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PubMed2003

Comprehension and memory for warning symbols: age-related differences and impact of training.

PROBLEM: Prior research indicates that many warning symbols are poorly understood, particularly by the elderly. METHOD: The effectiveness of three different training conditions to improve comprehension and memory for warning symbols was assessed for younger (18-35 years of age) and older (50-67 years of age) participants. All three conditions paired the symbols with associated text during training; however they differed in the extent to which they further elaborated on the meanings of the symbols. RESULTS: Training substantially improved accuracy and speed of responding on a comprehension test; however there was little difference among conditions. Additionally, while the magnitude of the training effect was similar for both age groups, older participants performed much more poorly than younger participants, both before (37% vs. 52% correct) and after training (68% vs. 88% correct on the immediate post-test), and found it more difficult to reject incorrect meanings (55% vs. 68% correct). CONCLUSION: Relatively simple training conditions can dramatically improve accuracy and speed of responding to warning symbols. IMPACT ON INDUSTRY: Training should be used to improve warning symbol comprehension since failures to adequately understand warning information may lead to injury or death. Furthermore, attempts should be made to address individual differences in warning processing such as those related to changes in cognitive processing across the lifespan.

Accidents, Occupational↗

PubMed2004

Neural responses to the production and comprehension of syntax in identical utterances.

Following up on an earlier positron emission tomography (PET) experiment (Indefrey et al., 2001), we used a scene description paradigm to investigate whether a posterior inferior frontal region subserving syntactic encoding for speaking is also involved in syntactic parsing during listening. In the language production part of the experiment, subjects described visually presented scenes using either sentences, sequences of noun phrases, or sequences of syntactically unrelated words. In the language comprehension part of the experiment, subjects were auditorily presented with the same kinds of utterances and judged whether they matched the visual scenes. We were able to replicate the previous finding of a region in caudal Broca's area that is sensitive to the complexity of syntactic encoding in language production. In language comprehension, no hemodynamic activation differences due to syntactic complexity were found. Given that correct performance in the judgment task did not require syntactic processing of the auditory stimuli, the results suggest that the degree to which listeners recruit syntactic processing resources in language comprehension may be a function of the syntactic demands of the task or the stimulus material.

Attention↗

PubMed2001

When the bough breaks: provider-initiated comprehensive care is more effective and less expensive for sole-support parents on social assistance.

This 5-year study conducted in Ontario, Canada is designed to assess the effects and expense of adding a mix of provider-initiated interventions to the health and social services typically used in a self-directed manner by sole-support parents and their children receiving social assistance in a national system of health and social insurance. Results from a 2-year interim analysis show that providing social assistance families with proactive comprehensive care (health promotion, employment retraining, and recreation activities for children) compared to allowing families to fend for themselves in a self-directed manner, results in 15% more exits from social assistance within 1 year and substantial savings to society in terms of social assistance payouts. It is no more expensive to provide health and social services in a comprehensive fashion, and equivalent reductions in parent mood disorder and child behavior disorders, as well as equivalent increases in parent social adjustment and child competence levels were also observed. This study presents clear evidence that providing comprehensive care to social assistance recipients produces tremendous short- and long-term financial gains and societal benefits.

Adolescent↗

PubMed2004

Exploration of strategies for facilitating the reading comprehension of high-functioning students with autism spectrum disorders.

Many students with autism spectrum disorders show good decoding combined with poor comprehension. Twenty adolescent students with autism spectrum disorders participated in a study concerning the effects of three kinds of facilitation on reading comprehension. In a within-subjects design, each students read passages under four conditions: answering prereading questions, completing cloze sentences embedded in the text, resolving anaphora by identifying relevant antecedents, and control (reading only). A repeated measures analysis of variance indicated that conditions differed significantly in their effects on reading comprehension. Post hoc contrasts showed that the effects of anaphoric cuing were statistically significant and medium in size; the effects of prereading questions and cloze completion were small and not statistically significant. Instructional implications for text preparation, remedial instruction, and the design of educational software are discussed.

Adolescent↗

PubMed2004

Effect of a comprehensive intervention program targeting general practice staff on quality of life in patients at high cardiovascular risk: a randomized controlled trial.

