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PubMed2000

Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?

While the vision for restructuring health care in South Africa is based on a comprehensive primary health care system, care at the primary level remains largely biomedical in orientation. Given this, I argue that whilst adding mental health care to primary level care may increase accessibility of psychiatric care. it will not, however, provide for comprehensive integrated primary mental health care as planned. This would require a paradigm shift towards a comprehensive discourse of care which includes mental health care. While efforts towards reorienting health care personnel in South Africa towards the primary health care approach have been initiated, an examination of the primary health care system in one sub-district in South Africa, reveals that the delivery of biomedical care is sustained by a number of factors within the primary health care system as well as within the macro-context. A shift in the paradigm of care provided would therefore require the transformation of the system on many fronts. Of central importance would be the restructuring of the primary health care system to be supportive of emotional labour, health promotion, empowerment of service users and of care which takes the subjectivity of the illness experience for the patient into account.

Culture↗

PubMedDate not supplied

Language production and comprehension in an adult with ACoA syndrome.

This study explored the prediction that cases with anterior communicating artery (ACoA) syndrome will exhibit deficits in higher-level language production and comprehension. A 65-year-old adult male with a history of ACoA syndrome was tested on higher-level linguistic tasks. The patient's performance on discourse comprehension. discourse production, and linguistic ambiguity comprehension tasks was impaired.

Aphasia↗

PubMed1998

Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing.

PURPOSE: Conformal treatment using static multisegmental intensity modulation was developed for patients requiring comprehensive irradiation for head and neck cancer. The major aim is sparing major salivary gland function while adequately treating the targets. To assess the adequacy of the conformal plans regarding target coverage and dose homogeneity, they were compared with standard irradiation plans. METHODS AND MATERIALS: Fifteen patients with stage III/IV head and neck cancer requiring comprehensive, bilateral neck irradiation participated in this study. CT-based treatment plans included five to six nonopposed fields, each having two to four in-field segments. Fields and segments were devised using beam's eye views of the planning target volumes (PTVs), noninvolved organs, and isodose surfaces, to achieve homogeneous dose distribution that encompassed the targets and spared major salivary gland tissue. For comparison, standard three-field radiation plans were devised retrospectively for each patient, with the same CT-derived targets used for the clinical (conformal) plans. Saliva flow rates from each major salivary gland were measured before and periodically after treatment. RESULTS: On average, the minimal dose to the primary PTVs in the conformal plans [95.2% of the prescribed dose, standard deviation (SD) 4%] was higher than in the standard plans (91%, SD 7%; p = 0.02), and target volumes receiving <95% or <90% of the prescribed dose were smaller in the conformal plans (p = 0.004 and 0.02, respectively). Similar advantages of the conformal plans compared to standard plans were found in ipsilateral jugular nodes PTV coverage. The reason for underdosing in the standard treatment plans was primarily failure of electron beams to fully encompass targets. No significant differences were found in contralateral jugular or posterior neck nodes coverage. The minimal dose to the retropharyngeal nodes was higher in the standard plans. However, all conformal plans achieved the planning goal of delivering 50 Gy to these nodes. In the conformal plans, the magnitude and volumes of high doses in noninvolved tissue were significantly reduced. The main reasons for hot spots in the standard plans (whose dose calculations included missing tissue compensators) were photon/electron match line inhomogeneities, which were avoided in the conformal plans. The mean doses to all the major salivary glands, notably the contralateral parotid (receiving on average 32% of the prescribed dose, SD 7%) were significantly lower in the conformal plans compared with standard radiation plans. The mean dose to the noninvolved oral cavity tended to be lower in the conformal plans (p = 0.07). One to 3 months after radiation, on average 60% (SD 49%) of the preradiation saliva flow rate was retained in the contralateral parotid glands and 10% (SD 16%) was retained in the submandibular/sublingual glands. CONCLUSIONS: Planning and delivery of comprehensive irradiation for head and neck cancer using static, multisegmental intensity modulation are feasible. Target coverage has not been compromised and dose distributions in noninvolved tissue are favorable compared with standard radiation. Substantial major salivary gland function can be retained.

