Phonological assessment: a systematic comparison of conversation and picture naming.

The purpose of the present study was to systematically compare two methods of speech elicitation for phonological assessment: conversation and picture naming. Subjects were 13 male, phonologically impaired children (aged 4.2 to 5.11 years). All were English speaking and had received no prior speech-language therapy. The children's performance was assessed on a conversational speech task (CST) and a 162-item picture naming task (PNT) using three levels of phonological analysis. The CST and PNT generally yielded similar sound error patterns, and severity measures on the two tasks were highly correlated. However, the PNT yielded more phonological errors. It is suggested that both methods of speech elicitation are useful clinical tools for assessment. However, to obtain a thorough sample of a child's speech output, an extensive, well-designed PNT may tap the child's phonological system more deeply, may be more efficient in some cases, and may represent a good index of phonological ability.

Adherence in AIDS clinical trials: a framework for clinical research and clinical care.

Assessment of adherence within AIDS clinical trials is a critical component of the successful evaluation of therapeutic outcomes. Poor medication adherence can result in the misinterpretation of clinical trial data. Research on factors affecting adherence in AIDS clinical trials has been scarce, and few investigations have evaluated strategies for enhancing patient participation. One reason may be the absence of a conceptual framework to guide research. Consistent with previous research on medical adherence, we propose a framework whereby factors affecting adherence in AIDS clinical trials can be categorized as characteristics of the: (a) individual, (b) treatment regimen, (c) patient-provider relationship, (d) clinical setting, and (e) disease. This framework is used as a heuristic for reviewing studies that examine factors affecting adherence in AIDS clinical trials. Suggestions for future research and clinical intervention are provided. These efforts are timely because adherence is now the center of attention in discourse about the efficacy of the new class of protease inhibitor drugs; non-adherence has been linked to viral resistance and drug failure. Efforts to identify factors that influence adherence to AIDS clinical trials can inform future attempts to improve adherence and retention. Better adherence protects the scientific integrity of AIDS clinical trials, promoting more efficient and accurate evaluations of therapeutic value. Accelerated access to new treatments may follow, ultimately enhancing patient care.

Employment and coronary risk in women at midlife: a longitudinal analysis.

This study investigated the relation between employment and cholesterol in 541 women aged 42-50 years who resided in Allegheny County, Pennsylvania, in 1985-1988. Employment, health-related variables, and cholesterol were assessed at baseline and 3 years later. At baseline, employed and nonemployed women did not differ in cholesterol or health behaviors. However, women employed at baseline had a significant decrease in total high density lipoprotein cholesterol (1.9 mg/dl) and high density lipoprotein2 cholesterol subfraction (3.2 mg/dl) at follow-up. Those who were employed at both assessments had the lowest high density lipoprotein cholesterol at follow-up. These effects could not be accounted for by sociodemographics or employment quality variables. Post hoc analyses were conducted to examine health behaviors as a potential mechanism to account for the association between employment status and cholesterol. Over the study period, those who were employed at baseline were less likely to increase exercise and more likely to gain weight than those who were not employed at baseline. With menopause-related changes in metabolism, this can result in detrimental effects for cholesterol levels and coronary health. The results highlight the importance of longitudinal assessment in the study of employment and health.

Depressed affect and male sexual arousal.

We investigated the effects of elated and depressed affect on sexual arousal in 15 sexually functional males. Subjects received elation and depression mood inductions in a repeated-measures design. Immediately following each induction, subjects viewed a brief erotic film during which penile tumescence and subjective sexual arousal were recorded continuously. Following depression induction there was a trend toward diminished subjective sexual arousal in the early portion of erotic exposure, and achievement of maximum subjective arousal was delayed; however, penile tumescence was unaffected. Multiple regression analysis indicated that tumescence during erotica was predictive of posterotica affect, independent of pre-erotica effect. The findings of delayed subjective arousal with no diminution in tumescence, although contrary to predictions, are consistent with previous research with sexually dysfunctional men. The study provides partial support for the role of depressed affect in the etiology of erectile dysfunction.

Psychiatric symptoms in mentally ill chemical abusers.

