The authors tested whether self-efficacy for orthopedic rehabilitation tasks accounted for significant variance in rehabilitation outcome, over the variance accounted for by dispositional optimism, health competence, and health value. Whether health value moderated expectancy-outcome relationships also was examined. One hundred five older clients at 2 orthopedic rehabilitation facilities completed a battery of instruments; physical functioning also was assessed. After controlling for physical functioning at admission and for other variables, self-efficacy predicted significant variance in rehabilitation outcome. Health value did not moderate expectancy-outcome relationships. Results suggest that psychologists can improve patients' recovery from serious orthopedic problems by augmenting their self-efficacy beliefs.Orthopedic injury is a major health care concern in the United States for persons 65 years old and older. For example, approximately 250,000 persons are hospitalized each year for treatment of a fractured hip. Risk factors include age, gender, race, medication use, and mental distress (Allegrante, MacKenzie, Robbins, & Cornell, 1991;Forsen et al., 1999). In addition to fall-related orthopedic injuries, elderly persons also require orthopedic surgery for degenerative joint disease of the hip or knee (Orbell, Espley, Johnston, & Rowley, 1998). National health care costs from orthopedic injuries exceed $7 billion per year (Allegrante et al., 1991), and up to 60% of orthopedic patients face postsurgery complications including loss of functional capacity and independence, with many patients requiring long-term institutional care.In an attempt to ameliorate the negative effects of orthopedic surgery and aid rehabilitation, psychologists have begun to focus on psychological factors that affect the disabled patient's condition, including thoughts, beliefs, and attitudes (Bloom, 1988). Broad beliefs such as dispositional optimism (Scheier & Carver, 1985), moderately broad beliefs such as perceived health competence (Wallston, 1991), and more specific beliefs such as selfefficacy expectancies (SE; Bandura, 1997) all have predicted important outcomes among disabled persons or other populations. However, no study has examined these beliefs as predictors of rehabilitation following orthopedic surgery. Studying positive beliefs and their relationship to health-related outcomes is consistent with counseling psychology's emphasis on psychological assets and positive facets of growth (Fretz, 1982;Gelso & Fretz, 1992).

Neurocognitive problems have been endemic to the HIV epidemic since its beginning. Four decades later, these problems persist, but currently, they are attributed to HIV-induced inflammation, the long-term effects of combination antiretroviral therapy, lifestyle (i.e., physical activity, drug use), psychiatric, and age-associated comorbidities (i.e., heart disease, hypertension). In many cases, persons living with HIV (PLWH) may develop cognitive problems as a function of accelerated or accentuated normal aging and lifestyle rather than HIV itself. Nonetheless, such cognitive impairments can interfere with HIV care, including medication adherence and attending clinic appointments. With more than half of PLWH 50 years and older, and 30%-50% of all PLWH meeting the criteria for HIV-associated neurocognitive disorder, those aging with HIV may be more vulnerable to developing cognitive problems. This state of the science article provides an overview of current issues and provides implications for practice, policy, and research to promote successful cognitive functioning in PLWH.

Immediately after infection, Human immunodeficiency virus, type 1 (HIV-1) enters the central nervous system (CNS) and is localized in highest concentration in the hippocampus and basal ganglia. Since these areas are associated with HPA axis and autonomic activities as well as cognition, it has been hypothesized that these functions will be impacted adversely in HIV-1 infection. In the treatment of HIV infection, although the highly potent antiretroviral (HAART) drugs have been effective in reducing peripheral viral load and prolonging life expectancy, these drugs do not cross the blood-brain barrier in therapeutic concentrations. Therefore, it has been proposed that the beneficial effects of HAART on the CNS will be limited. Our investigations on seropositive individuals, showing hypo-reactivity of the autonomic system and HPA axis activity suggest that HIV-1 infection is a model of chronic stress. Furthermore, an elevated baseline TNF-alpha level as well as its increased reactivity to an alpha-adrenergic challenge among HIV-1+ individuals, may lead to additional neurodegeneration. It is proposed that the effects of HIV-1 infection on the brain will have implications for neurocognitive and mental health functioning in seropositive individuals even in patients undergoing HAART therapy. These outcomes may result in the need to develop facilities for long term "care-giving".

No abstract

This study evaluated a 12-week, home-based combined aerobic exercise (walking) and computerized cognitive training (EX/CCT) program on heart failure (HF) self-care behaviors (Self-care of HF Index [SCHFI]), disease specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity (6-minute walk distance) compared to exercise only (EX) or a usual care attention control (AC) stretching and flexibility program. Participants ( N = 69) were older, predominately female (54%) and African American (55%). There was significant improvement in self-care management, F(2, 13) = 5.7, p < .016; KCCQ physical limitation subscale, F(2, 52) = 3.4, p < .039; and functional capacity (336 ± 18 vs 388 ± 20 m, p < .05) among the EX/CCT participants. The underlying mechanisms that EX and CCT targets and the optimal dose that leads to improved outcomes are needed to design effective interventions for this rapidly growing population.