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PubMed2003

Mental imagery and idiom comprehension: a comparison of school-age children and adults.

Previous research has shown that transparent idioms (e.g., paddle your own canoe) are generally easier for children to interpret than opaque idioms (e.g., paint the town red), results that support the metasemantic hypothesis of figurative understanding (M. A. Nippold, 1998). This is the view that beyond exposure to idioms and attention to the linguistic context, the learner analyzes the expressions internally to infer meaning, a process that is easier to execute when the literal and nonliteral meanings overlap. The present study was designed to investigate mental imagery in relation to the discrepancy in difficulty between transparent and opaque expressions. Twenty familiar idioms, half transparent and half opaque, were presented to 40 school-age children (mean age = 12;3 [years;months]) and 40 adults (mean age = 27;0) who were asked to describe in writing their own mental images for each expression. The participants were also given a written multiple-choice task to measure their comprehension of the idioms. The results indicated that mental imagery for idioms undergoes a developmental process and is associated with comprehension. Although school-age children were able to report relevant mental images for idioms, their images were less sophisticated than those of adults and were more likely to be concrete and to reflect only a partial understanding of the expressions. In contrast, the images reported by adults were more likely to be figurative. The findings suggest that the mental images people report for idioms may serve as a barometer of their depth of understanding of the expressions.

Adult↗

PubMed2003

Prevention of weight loss in dementia with comprehensive nutritional treatment.

OBJECTIVES: To determine whether body weight can be maintained or improved in dementia residents of special care units (SCUs) using a comprehensive intervention strategy. DESIGN: Quasi-experimental with an interventional site and a noninterventional site. SETTING: Four SCUs in two long-term care facilities in Ontario. PARTICIPANTS: The intervention site included 33 residents; the comparison site included 49 residents. MEASUREMENTS: Weight change over time was the primary outcome. Three time periods were compared: 9-month baseline period, 9-month intervention period (enhanced dietitian monitoring and menu changes at intervention site), and 12-month postintervention period (only menu changes at intervention site). Comparisons were made within and between sites. Full nutritional assessments were completed for the intervention group. Medical charts and basic anthropometric, behavioral, and cognitive measures were completed in both groups to determine baseline site differences. Weight change over time was analyzed with a repeated measures analysis, controlling for various covariates. Bivariate analyses were completed for other outcomes of death, number of infections, falls, and hospital days. RESULTS: The intervention period that included the dietitian time and menu changes significantly promoted weight gain, compared with the standard treatment at the comparison facility. Other covariates of pacing, type of dementia, sex, age, number of comorbid conditions, and medications were also significant predictors of weight change. Weight gain or maintenance regardless of site was associated with survival. CONCLUSION: Body weight can be maintained in residents of SCUs regardless of pacing and other clinical characteristics. The comprehensive intervention of clinical dietitian time and an enhanced menu designed to be individualized for ambulatory people with dementia promoted significant gains in body weight. A minimum 5% weight gain is associated with survival in these residents of SCUs.

Aged↗

PubMed1999

Comprehensive multidisciplinary programs for the management of patients with congestive heart failure.

OBJECTIVE: To evaluate the impact of comprehensive, multidisciplinary management programs on the process of care, resource utilization, health care costs, and clinical outcomes in patients with congestive heart failure. MEASUREMENTS AND MAIN RESULTS: A MEDLINE search identified seven english-language reports that compared the process of care, clinical outcomes, or economic variables related to implementation of a multidisciplinary congestive heart failure management program of at least 3 month's duration to a control or reference group. The primary intent of the programs was to emphasize compliance with recommended therapeutic principles, enhance patient education, and provide careful patient surveillance. Five of the studies reported improved functional status, aerobic capacity, or patient satisfaction. Six of the studies reported a 50% to 85% reduction in the risk of hospital admission. Three studies reported economic analyses with suggestive but not compelling evidence of financial benefit. CONCLUSIONS: Comprehensive, multidisciplinary management programs for congestive heart failure can improve functional status and reduce the risk of hospital admission, and they may lower medical costs.

Aged↗

PubMed2003

Influence of race in heart failure and cardiac transplantation: mortality differences are eliminated by specialized, comprehensive care.

