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.     

Environmental Modesty

Despite this virtue's history as an instrument of women's oppression, modesty, at its most basic, means voluntary restraint of one's power, undertaken for the sake of others. It is a mechanism that modifies unequal power relationships and encourages greater compassion and fairness. I use a Christian perspective with influences from Jewish and Muslim sources to examine modesty. The modest person, I argue, must be in relationship with others, must be honestly aware of her impacts on others, must be sensitive to those impacts, compassionate toward others, and willing to hold back for others' sakes. Moreover, modesty is not only a virtue that pertains to sexuality and clothing, but it also can promote virtuous environmental behavior, particularly as it leads to awareness of, and sensitivity to, the effects of everyday behaviors on vulnerable others.     

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.     

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.     

Health as a value: methodological and theoretical considerations

The concept of value placed on health is very important in several different theoretical approaches to the study of health behavior. In practice, however, health value is generally assumed to be universally high rather than being directly measured. If this assumption is incorrect, then theories that include health value have rarely been adequately tested. This paper presents a short 4-item Likert scale designed to measure the value placed on health. Norms from the utilization of this scale in five different samples are presented. Health value is found to increase with age among girls, but the increase apparently stops by late adolescence, before full adult levels of health value are achieved. Middle-aged women place a higher value on health than do middle-aged men, although no comparable sex difference appears in a sample of undergraduates. Consistent with theoretical predictions, both health locus of control beliefs and beliefs in the efficacy of certain preventive health behaviors correlate more highly with the performance of those same behaviors 5 to 9 months later among respondents who place a high value of health relative to those who do not value health so highly. However, this interaction is found only when it can be safely assumed that health is the primary value underlying the behavior. The importance of considering a variety of values in addition to health as possible motivators of preventive health behavior is stressed.     

Criminal profiling from crime scene analysis

Since the 1970s, investigative profilers at the FBI's Behavioral Science Unit (now part of the National Center for the Analysis of Violent Crime) have been assisting local, state, and federal agencies in narrowing investigations by providing criminal personality profiles. An attempt is now being made to describe this criminal-profile-generating process. A series of five overlapping stages lead to the sixth stage, or the goal of apprehension of the offender: (1) profiling inputs, (2) decision-process models, (3) crime assessment, (4) the criminal profile, (5) investigation, and (6) apprehension. Two key feedback filters in the process are: (a) achieving congruence with the evidence, with decision models, and with investigation recommendations, and (b) the addition of new evidence.     

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.     

Susceptibility to prosocial and antisocial influence in adolescence following mindfulness training

Mindfulness training programmes have shown to encourage prosocial behaviours and reduce antisocial tendencies in adolescents. However, less is known about whether training affects susceptibility to prosocial and antisocial influence. The current study investigated the effect of mindfulness training (compared with an active control) on self-reported prosocial and antisocial tendencies and susceptibility to prosocial and antisocial influence. 465 adolescents aged 11–16 years were randomly allocated to one of two training programmes. Pre- and post-training, participants completed a social influence task. Self-reported likelihood of engaging in prosocial and antisocial behaviours did not change post-training, and regardless of training group, participants showed a higher propensity for prosocial influence than for antisocial influence. Finally, participants were less influenced by antisocial ratings following both training programmes.     

SLOTE'S SATISFICING CONSEQUENTIALISM

The article discusses Michael Slote's Satisficing Consequentialism, which is the view that moral agents are not required to maximise the good, but merely to produce a sufficient amount of good. It is argued that Satisficing Consequentialism is not an acceptable alternative to Maximising Consequentialism. In particular, it is argued that Satisficing Consequentialism cannot be less demanding in practice than Maximising Consequentialism without also endorsing a wide range of clearly unacceptable actions. It is then argued that Slote's inability to provide adequate reasons for moral satisficing stems from a mistaken analogy between rationality and morals. The sense of ‘good enough’ which is relevant to morality is one which focusses on the effort an agent puts in, rather than on the outcome she produces. However, replacing outcomes with efforts would undermine Slote's Consequentialist project. Finally, it is suggested that similar problems will be faced by others who seek to construct essentially Consequentialist theories which are not unduly demanding.