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PubMedDate not supplied

Factors associated with comprehensive dental care following an initial emergency dental visit.

PURPOSE: The purpose of this study was to characterize the patient population utilization of a dental home as grouped by: (1) age; (2) sex; and (3) payment method. METHODS: A retrospective chart review of 1,020 patients, who initially presented for an emergency visit, was performed. From the original data pool, 2 groups were delineated: (1) those patients who returned for comprehensive dental care; and (2) those who did not return for comprehensive dental care. RESULTS: Patients with private dental insurance or Medicaid dental benefits were statistically more likely to return for comprehensive oral health care than those with no form of dental insurance. Younger patients (< or =3 years of age) were least likely to return for comprehensive dental care. CONCLUSIONS: Socioeconomic factors play a crucial role in care-seeking behaviors. These obstacles are often a barrier to preventive and comprehensive oral health care.

Adolescent↗

PubMed1992

Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight.

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatal care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, paraprofessional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers.

Birth Weight↗

PubMed1994

Providing comprehensive health care to children with chronic illness.

OBJECTIVES: To test whether a program of outreach and comprehensive health care for children with chronic disorders provides more complete care and reduces unmet health needs compared with traditional care. DESIGN: A pretest-posttest randomized control trial. SETTING: An inner-city municipal teaching hospital. SAMPLE: Two hundred nineteen systematically enrolled mothers of children with diverse chronic physical health conditions. INTERVENTIONS: A comprehensive outreach program, Pediatric Home Care (PHC), contrasted with Standard Care. MEASUREMENTS AND RESULTS: Nine elements of comprehensive care established in the literature as components of a basic package of care for those with chronic conditions. The PHC intervention addressed gaps in services and improved both the acquisition and maintenance of elements of comprehensive care. CONCLUSIONS: These data suggest mechanisms through which comprehensive care programs may contribute to the improvement in psychological and social outcomes previously reported for those in the PHC intervention.

Child↗

PubMed1987

Relationship between lesion extent in 'Wernicke's area' on computed tomographic scan and predicting recovery of comprehension in Wernicke's aphasia.

This study investigated the relationship between severity of auditory comprehension in Wernicke's aphasia and amount of temporal lobe damage within Wernicke's area (posterior two thirds of superior temporal gyrus region) as well as the total temporoparietal lesion size. There was a highly significant correlation between comprehension and the amount of temporal lobe lesion in Wernicke's area. There was no significant correlation between comprehension and the total temporoparietal lesion size. Patients with damage in only half or less than half of Wernicke's area had good comprehension at six months after the onset of stroke. Patients with damage in more than half of Wernicke's area had poor comprehension even one year after the onset of stroke. Additional anterior-inferior temporal lobe lesion extension into the middle temporal gyrus area was associated with particularly poor recovery.

Aged↗

PubMed1992

The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology.

The Comprehensive Assessment of Symptoms and History was developed for research studies of schizophrenia spectrum conditions and affective spectrum conditions. It is designed to provide a comprehensive information base concerning current and past signs and symptoms, premorbid functioning, cognitive functioning, sociodemographic status, treatment, and course of illness. Because the information base is broad, it is not wedded to a specific diagnostic system but rather permits clinicians and investigators to make diagnoses using a wide range of systems, including Research Diagnostic Criteria, DSM-III, DSM-III-R, and the International Classification of Diseases. Given the fact that disorders in psychiatry are not defined at the etiological or pathophysiological level, diagnostic criteria are prone to ongoing revision as our knowledge base changes. Research strategies suggest that investigators should maintain a flexible database to permit them to adapt to changes in diagnostic systems, to do comparative nosological studies, and, ultimately, to develop new diagnostic systems based on knowledge concerning the underlying neurobiological nature of disorders. Because it provides a comprehensive information base, the Comprehensive Assessment of Symptoms and History facilitates research of this type. Extensive developmental work has been done with the Comprehensive Assessment of Symptoms and History, including interrater and test-retest reliability studies, validity studies, training programs, and data entry programs.