BACKGROUND: Differences in mortality are thought to exist between African Americans and Caucasians with heart failure. These differences may be due to a variety of factors, including differences in disease process, socioeconomic status, and access to health care. Additionally, little data exist on racial differences between these two groups after cardiac transplantation. This study examines a single center, urban experience in treating African Americans and Caucasians with heart failure and after cardiac transplantation. We hypothesize that treatment in a specialized, comprehensive heart failure/cardiac transplantation program results in similar survival between African Americans and Caucasians. METHODS: We retrospectively reviewed the Rush Heart Failure and Cardiac Transplant Database from July 1994 to August 2000. Variables analyzed in the cardiomyopathy patients included survival (until death, placement of left ventricular assist device or cardiac transplantation), number of hospitalizations per year, length of stay per year, and utilization of outpatient resources. Follow-up period was from initial visit to death, transplantation, or implantation of left ventricular assist device. In those who underwent cardiac transplantation, we examined rejection rates (cellular and humoral), rejection burden, hospitalization data, and 5-year survival. A subgroup bridged to cardiac transplantation with a left ventricular device was also analyzed. RESULTS: Seven hundred thirty-four cardiomyopathy patients were identified: 203 were African Americans and 531 were Caucasians. The etiology of cardiomyopathy was more commonly ischemic in Caucasians as compared to non-ischemic in African Americans (P <.01). African Americans had more admissions to the hospital per year compared with Caucasians, 1.2 +/- 2.1 versus.5 +/- 1.1 (P <.01) with longer length of stay per year, 1.4 +/- 25.2 days versus 4.4 +/- 14.3 days (P <.01). Utilization of outpatient resources was significantly higher in African Americans compared with Caucasians with more use of continuous inotropes (13% versus 6%, P <.01), intermittent inotropes (11% versus 5%, P <.01), and home nursing after hospital discharge (52% versus 32% of hospital discharges, P <.01). Survival by Kaplan-Meier analysis was comparable between the two groups (mean survival 1,470 +/- 72 days in African Americans versus 1521 +/- 46 days in Caucasians, log rank test [P =.6]). During this time, 30 African Americans and 73 Caucasians underwent cardiac transplantation. Fifty-three were bridged to transplantation with a left ventricular assist device (20 African Americans, 33 Caucasians). There were no differences in 5-year survival by Kaplan-Meier analysis despite higher peak preoperative panel reactive antibody levels in African Americans versus Caucasians (12% +/- 30% compared with 5% +/- 15%, P =.04), more overall treated rejection episodes per year in the African Americans (P <.01), as well as more posttransplant hospitalizations (2.2 +/- 1.2 times per year as compared with 1.7 +/- 2.1 times per year, P =.04). CONCLUSION: Delivery of care to heart failure patients in a comprehensive, specialized program results in similar survival regardless of race despite higher utilization of inpatient and outpatient resources. The finding that, after cardiac transplantation, African Americans do not have higher mortality rates, despite having higher rates of rejection overall and more hospitalizations, further supports the hypothesis that optimal care can improve outcomes despite unfavorable baseline clinical characteristics.

Black or African American↗

PubMed2004

[Observance of legal preventive measures and implications for a comprehensive prevention law].

The observance and realisation of a variety of prevention laws in different spheres was analysed to deal more extensively with the problem of a new comprehensive prevention law. The analysis was based on a study of the literature and on invited statements by experts, as well as on interviews conducted according to guidelines. The observance and implication of existing laws by statutory bodies differs noticeably according to prevailing traditions and individual interpretations of key concepts. In all the spheres we noticed a potential for supporting and optimising prevention. The mandatory next step would be to standardise the plethora of terms and to discuss the understanding of prevention. It is also imperative to realise on-target cooperation, to define the tasks to be accomplished, and to determine to whom they should be delegated. The financing procedure must also be determined. Modification and supplementation of existing laws would be meaningful in some cases. A new specific and comprehensive prevention law would increase the status of prevention in the German public health system and link up the involved institutions more effectively.

Comprehensive Health Care↗

PubMed2005

Inference comprehension of adolescents with traumatic brain injury: a working memory hypothesis.

This study investigated inference comprehension performance in adolescents who had suffered a traumatic brain injury (TBI). Using stimuli adapted from Lehman-Blake and Tompkins, participants listened to short paragraphs that varied according to the working memory demands of the task and answered comprehension questions that required inferences to be generated. Six adolescents, aged 12-16 years, who had suffered a TBI prior to the age of 10 years, were assessed and their performance was compared to six individually age-matched peers with typical development. Analysis revealed that individuals with TBI did not differ from non-injured peers in their understanding of inferences when the storage demands of the task were minimized. However, when storage demands were high, adolescents with TBI performed poorly compared to their age-matched peers. Results are discussed relative to a working-memory hypothesis of impairment following TBI.

