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PubMed2003

Juvenile offenders' Miranda rights comprehension and self-reported likelihood of offering false confessions.

This study examined whether age, IQ, and history of special education predicted Miranda rights comprehension and the self-reported tendency to falsely confess to a crime among 55 delinquent boys. The Miranda Rights Comprehension Instruments-II, a revised version of Grisso's Instruments for Assessing Understanding and Appreciation of Miranda Rights, were developed for this study and are described in detail in this article. Results revealed that age, IQ, and special education were related to comprehension of Miranda rights. When Miranda comprehension, age, and IQ were simultaneously tested as predictor variables of the self-reported likelihood of false confessions, only age served as an independent predictor. Research and policy implications of this study are presented, and recommendations for use of the original and revised instruments are reviewed.

Adolescent↗

PubMed2004

Impact of a school-based comprehensive program for pregnant teens on their contraceptive use, future contraceptive intention, and desire for more children.

In response to multiple problems faced by pregnant or parenting teens, or both, many alternative school-based comprehensive programs have been established to provide the teens with multiple services. However, few of these programs have been evaluated to assess their impact on the teens. In this study, we have made a systematic evaluation of such a school-based comprehensive program-the Paquin School Program in Baltimore City-to assess its impact on contraceptive use, future contraceptive intention, and desire for more children. We used data collected from a sample of 371 pregnant and parenting teens who attended the Paquin School Program between 1999 and 2001, and from a sample of 506 comparable teens, who did not attend the Program. Our findings showed that the percentages of the Paquin School enrollees who were using contraceptives or who expressed intention to use contraceptives in the future were higher than those of their counterpart nonenrollees from the comparison schools. The findings also showed that the use of Depo-Provera and desire for no more children were higher among the Paquin School enrollees than among the enrollees from the comparison schools. Because the Paquin School enrollees self-selected into its program, some unobserved differences between them and their counterpart nonenrollees might have affected the outcomes of this article. However, the consistent patterns of positive outcomes for the Paquin School enrollees with regard to contraceptive use, future intention to use contraceptives, and desire for no more children, compared to those from the comparison schools, seem to suggest that the Paquin School's alternative comprehensive program has been successful in its effort to promote family planning. One possible reason for this success of the effort to promote family planning is its integration with the multiple services of the comprehensive program of the Paquin School that enables its teens to plan their fertility.

Adolescent↗

PubMed1998

State funding of comprehensive primary medical care service programs for medically underserved populations.

OBJECTIVES: This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities. METHODS: A brief questionnaire was used to ask health agencies in all 50 states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs. RESULTS: Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program. CONCLUSIONS: The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative.

Comprehensive Health Care↗

PubMed2004

[Text comprehension and individual differences in working memory: the different contributions of the storage and the retrieval processing].

The present study addressed the relationship between an individual difference in the reading span test (RST) and the performance in text comprehension with respect to storage and retrieval systems. In Experiment 1, an effect of the serial recall task on performance in text comprehension was compared between high and low RST score groups. In Experiment 2, an effect of the word fluency task on performance in text comprehension of two groups was investigated. The results of both experiments showed that the performance in text comprehension of the low RST score group was impaired when the serial recall task was the secondary task; in contrast, the performance of the high RST score group was influenced when the word fluency task was used. The results suggested that the high RST score group comprehended text not only by using a temporary storage system but also by using a retrieval system efficiently.

Adult↗

PubMed2002

The declining comprehensiveness of primary care.

BACKGROUND: Recent studies suggest that comprehensiveness of primary care has declined steadily over the past decade. This study tracks the participation rates of general practitioners and family physicians in 6 nonoffice settings across Ontario and examines among which types of physicians this decline in comprehensiveness has occurred. METHODS: Billing (claims) records were used to determine the proportions of fee-for-service general practitioners and family physicians who provided emergency, inpatient, nursing home, house call, anesthesia or obstetrical services from 1989/90 to 1999/2000. "Office-only" physicians were those who worked in none of these nonoffice settings. The relation of various physician characteristics to comprehensiveness of care was tested with multivariate analysis for 1999/2000. RESULTS: The proportion of "office-only" general practitioners and family physicians rose from 14% in 1989/90 to 24% in 1999/2000 (p < 0.001). Significant increases in this proportion were noted among general practitioners and family physicians of all ages, both sexes and all practice locations. In 1999/2000, recent graduates (who had completed medical school within the past 7 years) had higher participation rates for emergency medicine (40% v. 5% for physicians aged 65 years and older); female physicians had higher participation rates for obstetrics (16% v. 11% for males); and older physicians had higher participation rates for nursing home visits and house calls (20% and 57% respectively v. 11% and 37% for recent graduates). However, "office-only" physicians were more likely to be female (odds ratio [OR] 2.65, 95% confidence interval [CI] 2.37-2.96), recent graduates (OR 1.35, 95% CI 1.15-1.60), aged 65 years and older (OR 1.45, 95% CI 1.20-1.75) or practising in a city with a medical school (OR 2.30, 95% CI 2.06-2.56) and were less likely to be rural physicians (OR 0.31, 95% CI 0.24-0.41) or certified in family medicine (OR 0.58, 95% CI 0.52-0.66). INTERPRETATION: There has been a decline in the provision of comprehensive care by general practitioners and family physicians in Ontario. The decline is evident across all age groups and for both male and female physicians. It is also evident in rural areas and in cities with and without medical schools.