Databases, Factual↗

PubMed1996

Management of intra-abdominal infections. The case for intraoperative cultures and comprehensive broad-spectrum antibiotic coverage. The Canadian Intra-abdominal Infection Study Group.

OBJECTIVE: To test the hypothesis that comprehensive broad-spectrum empirical antimicrobial therapy is superior to limited-spectrum empirical antimicrobial therapy in intra-abdominal infections. DESIGN: Prospective, randomized, double-blinded study. SETTING: University-affiliated hospitals in Canada. PATIENTS: Two hundred thirteen patients with intra-abdominal infections and planned operative or percutaneous drainage. INTERVENTION: Limited-spectrum empirical antimicrobial therapy consisted of cefoxitin sodium, 2 g, intravenously, every 6 hours (n = 109). Comprehensive broad-spectrum empirical antimicrobial therapy consisted of a combination of imipenem and cilastatin sodium, 500 mg, intravenously, every 6 hours (n = 104). MAIN OUTCOME MEASURES: Failure to cure the intra-abdominal infection (persistence of infection or death). RESULTS: Of initial isolates, 98% were sensitive to imipenem plus cilastin sodium compared with 72% for cefoxitin. No difference was found in the failure rate between treatment groups. Among various reasons for failure (including technical), 12 of 80 patients in the limited-spectrum empirical antimicrobial therapy group had resistant organisms at a second intervention compared with 1 of 74 in the comprehensive broad-spectrum empirical antimicrobial therapy group (P < .003, chi 2). One death in the limited-spectrum empirical antimicrobial therapy group was due to autopsy-proved disseminated Pseudomonas aeruginosa (blood, peritoneum, lung, and pleural fluid) that was resistant to cefoxitin, and the other was associated with peritonitis due to cefoxitin-resistant Enterobacter cloacae. One death in the comprehensive broad-spectrum empirical antimicrobial therapy group was associated with peritonitis from Clostridium perfringens that was sensitive to imipenem plus cilastin sodium, and the other was associated with peritonitis from Pseudomonas aeruginosa that was resistant to imipenem plus cilastin sodium. CONCLUSION: Treatment failure of intra-abdominal infection may be due, in part, to the presence of resistant pathogens at the site of infection. Therefore, routine culture of these sites seems worthwhile and empirical therapy should be as comprehensive as possible and should cover all potential pathogens.

Abdomen↗

PubMed1995

Representation, referentiality, and processing in agrammatic comprehension: two case studies.

A number of investigators have argued that agrammatic comprehension, the pattern of sentence comprehension often associated with Broca's aphasia, can be characterized in terms of a representational disruption in one or another module of the normal grammar. In this study, these proposals are reviewed and their adequacy is examined in light of two case studies of agrammatic comprehension. In particular, we present data from sentences that have composed the core of the agrammatic comprehension pattern, as well as data from three different classes of sentences including comprehension of the matrix clause of center-embedded relative constructions, pronoun and anaphor dependencies, and Wh-questions. Our conclusion is that none of the existing representational models provides a fully adequate account of the data, and we propose some alternative approaches that distinguish between referential and nonreferential elements and potential processing differences between the two.

Aged↗

PubMed1999

Agrammatic aphasic subjects' comprehension of subject and object extracted Wh questions.

This study attempted to replicate the unusual wh question comprehension pattern of Hickok and Avrutin's (1996) subjects who showed an expected subject/object extraction asymmetry for which NP questions, but not for who questions. We also examined comprehension of what and which one questions, which are similar to who and which NP questions, respectively, and we examined passivized wh questions in order to test predictions of Grodzinsky's (1995) restrictive theory of trace deletion, the Trace-Based Account (TBA). Results, using both a figurine manipulation task and a picture pointing task, showed that only one of four agrammatic (Broca's) aphasic subjects showed the pattern reported by Hickok and Avrutin and that this pattern extended to comprehension of what and which one questions. One of the subjects showed subject/object asymmetry for all wh questions tested, as would be predicted by the original trace deletion hypothesis (Grodzinsky, 1984), and two subjects showed neither pattern. None of our subjects demonstrated ability to comprehend passivized wh questions as predicted by the TBA. We discuss our findings in terms of the lack of homogeneity of wh question comprehension among individuals with agrammatic aphasia and we explore alternatives to the syntactic explanation for differences between who and which NP question comprehension advanced by Hickok and Avrutin.