Adolescent↗

PubMed2006

Working memory and proverb comprehension in adolescents with traumatic brain injury: a preliminary investigation.

PRIMARY OBJECTIVE: This study investigated the relationship between working memory and comprehension of low-familiarity proverbs in adolescents with traumatic brain injury (TBI). METHODS AND PROCEDURES: Ten adolescents, aged 12-21 years who had suffered a TBI prior to the age of 10 years and 10 individually age-matched peers with typical development participated in the study. The participants listened to short paragraphs containing a proverb and interpreted the meaning of the proverb using a forced-choice task. In addition, participants engaged in a task that evaluated working memory ability. MAIN OUTCOMES AND RESULTS: Analysis revealed that individuals with TBI differed from their non-injured peers in their understanding of proverbs. In addition, working memory capacity influenced performance for all participants. CONCLUSIONS: The importance of considering working memory when evaluating figurative language comprehension in adolescents with TBI is highlighted. Implications for future research, particularly with regard to varying working memory and task demands, are considered.

Adolescent↗

PubMed1987

Comprehension of informed consent information by young-old through old-old volunteers.

Comprehension of typewritten informed consent information was evaluated for young-old (60-69 years) through old-old (80-89 years) volunteers as a function of years of education (less than 12, 12, and greater than 12), readability of information (low [college level] vs high [7th grade]), and typeface used in the preparation of the materials (Prestige Elite 72, Letter Gothic, and Orator). All volunteers (N = 235) read a typewritten information sheet and retained it for review while answering eight multiple choice questions. Immediate feedback was provided, and a second test was administered if any answers were incorrect. The findings indicated that comprehension varied directly with education and inversely with age. Typeface and age interacted due to age-related differences with the two smaller (Prestige Elite and Letter Gothic), but not with the largest of the typefaces (Orator). These findings suggest that the observed age-related differences may have been due to visual and not cognitive deficits. Readability did not affect performance either by itself or in combination with any other variable.

Age Factors↗

PubMed2006

Text comprehension in middle aged adults: is there anything wrong?

Two experiments tested text comprehension skills in adults varying in age from 20 to 69 years. A coherence judgment task (n = 39), in which the pragmatic connection of two sentences had to be evaluated, did not yield any age effects. Both error rates and reaction times were largely independent of age. In a word recognition paradigm (n = 60), testing the strength of different text representation levels, there was a gradual, linear decrease in performance with age, accompanied by a similarly gradual increase in processing times. The results confirm that aging affects comprehension under high memory demands, but spares the conceptual, situation-based levels. Most importantly, it was shown that these changes become apparent during middle age already. Implications for education and neuropsychology are discussed.

Adult↗

PubMed2006

Working memory capacity and the construction of spatial mental models in comprehension and deductive reasoning.

We asked 149 high-school students who were pretested for their working memory capacity (WMC) to read spatial descriptions relating to five objects and to evaluate conclusions asserting an unmentioned relationship between two of the objects. Unambiguous descriptions were compatible with a single spatial arrangement, whereas ambiguous descriptions permitted two arrangements; a subset of the ambiguous descriptions still determined the relation asserted in the conclusion, whereas another subset did not. Two groups of participants received different instructions: The deduction group should accept conclusions only if they followed with logical necessity from the description, whereas the comprehension group should accept a conclusion if it agreed with their representation of the arrangement. Self-paced reading times increased on sentences that introduced an ambiguity, replicating previous findings in deductive reasoning experiments. This effect was also found in the comprehension group, casting doubt on the interpretation that people consider multiple possible arrangements online. Responses to conclusions could be modelled by a multinomial processing model with four parameters: the probability of constructing a correct mental model, the probability of detecting an ambiguity, and two guessing parameters. Participants with high and with low WMC differed mainly in the probability of successfully constructing a mental model.

Adolescent↗

PubMed2005

Sign and speech: amodal commonality in left hemisphere dominance for comprehension of sentences.

