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PubMed1982

Assessing comprehension in a survey of public reactions to complex issues.

This paper reports results of research to develop household interview procedures for obtaining reasonably informed public judgements about ethical issues in biomedical research. We describe (1) an interviewing strategy designed to enhance comprehension among survey respondents, and (2) a composite comprehension index based on three types of information from the interview. Using data from a cross-section sample, we identify subgroups that differ significantly with respect to scores on the comprehension index, and we then describe the observed levels of comprehension in terms of the operations defining the index. The results demonstrate both the feasibility and limits of obtaining informed rather than naive judgements about complex issues from lay respondents.

Attitude to Health↗

PubMed1998

Building comprehensive HIV/AIDS care services.

This article presents the experiences of three innovative programs for HIV/AIDS-related health care funded by the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The Comprehensive Healthcare projects were funded as part of a larger initiative for innovative HIV service delivery models, consisting of 27 grantees, the funding agency (HRSA), and an Evaluation and Dissemination Center. These projects--the University of Nevada School of Medicine's Early Nutrition Intervention in HIV and AIDS project, the University of Vermont and State Agricultural College's Rural HIV Service Delivery project, and Washington University School of Medicine's Helena Hatch Special Care Center for Women--have developed specialized medical care models within the context of a continuum of services in a medical clinic. This article serves to describe the initial experiences of these three service demonstration projects, and some of the lessons learned as a result of their implementation. All of these projects share the goal of providing integrated services, such as medical care, nutrition, case management, and social and mental health services to people living with HIV/AIDS. However, the projects target different populations, (e.g., those in rural areas versus those in a large inner city), and use contrasting service delivery models of comprehensive HIV care. These projects have undertaken diverse activities and have used numerous effective strategies to increase their ability to provide a continuum of care and services for people living with HIV/AIDS. Based on the valuable lessons that the Comprehensive Healthcare projects learned during the first 2 years of funding, a number of collective recommendations have been made. It is expected that these suggestions will prove extremely useful to other programs that consider offering comprehensive health-care services to people living with HIV/AIDS or other complex medical conditions.

Academic Medical Centers↗

PubMed1996

Word comprehension. The distinction between refractory and storage impairments.

We report a series of experiments in which we compare the residual word comprehension skills of patients with cortical degenerative conditions and those with an "access' dysphasia. Using word-picture matching tasks it was shown that (i) the presentation rate (the response-stimulus interval) affected the word comprehension performance of the patients with an access dysphasia but not of the patients with degenerative conditions; (ii) the semantic relatedness of the stimulus arrays had a greater influence in the performance of the access dysphasic patients than with a degenerative condition; (iii) word frequency was a strong determinant of the performance of patients with degenerative conditions but not those with an access dysphasia; and (iv) response inconsistency was a characteristic of the patients with an access dysphasia, whereas this was not observed in those with a degenerative condition. These four effects clearly differentiate the word comprehension performance of these two types of patients. Thus, two types of word comprehension impairment have been identified. A unitary account of the pattern of performance in the access patients in terms of refractoriness has previously been proposed and it is reiterated here. Similarly, a unitary account of the patients with degenerative conditions in terms of storage deficit is advanced. It is speculated that these two types of deficit, refractoriness and storage, reflect two sources of damage to the stored representations underpinning a word, rather than a dichotomy between deficits affecting the procedures of accessing semantic representations and the stored representations themselves. The implications for neurological diagnosis and therapeutic intervention are discussed.

Aged↗

PubMed1981

Sentence comprehension in elderly listeners: the factor of rate.

The study was designed to test the clinical observation that sentence comprehension in elderly listeners is enhanced when rate is slowed (time-expanded) and that comprehension is affected adversely when rate is speeded (time-compressed). Twenty normally-active elderly persons who ranged in age from 65 through 88 years listened to four matched sets of 10 sentences each that were modified electronically to produce the following four rate-alteration percentages: 100% (normal rate), 60% compression, 140% expansion, and 180% expansion. Sentences were presented binaurally to listeners who responded by selecting pictures that matched the sentences heard. Results indicated that sentence comprehension scores were significantly higher (p less than .01) at both the 60% and 140% alteration rates than at the normal speaking rate. Possible effects of the stimulus upon comprehension performance are discussed.

Aged↗

PubMed2001

Comparison of literal, inferential, and intentional text comprehension in children with mild or severe closed head injury.