BACKGROUND: We implemented a comprehensive intervention program targeting general practice staff, that proved successful in optimizing practice organization and clinical decision-making. In this paper, health-related quality of life (HRQL) is investigated as a clinical outcome. OBJECTIVE: To evaluate the effect of the implementation of an intervention program on the HRQL in patients at high cardiovascular risk. RESEARCH DESIGN: Randomized controlled trial. Intervention practices (n = 62) received a comprehensive intervention program (by means of outreach visitors) lasting 21 months. HRQL of patients at high cardiovascular risk was assessed by the MOS 36-Item Short-Form Health Survey (SF-36), at baseline and after intervention. Three patient categories were distinguished: diabetes mellitus, cardiovascular disease and hypertension. RESULTS: HRQL deteriorated in all respondents, but more pronounced in the control group. In diabetes patients the differences between intervention and control group were significant for the Vitality and Mental Health scales, with mean difference in change of 3.93 (95% CI: 1.08-6.78) and 3.71 (95% CI: 0.73-6.68), respectively. Patients with cardiovascular disease had significantly different changes on three scales: physical functioning (3.57, 95% CI: 0.71-6.43), vitality (3.01, 95% CI: 0.72-5.30) and social functioning (3.96, 95% CI: 0.50-7.42). In patients with hypertension, there were no differences between the intervention and control group. CONCLUSION: Our comprehensive intervention program resulted in changes in HRQL on several domains, particularly in patients with diabetes and cardiovascular disease.

Aged↗

PubMed2004

Testing subject comprehension of utility questionnaires.

Utility questionnaires are often considered difficult for subjects to understand. Our study reports pilot testing of two subject comprehension tests to determine whether comprehension can be directly measured. Current health utilities were assessed using the standard gamble (SG), time trade-off (TTO), and visual analog scale. Subjects were randomized to one of two tests: (1) Logical consistency was tested by comparing rankings of two health states with an investigator-assigned a priori ranking; (2) Utility responses for two hypothetical respondents were presented; the subject was asked who had the better health. Thirty-one subjects completed the SG and TTO for two health states: being blind and wearing glasses. No subjects had inconsistent rankings. Post hoc analyses found that subjects reporting utilities below the first decile for the state, wearing glasses, had significantly lower current health utility than remaining subjects. Of the thirty subjects who evaluated the hypothetical respondents' utilities, five incorrectly judged the respondent with worse utility to have better health. Those subjects also reported current health utilities significantly lower than the remaining subjects. Our study findings suggest that a minority should be expected to have difficulty completing utility questionnaires. Comprehension checks may improve the reliability of utility data by enhancing training and by identifying subjects who may have misunderstood the utility questions.

Adult↗

PubMed2006

Seeing, acting, understanding: motor resonance in language comprehension.

Observing actions and understanding sentences about actions activates corresponding motor processes in the observer-comprehender. In 5 experiments, the authors addressed 2 novel questions regarding language-based motor resonance. The 1st question asks whether visual motion that is associated with an action produces motor resonance in sentence comprehension. The 2nd question asks whether motor resonance is modulated during sentence comprehension. The authors' experiments provide an affirmative response to both questions. A rotating visual stimulus affects both actual manual rotation and the comprehension of manual rotation sentences. Motor resonance is modulated by the linguistic input and is a rather immediate and localized phenomenon. The results are discussed in the context of theories of action observation and mental simulation.

Adolescent↗

PubMed2006

Similarity-based interference during language comprehension: Evidence from eye tracking during reading.

The nature of working memory operation during complex sentence comprehension was studied by means of eye-tracking methodology. Readers had difficulty when the syntax of a sentence required them to hold 2 similar noun phrases (NPs) in working memory before syntactically and semantically integrating either of the NPs with a verb. In sentence structures that placed these NPs at the same linear distances from one another but allowed integration with a verb for 1 of the NPs, the comprehension difficulty was not seen. These results are interpreted as indicating that similarity-based interference occurs online during the comprehension of complex sentences and that the degree of memory accessibility conventionally associated with different types of NPs does not have a strong effect on sentence processing.

Attention↗

PubMed2004

The impact of aided language stimulation on symbol comprehension and production in children with moderate cognitive disabilities.

Over the past decade, aided language stimulation has emerged as a strategy to promote both symbol comprehension and symbol production among individuals who use graphic mode communication systems. During aided language stimulation, an interventionist points to a graphic symbol while simultaneously producing the corresponding spoken word during natural communicative exchanges. The purpose of this study was to determine the impact of aided language stimulation on children with moderate cognitive disabilities. Three preschool children with moderate cognitive disabilities who were functionally nonspeaking participated in the investigation. The investigator implemented a multiple-probe design across symbol sets/activities. Elicited probes were used to determine whether the children increased their comprehension and production of graphic symbols. Results indicated that all 3 children displayed increased symbol comprehension and production following the implementation of aided language stimulation.

