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.     

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.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

Do proposed facial expressions of contempt, shame, embarrassment, and compassion communicate the predicted emotion?

Shame, embarrassment, compassion, and contempt have been considered candidates for the status of basic emotions on the grounds that each has a recognisable facial expression. In two studies (N=88, N=60) on recognition of these four facial expressions, observers showed moderate agreement on the predicted emotion when assessed with forced choice (58%; 42%), but low agreement when assessed with free labelling (18%; 16%). Thus, even though some observers endorsed the predicted emotion when it was presented in a list, over 80% spontaneously interpreted these faces in a way other than the predicted emotion.     

Temporal grouping effects in musical short-term memory

Recent theoretical accounts of verbal and visuo-spatial short-term memory (STM) have proposed the existence of domain-general mechanisms for the maintenance of serial order information. These accounts are based on the observation of similar behavioural effects across several modalities, such as temporal grouping effects. Across two experiments, the present study aimed at extending these findings, by exploring a STM modality that has received little interest so far, STM for musical information. Given its inherent rhythmic, temporal and serial organisation, the musical domain is of interest for investigating serial order STM processes such as temporal grouping. In Experiment 1, the data did not allow to determine the presence or the absence of temporal grouping effects. In Experiment 2, we observed that temporal grouping of tone sequences during encoding improves short-term recognition for serially presented probe tones. Furthermore, the serial position curves included micro-primacy and micro-recency effects, which are the hallmark characteristic of temporal grouping. Our results suggest that the encoding of serial order information in musical STM may be supported by temporal positional coding mechanisms similar to those reported in the verbal domain.     

Children's and adults’ understanding of the “disgust face”

By the age of 4 years, children (N=120) know the meaning of the word disgust as well as they know the meaning of anger and fear; for example, when asked, they are equally able to generate a plausible cause for each of these emotions. Yet, in tasks involving facial expressions (free labelling of faces, deciding whether or not a face expresses disgust, or finding a “disgust face” in an array of faces), a majority of 3- to 7-year-old children (N=144) associated the prototypical “disgust face” with anger and denied its association with disgust (25% of adults on the same tasks did so as well). These results challenge the assumption that all humans easily recognise disgust from its facial expression and that this recognition is a precursor to children's understanding of the emotion of disgust.