Adult↗

PubMed2003

Patient and provider factors related to comprehensive arthritis care in a community setting in Ontario, Canada.

OBJECTIVE: To determine factors that correlate with recommendations for nonpharmacologic and pharmacologic interventions (comprehensive therapy) in community dwelling adults. METHODS: Eligible participants were >/= 55 years of age with hip and knee arthritis symptoms and disability. Comprehensive therapy was classified as a recommendation for exercise and weight loss (if required) and any pharmacotherapy. RESULTS: Only one-half of participants received a recommendation for comprehensive therapy. Participants who had seen a specialist and a therapist were almost twice as likely to receive a recommendation for comprehensive therapy. CONCLUSION: In our setting, many people with hip or knee arthritis were not receiving even minimum recommended treatment. Changes in educational and organizational policies are needed to address this situation.

Comprehensive Health Care↗

PubMed2003

The ability to learn new word meanings from context by school-age children with and without language comprehension difficulties.

This study investigated young children's ability to use narrative contexts to infer the meanings of novel vocabulary items. Two groups of 15 seven- to eight-year olds participated: children with normally developing reading comprehension skill and children with weak reading comprehension skill. The children read short stories containing a novel word and were required to produce a meaning for the novel word, both before and after its useful defining context. The proximity of the novel word to this context was manipulated. The results supported the hypothesis that children with weak reading comprehension skills are impaired in their ability to integrate information within a text, particularly when that information is non-adjacent and the processing demands are, therefore, high. Analysis of the error data revealed a similar pattern of types of errors for both groups: children with poor reading comprehension were not more likely to produce a thematically inappropriate response than their skilled peers.

Case-Control Studies↗

PubMedDate not supplied

[An evaluation of the accessibility of early post-stroke comprehensive rehabilitation in Poland].

BACKGROUND AND PURPOSE: According to the European Stroke Initiative recommendations every stroke patient should undergo rehabilitation; its program should be tailored according to the individual needs of the patient. The aim of our study was to evaluate the accessibility of comprehensive early stroke rehabilitation at neurological departments in Poland. MATERIALS AND METHODS: We have sent a questionnaire evaluating neurological and rehabilitation departments in Poland, where stroke patients are treated and undergo early rehabilitation. We divided them into 5 categories -- classes from A to F: class A -- having comprehensive rehabilitation (kinesitherapy minimum 60 minutes/day, speech therapy minimum 30 minutes for 5 days a week and rehabilitation of other cognitive impairments and group kinesitherapy at rehabilitation departments); B -- having the possibility of all types of therapy, but is done less frequently; C -- kinesitherapy and speech therapy; D -- kinesitherapy and cognitive rehabilitation; E -- only kinesitherapy. We also separated neurological departments without trained rehabilitation staff. RESULTS: We obtained responses from 191 of 215 (88.8%) neurological departments. According to criteria: 26 class A, 38 class B, 50 class C, 2 class D, 73 class E, 2 without specialized rehabilitation staff. We received filled questionnaires from 115 of 172 (66.9%) rehabilitation departments. According to criteria: 11 class A, 31 class B, 28 class C, 4 class D and 41 class E. CONCLUSION: Only 14% of all neurological departments and 10% of rehabilitation departments administered comprehensive early stroke rehabilitation in Poland. Improvement of comprehensive rehabilitation accessibility in Poland is necessary for lowering the number of disabled post-stroke patients.

Aphasia↗

PubMed2006

Comprehension of discharge information for minor head injury: a randomised controlled trial in New Zealand.