Aphasia, Broca↗

PubMed2000

Cognitive resource limitations during sentence comprehension in Parkinson's disease.

Patients with idiopathic Parkinson's disease (PD) were asked to identify the agent of the action in orally presented sentences with subject-relative or object-relative center-embedded clauses while simultaneously performing a secondary task that was less resource-demanding (finger tapping) or more resource-demanding (recognition span). We found that a subgroup of PD patients with impaired sentence comprehension at baseline (no secondary task) did not differ from random in their accuracy understanding all types of sentences during the more demanding (recognition span) condition and also had difficulty understanding the most complex sentences during the less demanding (finger tapping) condition. Control subjects and PD patients without baseline sentence comprehension difficulty were random only in their comprehension of the most complex sentences under the more demanding (recognition span) secondary task condition. Examination of response latencies for accurately understood sentences revealed only an effect for the type of sentence, and this was equally evident across all groups of subjects and regardless of the condition under which the sentences were administered. The sensitivity of PD patients' sentence comprehension accuracy to secondary task resource demands is most consistent with the hypothesis that limited cognitive resources contribute to sentence comprehension difficulty in PD.

Aged↗

PubMed2002

Age-related changes in working memory during sentence comprehension: an fMRI study.

Sentence comprehension declines with age, but the neural basis for this change is unclear. We monitored regional brain activity in 13 younger subjects and 11 healthy seniors matched for sentence comprehension accuracy while they answered a simple probe about written sentences. The sentences varied in their grammatical features (subject-relative vs object-relative subordinate clause) and their verbal working memory (WM) demands (short vs long antecedent noun-gap linkage). We found that young and senior subjects both recruit a core written sentence processing network, including left posterolateral temporal and bilateral occipital cortex for all sentences, and ventral portions of left inferior frontal cortex for object-relative sentences with a long noun-gap linkage. Differences in activation patterns for seniors compared to younger subjects were due largely to changes in brain regions associated with a verbal WM network. While seniors had less left parietal recruitment than younger subjects, left premotor cortex, and dorsal portions of left inferior frontal cortex showed greater activation in seniors compared to younger subjects. Younger subjects recruited right posterolateral temporal cortex for sentences with a long noun-gap linkage. Seniors additionally recruited right parietal cortex for this sentence-specific form of WM. Our findings are consistent with the hypothesis that the neural basis for sentence comprehension includes dissociable but interactive large-scale neural networks supporting core written sentence processes and related cognitive resources involved in WM. Seniors with good comprehension appear to up-regulate portions of the neural substrate for WM during sentence processing to achieve comprehension accuracy that equals young subjects.

Adult↗

PubMed1980

Logical relations and comprehension in conversation.

This study examines how logical relations (e.g., causality and identity) in spoken discourse affect comprehension. Research on cohesion, which shows that specific unit template structures link discourse and text together, is used to build a model of language comprehension that places template structures at the base of a context comparison operation. Subjects were engaged in ordinary conversation with a confederate trained to produce specific types of logical utterances unobtrusively. The comprehension model predicted that systematically different latencies, topical response, and remedial response of subjects would follow the test items produced by the confederate. The data support the predictions. It is shown that comprehension occurs via one processing path if there is a direct tie between the target item and the immediately prior item in discourse, and a separate processing path if the tie is between the target item and the earlier context. Subject response in conversation is shown to display useful evidence on the nature of comprehension achieved. The findings specify and extend the recent research on the integration of new information into a textual structure.

Adult↗

PubMed2003

Reading comprehension and aging: does an age-related difference necessarily mean impairment?