Carcinoma, Squamous Cell↗

PubMed2002

Comprehensive mutation scanning of the dystrophin gene in patients with nonsyndromic X-linked dilated cardiomyopathy.

OBJECTIVES: The goal of this study was to perform comprehensive mutation analysis of the dystrophin gene in patients with X-linked dilated cardiomyopathy (XLCM). BACKGROUND: X-linked dilated cardiomyopathy is a familial disease that is characterized by congestive heart failure without clinical signs of skeletal myopathy. Mutations in the dystrophin gene have been associated with the X-linked form of dilated cardiomyopathy. However, the fraction of XLCM with dystrophin mutations and the distribution of those mutations is not clear. Technical difficulties previously limited comprehensive mutation analysis of this very large gene. METHODS: The Detection Of Virtually All Mutations-Single Strand Conformation Polymorphism (SSCP) (DOVAM-S), a robotically enhanced multiplexed scanning method that is a highly sensitive modification of SSCP, has successfully detected all of 240 mutations and polymorphisms in three blinded analyses of the factor VIII, factor IX, and ATM genes. Utilizing this method all 79 coding exons and splice junctions for the muscle dystrophin gene, along with six alternative exon 1 sequences, were scanned in eight patients with XLCM. RESULTS: This is the first comprehensive scanning of the dystrophin gene in XLCM. Three of eight patients have putative mutations, including two splicing mutations and a missense mutation at a highly conserved amino acid. CONCLUSIONS: Mutations within the coding regions and splice junctions in the dystrophin gene only account for some cases of XLCM. Genetic heterogeneity and/or undetected mutations in auxiliary regulatory regions or deep within introns may occur in XLCM.

Adolescent↗

PubMedDate not supplied

Patient comprehension profiles: recent findings and strategies.

Poor comprehension of instructions is a major cause of failure to achieve desired results in patient education. Tests to measure comprehension levels of patients and formulas to predict readability levels of materials can effectively determine gaps between instruction and comprehension. Strategies, many of which require a minimum amount of additional effort, can be applied to eliminate gaps and thereby achieve a better quality of care through educational programs.

Communication↗

PubMed1997

Measurement issues in the comprehensive assessment of cancer pain.

OBJECTIVES: To examine issues related to the assessment of pain, symptoms and functional status in patients with cancer and the timing of assessment and appropriate tools to collect this information. DATA SOURCES: Review articles, research studies book chapters, and government guidelines pertaining to measurement issues in the assessment of cancer pain. CONCLUSIONS: Each component of the measurement process (ie, choice of an instrument to measure pain, timing and frequency of measurement measurement of symptoms accompanying pain or its treatment, and measurement of functional status) is important in developing an accurate and comprehensive assessment of cancer pain. This comprehensive assessment is a prerequisite to effective pain management. IMPLICATIONS FOR NURSING PRACTICE: For pain to be evaluated and treated effectively, regular consistent assessment of pain by the clinician is imperative. This comprehensive assessment allows the clinician to choose modalities most likely to work for the individual patient.

Activities of Daily Living↗

PubMed1999

Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: application to treatment of acute ischemic stroke.

A recent national panel on cost-effectiveness in health and medicine has recommended that cost-effectiveness analysis (CEA) of randomized controlled trials (RCTs) should reflect the effect of treatments on long-term outcomes. Because the follow-up period of RCTs tends to be relatively short, long-term implications of treatments must be assessed using other sources. We used a comprehensive simulation model of the natural history of stroke to estimate long-term outcomes after a hypothetical RCT of an acute stroke treatment. The RCT generates estimates of short-term quality-adjusted survival and cost and also the pattern of disability at the conclusion of follow-up. The simulation model incorporates the effect of disability on long-term outcomes, thus supporting a comprehensive CEA. Treatments that produce relatively modest improvements in the pattern of outcomes after ischemic stroke are likely to be cost-effective. This conclusion was robust to modifying the assumptions underlying the analysis. More effective treatments in the acute phase immediately following stroke would generate significant public health benefits, even if these treatments have a high price and result in relatively small reductions in disability. Simulation-based modeling can provide the critical link between a treatment's short-term effects and its long-term implications and can thus support comprehensive CEA.