AIMS: To investigate health literacy (i.e. understanding medical information) in North Shore Hospital's Emergency Medicine Department patients and to assess differences in comprehension between standard and simplified head injury advice sheets. METHODS: Prospective randomised controlled trial in a convenience sample of adult Emergency Medicine patients presenting to an urban emergency department (ED) in New Zealand. Consented patients were randomised to receive either the standard head injury advice sheet or a shorter, simplified sheet. Participants were asked 10 questions (to test comprehension of advice sheets), demographic data collected, and a Rapid Estimation of Adult Literacy in Medicine test administered. Data analysis included descriptive statistics with 95% confidence intervals, Mann Whitney U test, and regression model analysis. RESULTS: 200 participants. Mean age 43.4 years, 77.5% with 12 or more years of schooling, 84.5% with reading level of high school age or above. No significant differences in demographics, schooling, and reading levels were observed between study groups. The simplified form study group showed significantly higher comprehension scores (p<0.0001). In the regression analysis, factors associated with higher comprehension scores included: the simplified form, higher literacy level, more years of schooling, and younger age group. CONCLUSIONS: Previous studies have highlighted poor literacy levels in ED populations, a factor thought to affect understanding of discharge information. In this study population, where most read at high school level or above, the simplified advice sheet was still better understood. Recommendations for improving discharge information are discussed.

Adult↗

PubMedDate not supplied

Comparison of costs to the health sector of comprehensive and episodic health care for sickle cell disease patients.

Of 391 patients with sickle cell disease known to the health care facilities of the University of South Alabama, 194 patients used these facilities in 1989. In that year, 33.5 percent of patients seen at the University of South Alabama did not attend the Comprehensive Health Care Clinics developed for sickle cell patients. There were major differences in the patterns of use and in health care costs among sickle cell patients who attended the Comprehensive Health Care Clinics and those who did not. Patients not using these clinics, although they accounted for only 33.5 percent of the total patients, constituted 71.4 percent of visits to the emergency rooms and 42.3 percent of inpatient admissions. Patients enrolled in the Comprehensive Health Care Clinics used emergency rooms and inpatient units less frequently (P < 0.0001 and P = 0.0006, respectively) and were responsible for significantly smaller health care costs in each category (P < 0.0300). Evaluation of factors responsible for differences in the use patterns and patient education to improve use of comprehensive health care services should be considered.

Adult↗

PubMed2000

Patient comprehension and reaction to participating in a double-blind randomized clinical trial (ISIS-4) in acute myocardial infarction.

BACKGROUND: Although randomized clinical trials are currently the standard for the evaluation of new therapeutic strategies, little attention has been paid to the viewpoint of the patients recruited to these trials. OBJECTIVES: To examine the perspective of the Israeli patient cohort who participated in the Fourth International Study of Infarct Survival, a randomized trial in acute myocardial infarction. METHODS: A patient questionnaire was mailed to 360 Israeli patients who participated in the Fourth International Study of Infarct Survival and was returned by 150 of them. Main outcome measures included patient perception of consent procedures, comprehension of the study, subjective reaction to participating in the trial, and interest in present and future trials. RESULTS: Forty (31%) of 129 patients perceived that they had full comprehension of the trial, while 64 (50%) claimed partial understanding and 25 (19%), no understanding at all. Comprehension was related to a recollected explanation of 5 minutes or more (P<.001) and to an opportunity for discussion at the time of consent (P<.001). Most patients recollected the oral explanation; fewer, the written material. Patient consent was given by 64 (43%) of 150 patients in the hope of better treatment. In 36 cases (25%), the patients felt they received better treatment because of participation in the trial. CONCLUSIONS: Despite proper attention to accepted ethical and legal standards, perceived patient comprehension in this trial in acute myocardial infarction was incomplete or lacking in a considerable number of subjects. Much progress must be made toward the goal of true informed consent in clinical trials.

Attitude↗

PubMed1991

Dominant-side intracarotid amobarbital spares comprehension of word meaning.

Abolition of speech production after intracarotid amobarbital injection is generally considered evidence for language laterality. However, complex auditory comprehension may be preserved after injection of the dominant (left) side. The possibility that this sparing may be due to the intracarotid amobarbital injection not adequately deactivating some of the areas responsible for speech comprehension in the posterior part of the hemisphere was tested with a task known to be critically dependent on the left posterotemporal-inferoparietal region, one assessing visuo-verbal semantic relatedness. Even when the intracarotid injection of the left side produced marked deficits of speech production, comprehension of semantic relations was still intact in eight of 15 patients. Ten of these 15 patients also received right carotid injections, none of which affected comprehension of semantic relatedness. These data indicate that the intracarotid amobarbital injection cannot always specify the laterality of all language functions, an important concern when considering surgical procedures in the dominant posterotemporal-inferoparietal region.