BACKGROUND AND AIMS: This research investigated reading comprehension in groups of younger-old (55-69 years) and older-old (70-90 years) Italian adults to determine age-related differences and explore their extent. The second aim of our research was to investigate the nature of individual age-related differences and their relation to working memory and metacognition. METHODS: In Experiment 1,250 participants read two passages, a narrative and an expository text, and answered a series of multiple-choice inferential questions. In Experiment 2, three groups: younger-old good and poor comprehenders and older-old poor comprehenders were compared for working memory and metacognitive tasks. RESULTS: Although older-old adults had some difficulty compared with younger-old, a comparison with normative control scores (comprehension level achieved at the end of 8th grade compulsory education) showed that their reading comprehension of a narrative text was adequate, demonstrating basic comprehension skills for everyday life. Younger-old good comprehenders had higher working memory and metacognitive scores than younger-old poor comprehenders, consistent with results obtained in the literature with younger participants. Older-old adults had poorer working memory than younger-old poor comprehenders, although they did not differ in metacognitive performance. CONCLUSIONS: Results show that age differences influence the relationship between reading comprehension and memory and metacognition.

Aged↗

PubMed2007

An analysis of Miranda warnings and waivers: comprehension and coverage.

Miranda warnings enshrine the constitutional rights of custodial suspects against self-incrimination. However, the wording and sentence complexity of Miranda warnings and waivers vary dramatically from jurisdiction to jurisdiction. This study is the first extensive investigation of Miranda warning variations examining 560 Miranda warnings from across the United States. With Flesch-Kincaid reading comprehension as a useful metric, Miranda warnings varied from very simple comprehension (i.e., grade 2.8) to requiring postgraduate education. Miranda warnings are composed of five components (e.g., silence and evidence against you); marked variations were also observed in the comprehensibility of individual components. On average, the Miranda warning component on "continuing rights" requires a reading comprehension level six grades higher than the comparatively simple expression of the right to silence. Similar analyses were conducted on Miranda waivers. The content of these warnings differed on such issues as communicating (a) when access to an attorney would be granted (e.g., 45.9% specified only "during questioning") and (b) explicitly that indigent legal services were free (e.g., 31.8% directly informed suspects). Finally, the study identified representative Miranda components at different levels of reading comprehension as a template for further research.

Criminal Law↗

PubMed1994

Reading skill and comprehension of the dietary guidelines by WIC participants.

OBJECTIVE: The purpose of this study was to examine the match between reading skills and comprehension of the 1990 Dietary Guidelines in a Special Supplemental Food Program for Women, Infants, and Children (WIC) group (n = 32) compared with a non-WIC group and to determine which selected factors affected cloze scores. SUBJECTS/SAMPLES: The WIC group consisted of volunteers from WIC voucher pick-up sites, and the non-WIC group comprised women who met the qualification criteria for WIC, except income. METHODS: Reading skills were assessed using the Wide-Range Achievement Test-Revised Level II (WRAT-R). Comprehension skills were measured using the cloze technique. MATERIALS: The introductory section of the Dietary Guidelines, originally written at the 10th-grade level, was simplified to the 7th-grade level for comprehension comparison. RESULTS: The WIC group had a significantly (P < .001) lower reading skill (WRAT-R score = 60.1; 11th-grade level) than the non-WIC group (WRAT-R score = 70.8; college level). Cloze scores from all subjects tested at the 10th-grade level indicated that 75% (n = 24) would be frustrated or need instructional assistance to understand the Dietary Guidelines. Simplification contributed to higher cloze scores. The WRAT-R score was one factor that significantly affected the cloze score (P < .001). Both education level and WRAT-R scores varied significantly between groups; however, analysis of covariance revealed that the effects were identical within both groups. IMPLICATIONS: WRAT-R can be used as a quick screening method for reading-skill level of individuals in WIC programs and other counseling situations. The cloze techniques may be useful for assessing comprehension of specific printed materials. Assessment of reading skill and comprehension by nutrition educators is recommended to increase the likelihood of selecting and/or developing effective materials.