BACKGROUND: Children with head injury have impairments in pragmatic language at the level of both single words and texts. Text comprehension deficits are likely to be the more consequential for everyday and academic function, yet the relative magnitudes of literal and nonliteral text comprehension deficits have not been measured. DESIGN: We compared the magnitude of the impairment in three forms of text comprehension for children with mild or severe head injury relative with controls: literal language (understanding literal text information), inferential language (making pragmatic inferences, textual coherence inferences, or enriching inferences), and the language of mental states and intentions (eg, producing speech acts, appreciating irony, and understanding deception). MEASURES: Effect sizes were used to measure the magnitude of the difference between children with head injury and age-matched controls. RESULTS: Children with severe closed-head injury were significantly impaired on tasks of literal text understanding, inferencing, and intentionality. Children with mild head injury were impaired on some inferencing and all intentionality tasks, although they had no literal text comprehension deficits. CONCLUSIONS: For both groups, the greatest deficits (ie, the largest effect sizes) were on tasks requiring understanding of the language of mental states and intentions. The data bear on the long-term effects of childhood closed-head injury on text- and discourse-level language and also on the nature and timing of language rehabilitation in children with head injury.

Adolescent↗

PubMed2000

The effects of listening comprehension of various genres of literature on response in the linguistic area: an fMRI study.

Using fMRI at a static magnetic field strength of 1.5T, we investigated how comprehension and humor of sentences would correlate to activation of the language areas in listening comprehension of a native language. Sentences with a high comprehension score augmented activation in the left inferior parietal lobule and posterior part of the left superior temporal gyrus, which may be related to semantic processing. Sentences with a high humor score induced activation in Broca's area, which may be associated with syntactic processing and auditory working memory. Furthermore, sentences with a high humor factor and/or a low comprehension score activated the middle frontal gyrus, which may be attributed to auditory working memory.

Adult↗

PubMed2000

Cognitive sequence processing and syntactic comprehension in schizophrenia.

It has been repeatedly demonstrated that schizophrenic patients are impaired in the comprehension of sentences with complex syntax. We investigated the hypothesis that this syntactic comprehension impairment in schizophrenia is not a purely linguistic dysfunction, but rather the reflection of a cognitive sequence processing impairment that is revealed as task complexity increases. We tested 10 schizophrenic patients using a standard measure of syntactic comprehension, and a non-linguistic sequence processing task, both of which required simple and complex transformation processing. Patients' performance impairment on the two tasks was highly correlated (r2 = 0.84), and there was a significant effect for complexity, independent of the task. These results are quite similar to those of aphasic patients with left hemisphere lesions. This suggests that syntactic comprehension deficits in schizophrenia reveal the dysfunction of cognitive sequence processing mechanisms that can be expressed both in linguistic and non-linguistic sequence tasks.

Adult↗

PubMed2003

Effectiveness and cost-effectiveness of comprehensive rehabilitation programs.

Comprehensive rehabilitation involving multidisciplinary involvement of healthcare professionals is available to patients with rheumatic diseases. Studies were reviewed on the effectiveness of such programs for patients with chronic low back pain, widespread pain, and rheumatoid arthritis. When effects on the various outcome measures are demonstrated, improvements can only with difficulty be attributed to a specific component of a comprehensive program. Economic analyses for the effectiveness of comprehensive programs are scarce, but are needed by policy makers to allow optimal allocation of resources. Preferably the overall performance of comprehensive rehabilitation programs, not the individual components, should be evaluated.

Arthritis, Rheumatoid↗

PubMed1996

Intrapreneurial nursing: the Comprehensive Lower Extremity Assessment Form.

The Comprehensive Lower Extremity Assessment Form was developed in response to the need for a screening tool in a nurse-managed foot care clinic. It differs from other such tools because it includes clinical measures that identify the potential for foot pathology. The Comprehensive Lower Extremity Assessment Form also serves as an assessment teaching guide in a foot care course and is included as part of a home-study program. The authors demonstrate how the Comprehensive Lower Extremity Assessment Form has generated revenue as part of an intrapreneurial outgrowth of their foot clinic and provides a comprehensive approach to lower extremity assessment. The form can be tailored to meet the needs of the advanced practice nurse, the clinical setting, or patient population.

Entrepreneurship↗

PubMedDate not supplied

Incorporating ethics into your comprehensive organizational plan.

Today's health care executives find their organizations facing internal and external environments that are behaving in chaotic and unpredictable ways. From inadequate staffing and an increase in clinical errors to outdated risk management procedures and increased competition for scare reimbursements, these health care managers find themselves making decisions without being fully informed of the ethical ramifications of these decisions. A 6-part Comprehensive Organizational Plan is presented that helps the health care decision maker better understand the key success factors for the organization. The Comprehensive Organizational Plan is an overall plan that is intended to protect and serve your organization. The 6 plans in the Comprehensive Organizational Plan cover the following areas: competition, facilities, finances, human resources, information management, and marketing. The comprehensive organizational plan includes an overlay of the ethical considerations for each part of the plan.