Adolescent↗

PubMed2004

Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis.

CONTEXT: Comprehensive discharge planning plus postdischarge support may reduce readmission rates for older patients with congestive heart failure (CHF). OBJECTIVE: To evaluate the effect of comprehensive discharge planning plus postdischarge support on the rate of readmission in patients with CHF, all-cause mortality, length of stay (LOS), quality of life (QOL), and medical costs. DATA SOURCES: We searched MEDLINE (1966 to October 2003), the Cochrane Clinical Trials Register (all years), Social Science Citation Index (1992 to October 2003), and other databases for studies that described such an intervention and evaluated its effect in patients with CHF. Where possible we also contacted lead investigators and experts in the field. STUDY SELECTION: We selected English-language publications of randomized clinical trials that described interventions to modify hospital discharge for older patients with CHF (mean age > or =55 years), delineated clearly defined inpatient and outpatient components, compared efficacy with usual care, and reported readmission as the primary outcome. DATA EXTRACTION: Two authors independently reviewed each report, assigned quality scores, and extracted data for primary and secondary outcomes in an unblinded standardized manner. DATA SYNTHESIS: Eighteen studies representing data from 8 countries randomized 3304 older inpatients with CHF to comprehensive discharge planning plus postdischarge support or usual care. During a pooled mean observation period of 8 months (range, 3-12 months), fewer intervention patients were readmitted compared with controls (555/1590 vs 741/1714, number needed to treat = 12; relative risk [RR], 0.75; 95% confidence interval [CI], 0.64-0.88). Analysis of studies reporting secondary outcomes found a trend toward lower all-cause mortality for patients assigned to an intervention compared with usual care (RR, 0.87; 95% CI, 0.73-1.03; n = 14 studies), similar initial LOS (mean [SE]: 8.4 [2.5] vs 8.5 [2.2] days, P =.60; n = 10), greater percentage improvement in QOL scores compared with baseline scores (25.7% [95% CI, 11.0%-40.4%] vs 13.5% [95% CI, 5.1%-22.0%]; n = 6, P =.01), and similar or lower charges for medical care per patient per month for the initial hospital stay, administering the intervention, outpatient care, and readmission (-359 dollars [95% CI, -763 dollars to 45 dollars]; n = 4, P =.10 for non-US trials and -536 dollars [95% CI, -956 dollars to -115 dollars]; n = 4, P =.03, for US trials). CONCLUSION: Comprehensive discharge planning plus postdischarge support for older patients with CHF significantly reduced readmission rates and may improve health outcomes such as survival and QOL without increasing costs.

Aged↗

PubMed1983

Computed tomographic scan correlates of auditory comprehension deficits in aphasia: a prospective recovery study.

Lesion localization and volume as assessed on computed tomography were analyzed to determine their relationships to auditory comprehension deficits following left hemisphere ischemic stroke in 39 patients. Auditory comprehension was initially tested approximately four weeks after onset, and then monthly for five months, using the Token Test, a series of commands of increasing complexity. Computed tomographic scans obtained five months after onset were used for lesion localization and volume determination. Lesions in the posterior superior temporal and infrasylvian supramarginal regions were strongly associated with poor outcome. Patients with initially preserved auditory comprehension tended to have lesions that spared these regions, whereas patients with persistent deficits had lesions that included these regions. Six of 8 patients who initially had severe deficits in auditory comprehension but recovered completely lacked lesions in these regions. Lesion volume except when very large or very small was not closely associated with outcome.

Adult↗

PubMed2001

fMRI investigation of sentence comprehension by eye and by ear: modality fingerprints on cognitive processes.

The neural substrate underlying reading vs. listening comprehension of sentences was compared using fMRI. One way in which this issue was addressed was by comparing the patterns of activation particularly in cortical association areas that classically are implicated in language processing. The precise locations of the activation differed between the two modalities. In the left inferior frontal gyrus (Broca's area), the activation associated with listening was more anterior and inferior than the activation associated with reading, suggesting more semantic processing during listening comprehension. In the left posterior superior and middle temporal region (roughly, Wernicke's area), the activation for listening was closer to primary auditory cortex (more anterior and somewhat more lateral) than the activation for reading. In several regions, the activation was much more left lateralized for reading than for listening. In addition to differences in the location of the activation, there were also differences in the total amount of activation in the two modalities in several regions. A second way in which the modality comparison was addressed was by examining how the neural systems responded to comprehension workload in the two modalities by systematically varying the structural complexity of the sentences to be processed. Here, the distribution of the workload increase associated with the processing of additional structural complexity was very similar across the two input modalities. The results suggest a number of subtle differences in the cognitive processing underlying listening vs. reading comprehension.