Child, Preschool↗

PubMedDate not supplied

Administrative characteristics of comprehensive prenatal case management programs.

The purpose of this study was to examine comprehensive prenatal case management programs in terms of organizational, program, and process characteristics. Data from 66 program surveys of government agencies were used. Organizational capacity was measured as extent of organizational change and extent of interagency agreements. Program data included age and size of the program, reasons for having case management, and funding diversity. Process data were eight types of interventions. The most highly rated reason for having case management was to improve client outcomes. The greatest organizational change was in the area of the organizational structure, followed by financial status and types of services provided. Contracts with other agencies were rare. Agencies with more interagency contacts reported higher levels of change in the case management department and turnover among mid-level managers. Older programs had fewer employees. Approximately 49% of client contacts were not billed to Medicaid. Larger programs had significantly less time allocated to emotional support and coaching. Data on organizational characteristics, program, and process variables provide insights into comprehensive case management. Relationships among these variables underscore the importance of studying client outcomes within the context of program and organizational idiosyncrasies. Future studies of comprehensive prenatal case management should focus on cross-level questions.

Case Management↗

PubMed2004

Digit span in dyslexia: variations according to language comprehension and mathematics skills.

The aim of this study was to investigate digit span performance in dyslexia. It was hypothesised that differences would be found in accordance with subgrouping by language comprehension and mathematic skills, and by analyses of how the digit span scores were attained. Two digit span tasks were given to a group of dyslexic children and controls (n = 57), mean age 12.62 (SD = 1.43). The tasks were "Digit Span" of the WISC-R, and "Digit Span 2," where the use of back-up strategies like finger counting and lip reading were restricted. As expected, the digit span scores were significantly lower in the dyslexia group than in the control group. Restrictions of back-up strategies did not alter the scores in the control group, while the scores were lowered in the dyslexia group. Further analyses of longest digit span, serial recall, and serial position indicated different retrieval patterns in the subgroups. The subgroup with good language comprehension and mathematic skills (n = 12), showed impaired serial recall especially in backward recall. The subgroup with good language comprehension skills, but with mathematics impairment (n = 9), showed impaired serial recall in both forward and backward recall. The subgroup with language impairments (n = 16), recalled fewer digits than the two other subgroups. The findings were discussed in relation to the "Phonological loop" of the Multi Component Model of Working Memory, and implications for intervention were discussed.

Adolescent↗

PubMedDate not supplied

Older adults filter irrelevant information during metaphor comprehension.

In general, older adults are less likely than younger adults to inhibit irrelevant information when reading literal text (Hasher & Zacks, 1988). Are older adults also less likely to inhibit irrelevant information during metaphor comprehension? Young (mean age 19.2 years) and older adults (mean age 73.6 years) participated in a timed property-verification task. Although the older adults were generally slower than the younger, they displayed the same pattern of data. After reading metaphors, both groups verified metaphor-relevant properties more quickly after a metaphor prime than after a literal control prime, whereas metaphor-irrelevant properties were responded to more slowly after metaphor primes, relative to the controls. These results suggest that older adults, like younger ones, enhance metaphor-relevant properties and filter out metaphor-irrelevant properties during metaphor comprehension. Older adults' metaphor comprehension processes thus seem intact. Mechanisms for filtering out metaphor-irrelevant information are considered.

Adolescent↗

PubMedDate not supplied

Working memory, language comprehension, and aging: four experiments to understand the deficit.

Four experiments were carried out to investigate working-memory capacity and functioning in young and older subjects, and its relation with reading comprehension. Experiment 1 showed that older subjects had to trade off processing and storage functions, due to an assumed reduced pool of resources relative to young subjects. Working-memory measures were weakly correlated with reading comprehension in each age group. Experiment 2 revealed a specific processing impairment in older subjects, and showed that older subjects tended to sacrifice the maintenance of the concurrent mnemonic load to devote more resources to ongoing processing. In Experiment 3, the age-related differences in the processing/storage trade-off were again observed. Furthermore, differences in the speed/accuracy trade-off were revealed. Experiment 4 showed that whatever the instructions regarding the speed/accuracy trade-off, the older subjects remained slower and slightly more accurate than the young subjects. In conclusion, it appears that the age-related differences in working memory are both structural and functional. Different strategies may be implemented in each age group to deal with reading comprehension.

Adult↗

PubMed2006

Comprehension: an overlooked component in augmented language development.

