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PubMed1993

Schools as healthful environments: prerequisite to comprehensive school health?

The development of healthy schools to support and nature the well-being of students, teachers, and staff is proposed as a first step toward the goal of comprehensive health education. A focus on healthy schools incorporates elements of an expanded concept of comprehensive health education that demands careful consideration of the physical, psychological, and social environment of the nation's schools--worksite to 51 million (students, teachers, and staff). The active participation of all stakeholders in environmental assessments, health and safety audits, and restructuring of schools is an essential part of the school reform movement. A healthy worksite concept supports the transformation of the school environment to increase "productivity" by enhancing the ability of teachers, staff, and students to function well.

Adolescent↗

PubMed1992

Comprehensive care of pregnant mentally ill women.

Since the onset of deinstitutionalization, there has been an unanticipated and dramatic increase in pregnancies among women with chronic mental illness, with no specific planning for how to address the unique clinical needs of this high-risk population. Shortcomings in delivering care to mentally ill women within general health care systems are reviewed, including failure to assist with family planning, failure to observe worsening mental health during pregnancy, inadequate planning for child custody, lack of access to services, and omitted pelvic examinations. Necessary components of a system to provide comprehensive and coordinated care for pregnant mentally ill women are described. These include assessment of adaptation to pregnancy and competency to care for an infant, somatic and psychotherapeutic treatment, parenting skills training, family planning services, outreach, and close liaison with obstetric services. A Chicago-based collaborative program is described as an example of providing comprehensive, specialized care with limited financial resources.

Chicago↗

PubMed1999

[Initial experiences with a comprehensive ambulatory rehabilitation program for heart patients].

213 patients (197 males and 16 females, mean age 58.5 years) have taken part during the first 5 years in our comprehensive outpatient cardiac rehabilitation program (101 patients after acute myocardial infarction, 73 patients after heart surgery and 39 patients with various cardiac problems). The program consists of three elements: (1.) regular physical training in an outpatient group three times a week for 6-12 weeks; (2.) information and education of the patient and if possible of the family about risk factors and life-style changes, and (3.) psychosocial support. During 10,838 hours of active rehabilitation, no life-threatening complication occurred. After completion of the program, 73% of the patients were fully rehabilitated (return to work in the active working population, reintegration in the family and daily life in the retired and non-working patients), 15% of the patients interrupted the program because of further invasive treatment, and in 11% the goal of the rehabilitation program was not achieved. Follow-up was carried out by a questionnaire 3-56 months (mean 25 months) later. The percentage of smokers decreased from 55% before the program to 18% (p < 0.05), regular physical exercise increased from 49% to 76% (p < 0.05), and the perceived stress level of high intensity decreased from 53 to 9% (p < 0.05). Our findings indicate that a comprehensive cardiac rehabilitation program in an outpatient setting in conjunction with a community hospital is feasible; it can be conducted with a high degree of safety and is followed by considerable lifestyle changes.

Adult↗

PubMed2005

Characteristics of coordinated ongoing comprehensive care within a medical home in Maine.

OBJECTIVES: Access to coordinated, ongoing comprehensive care in a medical home (CCMH) is a national health objective and a federal performance measure. The National Survey of Children With Special Health Care Needs (National Survey of CSHCN) provides state level data on this Maternal Child Health Bureau performance measure. In Maine, only 60% of CSHCN received CCMH in 2001. Here we described characteristics of receiving comprehensive care in a medical home for CSHCN, in Maine. METHODS: Data from the National Survey of CSHCN were used for the analysis. We examined associations between receiving CCMH and demographic factors, severity of a condition or problem, and having adequate insurance coverage for services in univariate and multivariate logistic regression models. RESULTS: The distribution of children who received CCMH did not differ across gender, race, age, or poverty level. Children with adequate insurance were more likely to have received this care than those without adequate insurance and those with a more severe condition or problem were less likely to receive CCMH. CONCLUSIONS: We found that receiving CCMH was positively related to adequate insurance, independent of poverty. We also found that CSHCN with more severe conditions have more unmet needs than those with less severe conditions. CSHCN programs, which have a responsibility to assure that CSHCN receive CCMH, must work to maximize insurance coverage. Programs can also work to raise awareness among providers of the complexity of CCMH and the role it plays in maximizing the health of the child and family.

Adolescent↗

PubMed2005

Patient information leaflets--patients' comprehension of information about interactions and contraindications.

