lambda) as an independent measure of central commands descending to alpha and gamma motoneurons; (c) the equilibrium point, defined in terms of lambda, IC and static load characteristics, which is associated with the notion that posture and movement are controlled by a single mechanism; and (d) the muscle activation area (a reformulation of the "size principle")--the area of kinematic and command variables in which a rank-ordered recruitment of motor units takes place. The model is used for the interpretation of various motor phenomena, particularly electromyographic patterns. The stretch reflex in the lambda model has no mechanism to follow-up a certain muscle length prescribed by central commands. Rather, its task is to bring the system to an equilibrium, load-dependent position. Another currently popular version defines the equilibrium point concept in terms of alpha motoneuron activity alone (the alpha model). Although the model imitates (as does the lambda model) spring-like properties of motor performance, it nevertheless is inconsistent with a substantial data base on intact motor control. An analysis of alpha models, including their treatment of motor performance in deafferented animals, reveals that they suffer from grave shortcomings. It is concluded that parameterization of the stretch reflex is a basis for intact motor control. Muscle deafferentation impairs this graceful mechanism though it does not remove the possibility of movement.