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.     

International Applications of Computer-based Testing and Interpretation

The computer has been used to administer, score and interpret psychological tests in a number of countries throughout the world. This paper traces early work in the United States, Great Britain and continental Europe and reviews the current international status of computer-assisted psychological testing. Several problems with transporting existing computer-based psychological testing technology across languages and cultures are discussed.
Les ordinateurs sont utilisés pour administrer, noter et interpréter les tests psychologiques dans un certain nombre de pays du monde entier. Cet article évoque les travaux réalisés aux Etats-Unis, en Grande Bretagne et en Europe Occidentale, et passe en revue les données du courant international en la matière. Plusieurs problèmes technologiques sont soulevés par la diffusion de ces tests, notamment sur les plans du langage et de la culture.     

The valuing process: A study of favorite songs and the inner experience of persons diagnosed with schizophrenia

Since valuing is a process grounded in the organizational tendency of human behavior, the characteristics of a highly valued object should reflect the experience of the individual who selects it. This research compared the favorite songs of fourteen individuals diagnosed with schizophrenia to their inner experience as assessed in a standard interview. Many relationships were revealed between the two, often pertaining to important issues identified in theories of schizophrenia. Results may have therapeutic applications and shed light on processes through which psychological difficulties persist.     

AN ANALYSIS OF THE EFFECTS OF MULTIPLE SETTING EVENTS ON THE SOCIAL BEHAVIOR OF PRESCHOOL CHILDREN WITH SPECIAL NEEDS

We examined the effects of four combinations of setting events on the social interactions of 7 preschool children with social delays. In Study 1, the status of the teacher, activity materials, and peer varied across conditions. In Study 2, the status of the teacher and materials varied across conditions. Within the combinations of setting events, we also examined teacher behavior. Teacher presence and absence was varied in both studies. The type and rate of teacher prompting were varied in Study 2. The four combinations of setting events produced different rates of social behavior by the children with social delays. The optimal combination of setting events for promoting peer interaction and reducing teacher—child interaction included teacher absence from the activity, a limited number and form of materials, and children paired with a socially skilled partner.     

As If Your Life Depended on It: Promoting Cognitive Development to Promote Wellness

In this article the authors discuss key elements of the cognitive-developmental perspective and the need to integrate it as an important component of the wellness model. Each speaks to the personal empowerment of every person to live a rewarding and responsible life. Each also emphasizes the ongoing promotion of growth rather than secondary prevention or remediation.     

Phonological coding in word reading: Evidence from hearing and deaf readers

The ability of prelingually, profoundly deaf readers to access phonological information during reading was investigated in three experiments. The experiments employed a task, developed by Meyer, Schvaneveldt, and Ruddy (1974), in which lexical decision response times (RTs) to orthographically similar rhyming (e.g., WAVE-SAVE) and nortrhyming (e.g., HAVE-CAVE) word pairs were compared with RTs to orthographically and phonologically dissimilar control word pairs. The subjects of the study were deaf college students and hearing college students. In Experiments 1 and 2, in which the nonwords were pronounceable, the deaf subjects, like the hearing subjects, were facilitated in their RTs to rhyming pairs, but not to nonrhyming pairs. In Experiment 3, in which the nonwords were unpronounceable, both deaf and hearing subjects were facilitated in their RTs to both rhyming and nonrhyming pairs, with the facilitation being significantly greater for the rhyming pairs. These results indicate that access to phonological information is possible despite prelingual and profound hearing impairment. As such, they run counter to claims that deaf individuals are limited to the use of visual strategies in reading. Given the impoverished auditory, experience of such readers, these results suggest that the use of phonological information need not be tied to the auditory modality.     

San Diego suicide study: comparison of gay to straight males

Previous large studies of completed suicides have not considered sexual orientation in their data analyses. In this study, data from the known homosexual subpopulation (13 males, aged 21-42) in a series of 283 suicides were examined. They were compared with all other aged male suicides 21-42 (n = 106). Both groups showed considerable substance abuse plus a variety of other psychiatric diagnoses. Both also had a high frequency of relationship difficulties near the time of death. Gays who committed suicide did not have a history of more police trouble and were no more likely to be living alone than the comparison group. They did not have more prior suicide attempts or previous psychiatric treatment. We conclude that, among the factors examined here, there appears to be little difference between gay and heterosexual male suicides.     

Locus of control,choice, and satisfaction with an assigned task

P. E. Spector's (1982, Psychological Bulletin, 91, 482–497) hypothesis that under conditions of freedom of choice persons characterized by an internal locus of control will experience greater satisfaction with an undesirable task than persons characterized by an external locus of control is considered in light of distinctions between perceived control and perceived choice. Perceived choice is proposed as an intervening variable implicit in Spector's argument. This reasoning was tested with 46 male and female college student participants in a 2 (Choice) × 2 (Locus of Control) factorial design experiment. An interaction of Choice × Locus of Control on task satisfaction was obtained such that internals tended to be more satisfied when given a choice while externals experienced greater satisfaction when not given a choice. The implications of this result for Spector' hypothesis and for the manner in which undesirable work is assigned are discussed.     

Variations in explicitly unpaired training are differentially effective in producing conditioned inhibition

To evaluate a contingency interpretation of conditioned inhibition (CI), rats were given “explicity unpaired” training in which the locus and duration of a CS within the inter-US (shock) interval were systematically manipulated for different groups. Summation and retardation tests in Experiment 1 indicated that stronger CI resulted from both a backward and a trace CS than from a midlocus CS of equal or greater duration. Complementing these findings, the same tests in Experiment 2 showed that, by comparison with novel-stimulus controls, CI developed to a trace CS but not to a mid-locus CS, nor to a trace CS that was accompanied by an immediate signal for the US. These findings argue against a contingency interpretation of CI and favor a contiguity interpretation stressing the short-term rehearsal of stimulus events. Such rehearsal of the US allows a backward CS, but not a mid-locus CS with an extended US-CS interval, to be discriminated as a signal for nonreinforcement, and thus to develop as a conditioned inhibitor. Similarly, excitatory conditioning to the memory trace of a CS allows the nominal trace CS to develop as a signal for nonreinforcement, and thus as a conditioned inhibitor, but not when its memory trace is overshadowed by another CS that immediately precedes the US. In short, the development of CI is facilitated when excitation is mediated by the memorial processing of either the US or a discrete CS for the US rather than by contextual cues.