Adolescent↗

PubMed1987

The effect of redundant cues on comprehension of spoken messages by aphasic adults.

Aphasic adults with severe auditory comprehension impairment responded to redundant and nonredundant spoken and/or gestured messages by pointing to pictures. Messages of two types (pantomime and emblem) were presented under four conditions (spoken message alone, spoken message repeated, gestured message alone, and spoken message plus redundant gesture). Though spoken messages repeated and spoken messages with gestures were comprehended significantly more often than gestures alone, neither of these stimulus conditions was reliably superior to spoken messages alone. This finding casts doubt on the clinical strategy of supplementing spoken messages with redundant gestures when auditory comprehension is severely impaired, and raises questions about the ability of severely aphasic individuals to utilize semantically redundant message content. Pantomimes were consistently comprehended more frequently than emblems, regardless of stimulus condition. This finding was attributed to a depictability factor: the pictures associated with pantomimes were relatively direct representations of item content, while those associated with emblems were necessarily less direct representations. For this group of subjects, whose range of comprehension deficit was deliberately restricted, neither auditory nor reading comprehension at the single-word level was found to correlate with comprehension of symbolic gestures.

Aged↗

PubMed1993

Evoked potential measures of auditory cortical function and auditory comprehension in aphasia.

This study investigated the relation between severity of auditory comprehension impairment in aphasia and the functional integrity of the posterior superior temporal region as evaluated by middle- and long-latency auditory evoked potentials and dipole source analysis. AEPs were studied in 20 stroke patients and in age-matched controls. AEPs and language data were collected 1 year or more post onset, and were compared to performance early after onset. Patients were differentiated in a group with severe and a group with moderate to recovered auditory comprehension impairment. Significant asymmetries of auditory evoked dipole source potentials were more frequent in the severely impaired group. However, a severe auditory comprehension deficit was not incompatible with normal AEPs. The results confirm the importance of the posterior superior temporal region for auditory language comprehension, but the correlation between AEP asymmetry and auditory comprehension seems due to the close spatial relation of AEP generating substrate and posterior language area rather than to partial overlap. Dipole source analysis of AEPs proved to be a valuable method for the assessment of interhemispheric asymmetries, enhancing the sensitivity of AEPs to unilateral damage of auditory cortex.

Aged↗

PubMed1984

The semantic deficit in aphasia: the relationship between semantic errors in auditory comprehension and picture naming.

Thirty aphasic subjects were asked to point to pictures on auditory command both when the distractors came from the same semantic category as the target and when the distractors were unrelated to the target picture. The aphasics made significantly more semantic errors than non-aphasic brain-damaged controls; the incidence of semantic comprehension errors was unrelated to aphasic diagnostic groups but was related to the overall severity of aphasia. The subjects were subsequently asked to name the pictures from the comprehension task; pictures that had elicited semantic errors in comprehension were no less likely to be named than those that had not, but the incidence of semantic errors in comprehension correlated significantly with their incidence in naming. The implications of a semantic deficit common to both auditory comprehension and naming that is not specific to particular lexical items is discussed in relation to a number of information processing models of the lexicon.

Adolescent↗

PubMed1994

The relationship between comprehension and oral reading in progressive fluent aphasia.

The role played by comprehension in oral reading was investigated in three patients with progressive fluent aphasia. For patients J.L. and G.C., there was evidence of a deficit in semantic memory affecting both word production and comprehension. F.M., although equally anomic, had significantly better single-word comprehension than either J.L. or G.C. It was predicted that, for J.L. and G.C., success or failure in word comprehension should show item-specific correspondence with success or failure in reading exception words, but not regular words. This predicted pattern was obtained between word-picture matching tests and reading. For F.M., with only minimal comprehension impairment for the items used, a smaller trend in the same direction was observed. The results are discussed with respect to Patterson and Hodges' hypothesis (Neuropsychologia 30, 1025-1040, 1992) regarding the consequences of impaired semantic memory for the integrity of representations in the phonological output lexicon.

Aphasia↗