OBJECTIVE: To determine how well patients could correctly recognize and comprehend the various information items on patient information leaflets, and to explore the reasons underlying poor comprehensibility. METHODS: Leaflets from 30 randomly selected, commonly prescribed medicines were examined by experts using protocols to evaluate leaflet layout, language and content. The same leaflets were also evaluated by patients who had their medicines dispensed at 24 randomly selected Swedish pharmacies. A questionnaire was used for the patients' examination. RESULTS: The results showed that most information on the leaflets is sound and is well comprehended by the patients. For two information items regarding 'risks of interactions' and 'contraindications' the patient scores were low, indicating poor comprehensibility. CONCLUSION: Leaflets with low scores on warnings of interactions and contraindications were found to deliver more complex messages to older patients as compared to leaflets with high scores for these items.

Adult↗

PubMed2026

Comprehensive genomic profiling and tumor mutational burden in parathyroid carcinoma: a nationwide real-world study from Japan.

PURPOSE: Parathyroid carcinoma (PC) is an extremely rare endocrine malignancy with limited treatment options for unresectable or recurrent cases. With the increasing use of comprehensive genomic profiling (CGP), treatment based on genomic findings is becoming more common. However, the frequency and clinical significance of elevated tumor mutational burden (TMB) in PC remain unclear because previous studies have been limited by small sample sizes. METHODS: We retrospectively analyzed genomic and clinical data of patients with PC registered in the Center for Cancer Genomics and Advanced Therapeutics database in Japan between June 2019 and March 2025. TMB values were obtained as reported by each CGP assay. TMB-H was defined as TMB ≥ 10 mut/Mb for descriptive analyses. We also assessed genomic alterations, microsatellite instability (MSI) status, and clinicogenomic characteristics. RESULTS: Twenty-five patients with PC were included. The median assay-reported TMB was 4.0 mut/Mb (range, 0-35). Seven tumors (28.0%) had assay-reported TMB values of ≥ 10 mut/Mb, including three (12.0%) with TMB ≥ 20 mut/Mb. The most frequently altered genes were CDC73 (40%), TP53 (32%), and MEN1 (24%). No co-alterations were observed between CDC73 and MEN1 or between CDC73 and TP53. One tumor was MSI-high and was included in the TMB-H group. POLE alterations were detected in three cases, including two tumors in the TMB-H group. CONCLUSION: This nationwide, real-world study demonstrated that a subset of PCs showed elevated assay-reported TMB values and genomic features potentially related to abnormalities in DNA replication or repair pathways. These findings support the clinical relevance of comprehensive genomic profiling in identifying the molecular heterogeneity and potential therapeutic opportunities for this rare malignancy.

Humans↗

PubMed1984

Factors influencing comprehension of information for informed consent: ethical implications for nursing research.

Empirical studies on comprehension of information for informed consent show that research subjects often do not understand major portions of that to which they have consented. This raises the ethical question of whether or not the consent process has accomplished its purpose--the protection of the individual's right to self-determination. This article focuses on the following factors derived from the research literature that influence comprehension of information for informed consent: the nature of information, method of presentation of information, demographic factors, and personal factors. From these factors and methodological considerations, ethical implications for nursing research are addressed.

Comprehension↗

PubMedDate not supplied

A comprehensive primary health care delivery model.

Primary health care has emerged as a key element in the health care delivery system. A well-organized system of primary care is needed to reduce the fragmented, often parallel approaches currently seen in the delivery of health care. Important aspects of primary care include not only comprehensive services and continuity of care to the individual client but health assessment and intervention to meet the community needs as a whole. A nursing model is presented for comprehensive interdisciplinary primary health care practice, education, and research. A unique aspect of this model is the partnership with the community, which is an essential component for operationalization of the model. Use of this model will provide an opportunity for cost-effective, acceptable, accessible, and holistic health care that better meets the needs of the community.

Community Health Planning↗

PubMed2006

Quantifier comprehension in corticobasal degeneration.

In this study, we investigated patients with focal neurodegenerative diseases to examine a formal linguistic distinction between classes of generalized quantifiers, like "some X" and "less than half of X." Our model of quantifier comprehension proposes that number knowledge is required to understand both first-order and higher-order quantifiers. The present results demonstrate that corticobasal degeneration (CBD) patients, who have number knowledge impairments but little evidence for a deficit understanding other aspects of language, are impaired in their comprehension of quantifiers relative to healthy seniors, Alzheimer's disease (AD) and frontotemporal dementia (FTD) patients [F(3,77)=4.98; p<.005]. Moreover, our model attempts to honor a distinction in complexity between classes of quantifiers such that working memory is required to comprehend higher-order quantifiers. Our results support this distinction by demonstrating that FTD and AD patients, who have working memory limitations, have greater difficulty understanding higher-order quantifiers relative to first-order quantifiers [F(1,77)=124.29; p<.001]. An important implication of these findings is that the meaning of generalized quantifiers appears to involve two dissociable components, number knowledge and working memory, which are supported by distinct brain regions.