The purpose of this study was to determine whether mentally ill chemical abusers (MICA patients) report greater distress than do psychiatric patients who do not abuse psychoactive substances. Thirty-two MICA patients and 31 non-substance-abusing patients completed the SCL-90-R. Group comparisons indicated that MICA patients reported greater levels of somatization, depression, anxiety, obsessive-compulsiveness, paranoia, and psychotic symptoms. MICA patients also reported greater overall distress than did psychiatric patients without substance abuse problems.

Reliability and validity of the appraisal of diabetes scale.

The present research evaluated the psychometric properties of a brief self-report instrument designed to assess appraisal of diabetes. Two hundred male subjects completed the Appraisal of Diabetes Scale (ADS) and provided blood samples that were subsequently assayed to provide an index of glycemic control (i.e., glycosylated hemoglobin). Subjects also completed either (a) additional measures of diabetes-related health beliefs, diabetic daily hassles, perceived stress, diabetic adherence, and psychiatric symptoms or (b) the ADS on two additional occasions. Results indicated that the ADS is an internally consistent and stable measure of diabetes-related appraisal. The validity of the measure was supported by correlational analyses which documented the relationship between the ADS and several related self-report measures.

Learned resourcefulness, drinking, and smoking in young adults.

The purpose of this study was to examine the relationship between learned resourcefulness and two common addictive behaviors, namely, drinking and smoking. Male and female college students (N = 175) completed the Self-Control Schedule (SCS), the Quantity-Frequency-Variability questionnaire, and a smoking history form. Learned resourcefulness was related to self-reported patterns of alcohol consumption; specifically, heavy drinking subjects were lower in learned resourcefulness than were light and moderate drinkers who, in turn, were lower in learned resourcefulness than were infrequent drinkers and abstainers. Learned resourcefulness was only modestly related to smoking, with students who had never smoked evidencing somewhat higher learned resourcefulness than ex-smokers and current smokers. Overall, these data provide correlational support for the notion that learned resourcefulness may protect young adults against substance abuse.

A critical reevaluation of nocturnal penile tumescence monitoring in the diagnosis of erectile dysfunction.

The use of nocturnal penile tumescence (NPT) monitoring for the differential diagnosis of erectile dysfunction has burgeoned during the last decade. This article reviews the history, development, and attempts at validation of NPT for diagnostic purposes. Problems associated with NPT are discussed, including the potential effects of unrecorded concomitant sleep parameters and variability in data scoring and diagnostic criteria. In addition, less expensive and more convenient methods of NPT monitoring are reviewed, and their strengths and weaknesses are discussed. Finally, theoretical problems related to the use of NPT for differential diagnosis of organic and psychogenic erectile dysfunctions are presented. In light of the problems associated with NPT monitoring, exclusive reliance on this technique for diagnostic purposes is discouraged. Instead, a biopsychosocial approach to the understanding and assessment of erectile dysfunction is advocated.

Use of the malleable penile prosthesis in the treatment of erectile dysfunction: a prospective study of postoperative adjustment.

Much of the research on the postoperative adjustment of penile prosthesis recipients and their partners has been hampered by retrospective designs, unreliable assessment procedures and other methodological limitations. To address these shortcomings and to increase current knowledge regarding postoperative adjustment, we completed a prospective, longitudinal study of 19 implant recipients and their partners. Our results suggest that most patients and partners were satisfied with the prosthesis 1 year postoperatively, although use of the prosthesis sometimes was accompanied by short-term complications. Satisfaction tended to be lower among spouses than patients. Frequency of sexual intercourse increased during the followup period but there were no changes in sexual desire. Neither marital nor psychological adjustment changed significantly during this period.

Success and failure in penile prosthesis surgery: two cases highlighting the importance of psychosocial factors.

Two cases, carefully selected from a longitudinal, prospective investigation of the relationship between psychosocial variables and postsurgical adjustment to a penile prosthesis implantation, were studied intensively. In both cases, the patient and sexual partner were assessed, presurgically, on a number of psychological, marital, and sexual functioning variables; their subsequent satisfaction with the prosthesis, and their psychological, marital, and sexual adjustment were measured at 6 and 12 months postsurgery. Despite many similarities in medical aspects of the surgery, for one couple a successful outcome was evidenced, whereas the other couple demonstrated a therapeutic failure despite the technical success of the surgery. Psychosocial differences between the couples were identified as they may relate to the discordant outcomes observed. Clinical implications of these results are discussed, as are the strengths and weaknesses of our methodological approach.