Decision Making, Organizational↗

PubMed1997

Speech perception and speech comprehension investigations of pre-term newborns and high-risk neonates of pre-school age.

The purpose of this study is to establish whether there is any connection between neonatal morbidity and speech perception and comprehension in children of pre-school age who have previously been treated as newborn infants in an intensive care unit. The test applied is a method invented in Hungary for the analysis of global hearing, speech perception and comprehension. The authors summarize the results of their follow-up studies of 52 children with respiratory disorders as newborns, some of whom were born as pre-term and some as full-term newborns with asphyxia. The children have been put into three groups according to their maturity and their birthweight. Newborns with hearing loss and mental retardation were excluded from this study. Of the various neonatal factors the results show: complications of delivery, birthweight, hypoxia, persistent ductus arteriosus, duration of ventilation and complications of respiratory treatment are found to be correlated to perception and comprehension. Incidences of poor achievement obtained in the most characteristic subtests have been compared among the different groups of newborns. The intelligence level of pre-school children is found to be closely correlated to speech perception and comprehension.

Asphyxia Neonatorum↗

PubMed1982

Comprehension of spoken, written and signed sentences in childhood language disorders.

Nine children suffering from Landau-Kleffner syndrome and 25 children with developmental expressive disorder were tested for comprehension of the grammatical structure of English in spoken, written and signed (Paget-Gorman) language modalities. It is shown that the comprehension problems of children with landau-Kleffner syndrome are not restricted to spoken language, but are also found when written or signed language is used. Further, in all three language modalities these children show deviant patterns of comprehension consistent with the notion that they treat language as having a sequential rather than a hierarchical structure. However, similar patterns of performance are found in profoundly deaf children, indicating that peripheral auditory deprivation is a sufficient condition for these deviant patterns of comprehension to develop.

Adolescent↗

PubMed1994

Program management: a necessary component for the comprehensive school health program.

The definition of a comprehensive school health program changed dramatically in the 20th century. Publication of the book Health Education, in the 1920s, provided a vision of health education as an instructional experience. In the 1950s, the concept of school health programs grew with addition of components in health services and a healthy school environment. An expanded concept of comprehensive school health programs now includes the components of physical education, food services, counseling, staff health promotion programs, and involvement of parents and the community. The next step involves inclusion of a "focusing" or "integrating" component that unifies elements of the comprehensive school health model. This component provides leadership and management to ensure that potential benefits of a comprehensive school health program are fully realized.

Adolescent↗

PubMed1986

The effects for recall patients of a comprehensive sealant program in a clinical dental public health setting.

The preventive outcomes of a comprehensive sealant program in a dental public health treatment center for low SES children are reported. The Linn County (Iowa) Dental Health Center implemented a comprehensive sealant philosophy in 1978. Since then, virtually all pits and fissures in primary and permanent teeth for all new and recall patients have been sealed. The comprehensive sealant philosophy was formulated following a previously reported Dental Health Center study documenting the negative outcomes of unmet treatment need as a result of the lack of continuity of care for this specific low SES target population. Sealants were evaluated for all recall patients seen over a two-month period. The sealants had been placed six months to six years before the two-month examination period. Ninety-five percent of the sealants were intact for the recall patients. Only 3.3 percent of the sealants were in need of repair or resealing--a procedure easily incorporated into the preventive recall appointment. Only 1.5 percent of the teeth were carious, and to a minor extent. To maintain the total sealant treatment philosophy on repaired and newly erupted teeth for recall patients in the dental public health setting requires on the average approximately five additional minutes per recall appointment. Low SES children are at highest risk to dental caries, but are still not guaranteed access to ongoing preventive services. Sealants are of much greater importance than the usual prophylaxis-fluoride regimen for low SES children displaying more episodic than preventive dental behavior. Comprehensive sealant programs should be considered for all dental public health clinical treatment programs for children.

Child↗

PubMed1995

Individual differences in story comprehension and recall of poor readers.