Acute Disease↗

PubMed2003

Intersentential syntactic context effects on comprehension: the role of working memory.

The study investigated the influence of a syntactically biasing context sentence on the processing of syntactically complex object-first relative clauses and even more complex object-first complement clauses in readers with individual differences in working memory. Behavioral as well as brain responses (event-related potentials, ERPs) were recorded from two groups of participants with either a high or a low working memory span. The behavioral data taken from a post-sentence comprehension question task indicate an intersentential syntactic contextual influence on the comprehension of object-first relative clauses for low span readers, but not for high span readers. The on-line ERP measures taken at the disambiguating item revealed for the high span readers a main effect of structure (subject- versus object-first) i.e., a P600, independent of context. Low span readers, in contrast, did not show any P600 structure effect. Thus, the combined data indicate a differential context effect on sentence comprehension in low and high span readers. High span readers parse the incoming information independent of intersentential context, whereas low span readers use the intersentential context off-line.

Adult↗

PubMed2003

A practical approach to a comprehensive epicardial and epiaortic echocardiographic examination.

OBJECTIVE: More than a decade before the introduction of intraoperative transesophageal echocardiography (TEE), epicardial echocardiography was already in use as a diagnostic imaging modality to assist cardiac surgeons and anesthesiologists with clinical decision making. Although TEE has since become increasingly more popular, epicardial echocardiography may be the most convenient intraoperative imaging technique when TEE probe placement cannot be performed or is contraindicated. The authors developed a comprehensive examination protocol for the intraoperative interrogation of cardiac structures using an epicardial/epiaortic echocardiographic approach. DESIGN: Retrospective analysis of patient's medical records. SETTING: Single-center academic tertiary care hospital. PARTICIPANTS: Patients undergoing cardiac surgery. INTERVENTIONS: A total of 10 echocardiographic views were obtained for imaging cardiac structures, the ascending aorta, and proximal aortic arch. The described imaging planes permit the evaluation of ventricular performance, valvular function, cardiac structural abnormalities, and aortic disease. MEASUREMENTS AND MAIN RESULTS: A comprehensive epicardial/epiaortic echocardiographic examination was performed in 20 patients undergoing cardiac surgery requiring a full sternotomy. The described imaging planes were obtained in all patients in less than 8 minutes (range, 3.5-8 minutes; mean, 5.5 minutes). CONCLUSION: The present manuscript delineates a protocol for performing a comprehensive, intraoperative epicardial/epiaortic echocardiographic examination. Echocardiographic imaging planes of cardiac and aortic anatomy are described. This protocol may be useful for cardiac surgeons and anesthesiologists seeking to use this technique as a cardiac imaging modality that is complementary to TEE.

Aorta↗

PubMed2000

Assessment of the readability and comprehensibility of a CFC-transition brochure.

BACKGROUND: In anticipation of public confusion about the availability of medications during the metered-dose inhaler CFC phaseout period, a multidisciplinary effort has resulted in the development of a brochure designed to educate patients and health care providers about the health consequences of ozone depletion and the transition to CFC-free inhaled products. This brochure is the subject of this assessment. OBJECTIVES: The primary purpose of this study was to estimate the grade of reading difficulty of a brochure designed to educate patients about the change to CFC-free inhalation products. A secondary objective was to assess baseline knowledge of patients concerning CFC transition and their comprehension of this issue after reading the brochure. METHODS: Standard readability formulae were used to assess the grade level of the CFC transition brochure. In addition, baseline knowledge of the CFC transition process and comprehensibility of the brochure were measured via a 2-page questionnaire. RESULTS: The SMOG, Rix, and Flesch-Kincaid tests yielded readability at grade levels of 14, 10, and 10.4, respectively. The survey indicated that even after reading the brochure, many patients had concerns about the transition process. CONCLUSIONS: These results suggest that the readability of the brochure entitled Your Metered-Dose Inhaler Will Be Changing... Here Are the Facts...may not be appropriate for a large segment of the population for whom it is intended. Further, the comprehensibility assessment suggests that many patients are either unaware of or unable to understand the impending changes to their inhaled therapies.