Aged↗

PubMed2006

Testing idiom comprehension in aphasic patients: the effects of task and idiom type.

Idiom comprehension in 15 aphasic patients was assessed with three tasks: a sentence-to-picture matching task, a sentence-to-word matching task and an oral definition task. The results of all three tasks showed that the idiom comprehension in aphasic patients was impaired compared to that of the control group, and was significantly affected by the type of task and type of idiom. Whilst performance on the oral definition and sentence-to-picture matching tasks was similarly impaired, the patients performed significantly better on the sentence-to-word matching task. The results confirm the relevance of task and idiom type in drawing conclusions about figurative language interpretation in brain-damaged patients.

Aged↗

PubMed2006

Semantic and syntactic processing in Chinese sentence comprehension: evidence from event-related potentials.

An ERP experiment was conducted to explore semantic and syntactic processes as well as their interplay in Chinese sentence comprehension. Participants were auditorily presented with Chinese ba sentences, which were either correct, semantically incorrect, syntactically incorrect, or both semantically and syntactically incorrect. The syntactic violation, which was created by eliminating the object-noun phrase from a preposition-object phrase structure, elicited an early starting anterior negativity which merged into a sustained negativity over anterior sites and a temporally limited centro-parietal negativity. The semantic violation elicited an early starting N400 effect. The combined violation in which the syntactic phrase structure violation and the semantic violation were crossed elicited an early staring sustained anterior negativity similar to the pure syntactic effect, and a centro-parietal negativity which was more negative than those of the syntactic condition and the semantic condition. No P600 was obtained neither for the syntactic nor for the combined condition. The results suggest that the syntactic processes (at about 50 ms) appear earlier than the semantic processes (at around 150 ms). They are independent from each other in the early time window (150-250 ms) but interact in a later processing phase (250-400 ms) during Chinese ba sentence comprehension. The broadly distributed negativity, which occurred during the N400 latency range observed in the three violation conditions, is thought to reflect thematic integration processes in the sentence-final position.

Adult↗

PubMed2006

Sentence comprehension and action: effector specific modulation of the motor system.

The purpose of the paper is to study whether sentence comprehension modulates the motor system. Participants were presented with 24 pairs of nouns and verbs that could be referred to hand and mouth actions (e.g., to unwrap vs. to suck the sweet), in the first block, or, in the second block, to 24 hand and foot actions (e.g., to throw vs. kick the ball). An equal number of non-sensible pairs were presented. Participants' task consisted of deciding whether the combination made sense or not: 20 participants responded by saying yes loudly into a microphone, 20 by pressing a pedal. Results support embodied theories of language comprehension, as they suggest that sentence processing activates an action simulation. This simulation is quite detailed, as it is sensitive to the effector involved. Namely, it leads to a facilitation in responses to 'mouth sentences' and 'foot sentences' compared to 'hand sentences' in case of congruency between the effectors - mouth and foot - involved in the motor response and in the sentence.

Adolescent↗

PubMed2005

Late interaction of syntactic and prosodic processes in sentence comprehension as revealed by ERPs.

The present study was designed to examine the processing of prosodic and syntactic information in spoken language. The aim was to investigate the long discussed relationship between prosody and syntax in online speech comprehension to reveal direct evidence about whether the two information types are interactive or independent from each other. The method of event-related potentials allowed us to sheet light on the precise time course of this relationship. Our experimental manipulation involved two prosodically different positions in German sentences, i.e., the critical noun in penultimate vs. final position. In syntactically correct sentences, a prosodic manipulation of the penultimate word gave rise to a late centroparietal negativity that resembled the classical N400 component. We interpreted the negativity as a correlate of lexical integration costs for the prosodically unexpected sentence-final word. Comparisons with syntactically incorrect sentences revealed that this effect was dependent on the sentences' grammatical correctness. When the prosodic manipulation was realized at the final word, we observed a right anterior negativity followed by a late positivity (P600). The right anterior negativity was present independent of the sentences' grammatical correctness. However, the P600 was not, as a late positivity was present for straightforward prosodic and syntactic violations but increased for the combined violations. This suggests that the right anterior negativity, and not the P600, should be considered as a pure prosodic effect. The combined data moreover suggest an interaction between prosody and syntax in a later time window during sentence comprehension.

Acoustic Stimulation↗

PubMed2005

Increased neuronal communication accompanying sentence comprehension.