This study sought to identify poor readers and characterise weaknesses in their knowledge and use of story structure in comprehension and recall. Eighty year 3 children, 20 good readers and 60 poor readers, were selected from an initial pool of children based on factor analysis of scores from three measures of reading ability. The poor readers were then divided into relatively homogeneous subgroups, using eight additional measures of language-reading comprehension, according to a numerical classification procedure. This procedure helped identify specific weaknesses in their language-reading comprehension. All children listened to three stores and retold the stories under free and probe recall conditions. Story recalls were analysed using the STein and Glenn story grammar. Comparison of recalls between the good readers and each of the subgroups of poor readers showed that poor readers in two subgroups evidenced reduced sensitivity to story structure. The children in these subgroups recalled less of the stories overall, recalled less information from story grammar categories to varying extents, and showed patterns of category recall that differed from those of normal readers. Children in one of the subgroups also displayed poor perception of causal relations across story episode boundaries. These results provide evidence of marked heterogeneity in poor readers' story comprehension and recall. Certain subgroups of poor readers may have qualitatively different problems processing stories, relative to other poor readers, which may require a more concerted approach to instruction in story structure.

Aptitude Tests↗

PubMed1996

Do levels of interest have an effect on children's comprehension monitoring performance?

This study examines the effect of interest levels on the comprehension monitoring ability of 8- and 9-year-old children. Two groups participated in the study; they were matched for single-word reading and vocabulary skills, but differed in comprehension skill. Two tests were carried out which required the children to read a number of brief passages, some of which contained embedded problems. The children's task was to identify the problems. Test 2 was game-like in nature and the children reported finding it more interesting than Test 1. Interest level was found to affect test performance in the poor comprehenders' comprehension monitoring: a significant improvement in their performance was found at high interest levels (Test 2). However, the performance of the good comprehenders was independent of interest level. This study suggests that the comprehension-monitoring deficit in the poor comprehenders is not irreversible, and is likely to be related to poor motivation and low levels of interest. The implications for remedial education are discussed.

Analysis of Variance↗

PubMed2005

Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition.

BACKGROUND AND PURPOSE: To develop recommendations for the establishment of comprehensive stroke centers capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. Recommendations were developed by members of the Brain Attack Coalition (BAC), which is a multidisciplinary group of members from major professional organizations involved with the care of patients with stroke and cerebrovascular disease. SUMMARY OF REVIEW: A comprehensive literature search was conducted from 1966 through December 2004 using Medline and Pub Med. Articles with information about clinical trials, meta-analyses, care guidelines, scientific guidelines, and other relevant clinical and research reports were examined and graded using established evidence-based medicine approaches for therapeutic and diagnostic modalities. Evidence was also obtained from a questionnaire survey sent to leaders in cerebrovascular disease. Members of BAC reviewed literature related to their field and graded the scientific evidence on the various diagnostic and treatment modalities for stroke. Input was obtained from the organizations represented by BAC. BAC met on several occasions to review each specific recommendation and reach a consensus about its importance in light of other medical, logistical, and financial factors. CONCLUSIONS: There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include: (1) health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology; (2) advanced neuroimaging capabilities such as MRI and various types of cerebral angiography; (3) surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy; and (4) other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry. Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center.

Academic Medical Centers↗

PubMed2006

Auditory language comprehension in children with developmental dyslexia: evidence from event-related brain potentials.

In the present study, event-related brain potentials (ERPs) were used to compare auditory sentence comprehension in 16 children with developmental dyslexia (age 9-12 years) and unimpaired controls matched on age, sex, and nonverbal intelligence. Passive sentences were presented, which were either correct or contained a syntactic violation (phrase structure) or a semantic violation (selectional restriction). In an overall sentence correctness judgment task, both control and dyslexic children performed well. In the ERPs, control children and dyslexic children demonstrated a similar N400 component for the semantic violation. For the syntactic violation, control children demonstrated a combined pattern, consisting of an early starting bilaterally distributed anterior negativity and a late centro-parietal positivity (P600). Dyslexic children showed a different pattern that is characterized by a delayed left lateralized anterior negativity, followed by a P600. These data indicate that dyslexic children do not differ from unimpaired controls with respect to semantic integration processes (N400) or controlled processes of syntactic reanalyses (P600) during auditory sentence comprehension. However, early and presumably highly automatic processes of phrase structure building reflected in the anterior negativity are delayed in dyslexic children. Moreover, the differences in hemispheric distribution of the syntactic negativity indicate different underlying processes in dyslexic children and controls. The bilateral distribution in controls suggests an involvement of right hemispherically established prosodic processes in addition to the left hemispherically localized syntactic processes, supporting the view that prosodic information may be used to facilitate syntactic processing during normal comprehension. The left hemispheric distribution observed for dyslexic children, in contrast, suggests that these children do not rely on information about the prosodic contour during auditory sentence comprehension as much as controls do. This finding points toward a phonological impairment in dyslexic children that might hamper the development of syntactic processes.

Child↗