PURPOSE: Despite the importance of children's receptive skills as a foundation for later productive word use, the role of receptive language traditionally has received very limited attention since the focus in linguistic development has centered on language production. For children with significant developmental disabilities and communication impairments, augmented language systems have been devised as a tool both for language input and output. The role of both speech and symbol comprehension skills is emphasized in this paper. METHOD: Data collected from two longitudinal studies of children and youth with severe disabilities and limited speech serve as illustrations in this paper. The acquisition and use of the System for Augmenting Language (SAL) was studied in home and school settings. Communication behaviors of the children and youth and their communication partners were observed and language assessment measures were collected. RESULTS: Two patterns of symbol learning and achievement--beginning and advanced--were observed. Extant speech comprehension skills brought to the augmented language learning task impacted the participants' patterns of symbol learning and use. CONCLUSIONS: Though often overlooked, the importance of speech and symbol comprehension skills were underscored in the studies described. Future areas for research are identified.

Child↗

PubMed1994

Compliance with social and safety recommendations in an outpatient comprehensive geriatric assessment program.

BACKGROUND: A unique contribution of a comprehensive outpatient geriatric assessment is its focus on social and safety issues in the frail elderly. The impact of such programs depends on the caregiver and/or patient complying with safety and social recommendations offered by the assessment team. Compliance in this setting has not been previously described. METHODS: A telephone survey was conducted of self-reported compliance in 124 frail geriatric patients with a high prevalence of dementia 3-21 months after completing a comprehensive geriatric assessment program at the University of California, San Diego, Medical Center. RESULTS: The social and safety recommendations constituted 52.8% of all the recommendations offered. The overall compliance rate (total number of safety and social recommendations followed/total number offered x 100) was 50.2% (95% CI: 43.7-56.6). Highest compliance was achieved with recommendations to complete a prior directive for health care (80.6%) and to wear a medic-alert bracelet (57.5%). Patients complied poorly with recommendations to change a living situation (36.2%). Analysis of variance showed compliance to increase with time between the assessment and survey. Stratifying for time, we found higher compliance in patients with greater impairment in functional or cognitive status. Most noncompliance was due to disagreement with the recommendations offered or failure to implement acceptable recommendations. CONCLUSIONS: Compliance with social and safety recommendations offered in a comprehensive geriatric assessment program approximates compliance observed in other clinical settings. In this setting compliance increases over time. When controlled for time, impairment in functional or cognitive status is associated with greater compliance.

Accidents, Home↗

PubMed1994

How informed can consent be? New light on comprehension among elderly people making decisions about enteral tube feeding.

Elderly people in long-term care facilities do not understand much about various medical procedures, including enteral feeding. After presentation of empirically precise information about enteral tube feeding, residents in both long-term care and community-dwelling groups showed significant improvement in their understanding. The community-dwelling group showed even greater improvement. For both, comprehension was negatively related to age and depression scores, but positively related to IQ, reading comprehension, social support, and mental status. The MMSE proved the best predictor of comprehension. Implications of the results are discussed.

Advance Directives↗

PubMed1975

Comprehensive pediatric care: the patient viewpoint.

Two meanings of the term comprehensive care are delineated. The first refers to a wide scope of health services, the second to a humanistic approach to the patient. Findings from a sample of patients from one pediatric practice suggest that the two meanings constitute two independent variables with respect to patient expeciations. Patient responses to questions regarding their expectations of the pediatrician revealed a tendency to hold a traditional disease orientation. Comprehensive care as a broad scope of health services that include mother guidance in child rearing is not a common goal for mothers utilizing the pediatric practice under study. On the other hand, a comprehensive approach by the pediatrician is a standard shared by most respondents in the sample: high priority is accorded the pattern of the personal physician with whom a patient forms a continuous doctor-patient relationship which instills in the patient trust that the physician's recommendations are based on thorough knowledge of the patient as an individual.

Black or African American↗

PubMed2004

Comprehensive care for haemophilia around the world.

Comprehensive haemophilia care has been defined as the continuing supervision of all medical and psychosocial factors affecting the person with haemophilia family. Services offered by haemophilia treatment centres (HTCs) adopting the comprehensive care model include establishing prophylaxis and other treatment protocols, development of psychosocial, education and research programme, maintenance of a patient registry, genetic and reference diagnostic services and orchestration and management of a wide variety of multidisciplinary interventions. Most centres practising this model of care are based in developed countries and can meet costs for plentiful treatment products through government or insurance-company funding. Not all the programmes are dependent on the level of product supply, however, and many have been supported in countries with emerging economies as part of national healthcare systems, particularly in relation to blood management. In this paper we present perspectives from different areas of the world on how to adopt, adapt and achieve economically appropriate models of comprehensive care.

Comprehensive Health Care↗