Asthma↗

PubMed1997

Comprehensive analysis of neurotransmitters and their metabolites including acetylcholine and choline in rat brain nuclei.

We have designed this method for the comprehensive and adequate analysis of neurotransmitters and metabolites including acetylcholine (ACh) and choline in specific brain nuclei. In physiological and pharmacological studies, the role of specific neurotransmitters in the central nervous system (CNS) has often been studied by microinjection of their agonist and antagonist into the target regions, with the action and role of the transmitter in question being deduced in a relatively straightforward manner from the results. However, none of these studies have investigated fluctuation in neurotransmitter and metabolite contents in response to a variety of stimuli in vivo. No comprehensive analysis of neurotransmitters in small specific area in the CNS has been undertaken due to the difficulties of proper analysis of ACh and choline. Different types of neuronal systems in the CNS affect each other. Thus, it is not necessarily clear that different types of neurons do in fact respond to an administered agonist and antagonist. For example, dopaminergic neuron mediated control of cholinergic interneuron in the striatum and dopaminergic regulation of cortical ACh release have been documented. Similarly, the cholinergic system affects dopaminergic and noradrenergic neurons. Intraventricular administration of an ACh esterase inhibitor, neostigmine, increases dopamine and noradrenaline release in the hypothalamus. So, an adequate comprehensive analysis of the transmitters and the metabolites in the same tissue sample provides valuable aid to clarify what types of neurons truly respond to the administered drugs and the excitation of physiological events. For an appropriate analysis we employed a microwave device, which made the estimation of ACh and choline possible. In addition to this, we employed a punch technique for the microdissection of the specific nuclei and area from the brain slice.

Acetylcholine↗

PubMed2001

Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure.

BACKGROUND: Beneficial training outcomes have been reported in patients with chronic heart failure (CHF) following leg exercise training. However, data from more comprehensive training programs are limited. The aim of this study was to test the hypothesis that exercise training applying the concept of comprehensive local muscle training can improve aerobic and functional working capacity as well as quality of life in patients with CHF. METHODS: Twenty-four men and women [age 63+/-9 years (mean+/-S.D.)] with stable, moderate chronic heart failure (left ventricular ejection fraction 30+/-10%), were investigated in a randomized controlled study with a training group of 16 patients and a control group of 8 patients. The training was performed as an aerobic resistance training by activating all the main muscle groups, one at a time. The patients exercised for 1 h, three times per week for 8 weeks. RESULTS: Patient groups did not differ at baseline. Peak oxygen uptake (8%, P<0.03), the distance walked in a 6-min walking test (11%, P<0.002), the health-related quality of life (P<0.001) and plasma norepinephrine levels at rest (32%, P<0.003) and at submaximal intensities (P<0.03) improved after training. No changes were found in the control group, except for decreased peak oxygen uptake (P<0.02) and quality of life scores (P<0.03). CONCLUSIONS: Since comprehensive physical training activating a minor muscle mass at a time markedly improves exercise capacity and quality of life and reduces catecholamine levels, it can be recommended for the rehabilitation of patients with CHF under supervision of a physical therapist.

Analysis of Variance↗

PubMed2003

Women's health after a first myocardial infarction: a comprehensive perspective on recovery over a 4-year period.

BACKGROUND: Little attention has so far been focused on follow ups of women's long-term recovery after a myocardial infarction (MI), especially from a comprehensive perspective. AIM: The aim of this study was to prospectively determine women's self-rated health after a first MI from a comprehensive perspective on recovery over a 4-year period. METHODS: Consecutively chosen women (n=240) who had suffered a first MI were asked to complete a self-rated questionnaire regarding health (including not only biophysical, but also behavioral, emotional, social and working conditions) before being discharged from hospital as well as 1 and 4 years later. The results were analyzed by descriptive and inferential statistics. RESULTS: Health improvements, especially during the first year, could be observed in the women's behavioral condition regarding their attitude to diet consciousness, exercise, simultaneous capability and smoking behavior as well as in the emotional condition regarding their stressful life events, depressed mood and loss of control. In the social condition, the women considered that the healthcare professionals had improved their support over time as well as treating the women's complaints more seriously. Regarding the working condition, the women felt that they were being controlled at work, especially during the first year after the MI. CONCLUSIONS: Based on a comprehensive perspective on women's recovery after a first MI, a favorable development of the women's health was observed in the behavioral and emotional conditions while deterioration in the social and working conditions was observed over time. Thus, further efforts are needed in the two latter conditions by means of further studies in combination with greater support from healthcare professionals.