The main purpose of this study was to examine large-scale oscillatory activity and frequency-related neuronal synchronization during the comprehension of English spoken sentences of different complexity. Therefore, EEG coherence during the processing of subject-subject (SS)- and more complex subject-object (SO)-relatives was computed using an adaptive fitting approach of bivariate auto-regressive moving average (ARMA) models which enabled the continuous calculation of coherence in the course of sentence processing with a high frequency resolution according to the dynamic changes of the EEG signals. Coherence differences between sentence types were observed in the theta (4-7 Hz), beta-1 (13-18 Hz) and gamma (30-34 Hz) frequency ranges, though emerging during the processing of different parts of these sentences: gamma differences were evident mainly during the relative clause while theta and beta-1 differed significantly following the end of the relative clause. These findings reveal no simple one to one map between EEG frequencies and cognitive operations necessary for sentence comprehension. Instead, they indicate a complex interplay and dynamic interaction between different EEG frequencies and verbal working memory, episodic memory, attention, morpho-syntactic and semantic-pragmatic analyses, which though distinct often co-occur.

Adult↗

PubMed2004

Gender differences in the impact of comprehensive services in substance abuse treatment.

This study examines the impact of comprehensive services on treatment outcomes for women and men. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3,142 clients (1,123 women and 2,019 men) from 59 treatment facilities. The results show that substance abuse treatment benefits both women and men. Further, both women and men benefit from comprehensive services provided as part of substance abuse treatment: specifically, the receipt of educational, housing and income support services is related to reduced post-treatment substance abuse for both women and men. Gender differences are revealed by the fact that, overall, greater proportions of women receive services and, when individual, service, and treatment organizational characteristics are controlled, women show greater reductions in post-treatment substance use. Further, women and men differ in their responsiveness to organizational characteristics: the availability of on-site services and the frequency of counseling significantly predict reduced post-treatment substance use for men but not for women.

Adolescent↗

PubMed2005

Event-related potentials suggest early interaction between syntax and semantics during on-line sentence comprehension.

Event-related potentials (ERPs) were used to investigate interaction between syntactic parsing and semantic integration processes during a visual sentence comprehension task. The linguistic stimuli were Finnish five-word sentences containing morphosyntactic and/or semantic violations. Single morphosyntactic violations evoked left anterior negativity (LAN) and P600 components. Single semantic violations elicited a robust N400 effect over the left hemisphere. A later and weaker N400-like response was also observed in the right hemisphere, left-right hemispheric latency difference being 40 ms. Combined morphosyntactic and semantic violations elicited a P600 component and a negative ERP component within the latency range of the LAN and N400 components. Further analysis of these ERP effects provided evidence for early processual interaction between syntax and semantics during on-line sentence comprehension. The hemispheric distribution of the LAN and N400 components was taken to suggest lateralization of initial morphosyntactic parsing and semantic integration processes to the left hemisphere. In contrast, the later syntax-related P600 component was observed as being more pronounced over the posterior areas of the right hemisphere.

Adult↗

PubMed2006

Speech comprehension assessed by electroencephalography: a new method using m-sequence modulation.

Electroencephalograms (EEGs) were recorded from eight Japanese speakers while they listened to Japanese and Spanish sentences (approximately 51s each). The sentences were modulated in amplitude by a binary m-sequence and played forward or backward. A circular cross-correlation function was computed between the EEG signals and the m-sequence and averaged across subjects. Independent component analysis of the averaged function revealed a component source response which was obtained only for the comprehensible Japanese and not for the incomprehensible sentences. The present study has thus shown that a 1-min long EEG signal is sufficient for the assessment of speech comprehension.

Acoustic Stimulation↗

PubMed2004

Imagery in sentence comprehension: an fMRI study.

This study examined brain activation while participants read or listened to high-imagery sentences like The number eight when rotated 90 degrees looks like a pair of spectacles or low-imagery sentences, and judged them as true or false. The sentence imagery manipulation affected the activation in regions (particularly, the intraparietal sulcus) that activate in other mental imagery tasks, such as mental rotation. Both the auditory and visual presentation experiments indicated activation of the intraparietal sulcus area in the high-imagery condition, suggesting a common neural substrate for language-evoked imagery that is independent of the input modality. In addition to exhibiting greater activation levels during the processing of high-imagery sentences, the left intraparietal sulcus also showed greater functional connectivity in this condition with other cortical regions, particularly language processing regions, regardless of the input modality. The comprehension of abstract, nonimaginal information in low-imagery sentences was accompanied by additional activation in regions in the left superior and middle temporal areas associated with the retrieval and processing of semantic and world knowledge. In addition to exhibiting greater activation levels during the processing of low-imagery sentences, this left temporal region also revealed greater functional connectivity in this condition with other left hemisphere language processing regions and with prefrontal regions, regardless of the input modality. The findings indicate that sentence comprehension can activate additional cortical regions that process information that is not specifically linguistic but varies with the information content of the sentence (such as visual or abstract information). In particular, the left intraparietal sulcus area appears to be centrally involved in processing the visual imagery that a sentence can evoke, while activating in synchrony with some core language processing regions.

Adolescent↗