Adult↗

PubMed1993

Structural description of agrammatic comprehension.

The trace-deletion hypothesis (Grodzinsky, 1990) holds that the comprehension deficit apparent in most agrammatic aphasics results from the absence of traces at the level of S-structure. This paper reports a test of this hypothesis in a case study of an agrammatic aphasic. Two experiments--one using a sentence-picture matching task, one using the truth-value judgment task-examined the comprehension of the matrix clause in center-embedded relatives such as, The tiger that chased the lion is big. These structures provide a crucial test of the trace-deletion hypothesis because comprehension of the matrix clause (i.e., knowing that the tiger is big and not the lion) is predicted to be unimpaired. Contrary to this prediction, however, the results of the present work show that comprehension of the matrix clause in such sentences is significantly impaired. We argue that a revised version of the trace-deletion hypothesis proposed by Hickok (1992a,b) can explain the present data and other previously unaccountable findings.

Aged↗

PubMed1995

Hypothesis on the nature of comprehension deficit in a patient with transcortical mixed aphasia with preserved naming.

Patients with poor comprehension and preserved naming have been occasionally described. Such patients, who are affected by transcortical aphasia, have been taken as evidence of the possibility of naming an object while bypassing the semantic system. We describe a patient affected with mixed transcortical aphasia who presented a clear dissociation between ability in naming and difficulties in performing word-picture matching tasks. The pattern is explained by the existence of covert compulsory automatic naming that interferes with less automatic procedures involved in word-picture matching. In fact, when we tried to oppose automatic naming by using, in word-picture matching tasks, pictures difficult to name, the comprehension improved. This finding excludes a semantic deficit at the basis of poor comprehension of our patient. We suggest that the dissociation between naming and comprehension could be an expression of a computational limitation within the processes involved in word-picture matching, due to the competition for limited processing resources by automatically activated hyperactive naming.

Aphasia↗

PubMed1995

A restrictive theory of agrammatic comprehension.

In this paper I propose a new, restrictive theory of Trace-Deletion in agrammatism. This theory subsumes the Trace-Deletion Hypothesis (TDH; Grodzinsky, 1984a,b, 1986, 1990), which maintains that traces are deleted from agrammatic representations and that a cognitive strategy augments the patients' performance. This claim accounts for the pattern of loss and sparing observed in these patients' comprehension of a wide variety of syntactic constructions and is thus important for our understanding of the neural representation of syntax. Yet there are reasons for revising the account and making it more precise, stemming from both recent empirical findings and new developments in the theory of syntax. The original TDH was based on observations of agrammatic comprehension of structures containing traces resulting from either NP- or Wh-movement. Nevertheless, heads (as opposed to phrasal projections) also move and leave traces behind. Head movement (of verbs, for instance) has come to play a central role in linguistic theory (which currently postulates a wider variety of empty categories than any previous theoretical framework). Recent findings suggest that verb movement is retained in agrammatism, indicating that a sweeping claim regarding the deletion of all empty categories is too strong. This motivates the first restrictive move, resulting in a theory that picks out a restricted set of traces--only those for which deficient performance is indeed observed. All other empty categories are left intact. Trace-Deletion is tied to theta-positions. The second restrictive move is motivated by two types of surprising asymmetries that have recently been discovered for agrammatic comprehenders: First, agrammatic comprehension on passives of psychological predicates provides an error pattern that distinguishes this construction from agentive passive, indicating that the deficit is tied to the thematic properties of the predicate: Second, asymmetries have been observed in agrammatic comprehension of questions and quantifiers. These findings motivate a modification of the augmentative strategy, whose domain of application is restricted to referential NPs. Thus, the new account amounts to the claim that only traces in theta-positions are deleted, and that the strategy applies to referential NPs alone. This, I argue, not only derives all the data precisely but is also conceptually superior to any previous account of agrammatism. Finally, I discuss the consequences of this account to linguistic theory, and to theories of brain/language relations.

Brain↗