Activities of Daily Living↗

PubMed2006

Comprehensive cardiac rehabilitation: a cost assessment based on a randomized clinical trial.

OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective.

Coronary Disease↗

PubMed1995

Actionality and mental imagery in children's comprehension of declaratives.

Previous work has demonstrated that children understand sentences with actional verbs better than nonactional verbs. This actionality effect has been reported to be restricted to passives and to be independent of experimental context. The present experiment was conducted with 48 French-speaking children aged 5; 0-7; 11. The actionality effect was studied by systematically varying the voice of the test sentences and the voice of the interpretive requests. Pictures corresponding or not to the predicate-argument structure of the sentences were presented to the subjects, who were independently classified as visualizers or nonvisualizers, in order to investigate the relation between sentence actionality and mental imagery. The interaction between actionality, voice of sentence, and interpretive request revealed that the actionality effect depends on the type of task used in order to assess comprehension, and that it can be reversed in some conditions. Our results also suggest that the actionality effect is linked to mental imagery. Visualizers demonstrated better comprehension of actional sentences than nonvisualizers, whereas the reverse was true for non-actional sentences. Mental image may serve as a support for the computations involved in sentence comprehension.

Attention↗

PubMed2004

The acquisition of relative clause comprehension in Hebrew: a study of SLI and normal development.

Comprehension of relative clauses was assessed in 10 Hebrew-speaking school-age children with syntactic SLI and in two groups of younger children with normal language development. Comprehension of subject- and object-relatives was assessed using a binary sentence-picture matching task. The findings were that while Hebrew-speaking children with normal development comprehend right-branching object relatives around the age of 6 ; 0, children with syntactic SLI are still at chance level in object relatives by age 11 ; 0. The four-year-olds were also at chance on object relatives. Comprehension of subject relatives was good in the SLI group, similar to the six-year-olds, and significantly better than the four-year-olds. The syntactic impairment is interpreted as a selective deficit to non-canonical sentences that are derived by movement.

Child↗

PubMed1999

Developments in early lexical comprehension: a comparison of parental report and controlled testing.

Six children were studied from the age of 0;6 to 1;6 in order to chart their developing comprehension vocabularies from the first to the 100th word. Observational data were used in the first instance to identify newly comprehended words and then controlled testing was carried out for each word to confirm and expand the observational data. Comprehension of words was divided into four categories--object names, context-bound object words, action words and personal names. The relative frequency of the different categories of word was found to change with the size of the comprehension vocabulary as personal names decreased in importance and both object names and action words became increasingly more common. There was considerable variation among the six children especially in the proportion of object names and action words that they understood but vocabulary composition became highly stable between 60 and 100 words.

Age Factors↗

PubMed2002

Effects of an intervention in active strategies for text comprehension and recall.

The aim of this study was to investigate the effects of an intervention program to promote active text-processing strategies (main-idea identification and summarization) at two developmental levels (12- and 16-year-olds). The independent variables were training condition (experimental and control) and school level (7th and 10th grades). Several measures were taken as dependent variables: reading span, reading time, construction of macrostructure, and structural recall. The hypothesis claimed that training would increase comprehension and recall significantly. Furthermore, as a result of the training program, a reduction in developmental differences in the experimental groups at posttest was also expected. Results supported the predictions, showing a significant improvement in the experimental groups' reading comprehension and recall. These results are discussed in terms of the importance of active and self-controlled strategies for text comprehension and recall.

Adolescent↗