The neural basis of functional lateralization in language processing is a fundamental issue in systems neuroscience. We used functional MRI (fMRI) to examine hemispheric dominance during the processing of signed and spoken sentences. By using tasks involving comprehension of sentences (Sc) and sentential non-word detection (Sn), we compared different groups and stimulus conditions. Under the sign condition with sentence stimuli in Japanese Sign Language (JSL), we tested two groups of subjects: Deaf signers (Deaf) of JSL, and hearing bilinguals (children of Deaf adults, CODA) of JSL and Japanese (JPN). Under the speech condition, we tested hearing monolinguals (Mono) of JPN with auditory JPN stimuli alone (AUD), or with an audiovisual presentation of JPN and JSL stimuli (A&V). We found that the overall bilateral activation patterns under the four experimental conditions of Deaf, CODA, AUD and A&V were almost identical, despite differences in stimuli (JSL and JPN) and groups (Deaf, CODA and Mono). Moreover, consistently left-dominant activations involving frontal and temporo-parietal regions were observed across all four conditions. Furthermore, irrespective of the modalities of sign and speech, the main effects of task (Sc-Sn) were found primarily in the left regions: the ventral part of the inferior frontal gyrus (F3t/F3O), the precentral sulcus, the superior frontal gyrus, the middle temporal gyrus, the angular gyrus and the inferior parietal gyrus. Among these regions, only the left F3t/F3O showed no main effects of modality condition. These results demonstrate amodal commonality in the functional dominance of the left cortical regions for comprehension of sentences, as well as the essential and universal role of the left F3t/F3O in processing linguistic information from both signed and spoken sentences.

Acoustic Stimulation↗

PubMed2006

Sentence comprehension in autism: thinking in pictures with decreased functional connectivity.

Comprehending high-imagery sentences like The number eight when rotated 90 degrees looks like a pair of eyeglasses involves the participation and integration of several cortical regions. The linguistic content must be processed to determine what is to be mentally imaged, and then the mental image must be evaluated and related to the sentence. A theory of cortical underconnectivity in autism predicts that the interregional collaboration required between linguistic and imaginal processing in this task would be underserved in autism. This functional MRI study examined brain activation in 12 participants with autism and 13 age- and IQ-matched control participants while they processed sentences with either high- or low-imagery content. The analysis of functional connectivity among cortical regions showed that the language and spatial centres in the participants with autism were not as well synchronized as in controls. In addition to the functional connectivity differences, there was also a group difference in activation. In the processing of low-imagery sentences (e.g. Addition, subtraction and multiplication are all math skills), the use of imagery is not essential to comprehension. Nevertheless, the autism group activated parietal and occipital brain regions associated with imagery for comprehending both the low and high-imagery sentences, suggesting that they were using mental imagery in both conditions. In contrast, the control group showed imagery-related activation primarily in the high-imagery condition. The findings provide further evidence of underintegration of language and imagery in autism (and hence expand the understanding of underconnectivity) but also show that people with autism are more reliant on visualization to support language comprehension.

Adult↗

PubMed2003

Training with cognitive sequences improves syntactic comprehension in agrammatic aphasics.

A major open question in cognitive neuroscience concerns the modularity of language: does human language rely, in part, on neural processes that are not language specific? Such reliance would predict that learning should transfer between non-linguistic and linguistic domains via this common neural basis. To test this prediction, we studied effects of non-linguistic cognitive sequence training on syntactic comprehension of six left-hemisphere damaged aphasic patients. Syntactic comprehension impairment was quantified before and after 10 weeks of training on a non-linguistic sequence processing task. This task used a transformational rule specifically corresponding to the transformation required for understanding a particular type of sentence referred to as relativised. Non-linguistic sequencing improved significantly with training (day effect: F(9,45)=3.7, <0.005). Moreover, a significant transfer of this improvement was observed for relativised, but not active nor passive sentences (pre-post x type interaction: F(2,10)=4.72, <0.05). The specificity of this transfer indicates that language relies partially on functional and neural processes that are not language specific.

Aged↗

PubMed1985

Evaluating continuity and comprehensiveness of care in an elective family practice clerkship.

The University of Wisconsin Medical School has operated an intensive, elective, three-month family practice clerkship since 1980. Beginning in 1981, a computerized, sampling instrument has been used to generate measures of the continuity and comprehensiveness of care being learned by the students and the clinical content of the students' experience. This tool has proved useful for motivating students and faculty members to concentrate on the factors of continuity and comprehensiveness in the clerkship experience. The data collected regarding the students' activities are presented here.

Clinical Clerkship↗

PubMed1999

Avoidable costs of comprehensive case management.

Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.

Attitude of Health Personnel↗

PubMedDate not supplied

Comprehensive cancer screening in a primary care population: Gender differences in the impact of ambulatory care system factors.

There is a great deal to be learned about how factors within the context of primary care influence the provision of comprehensive preventive services. This study assessed the prevalence of cancer screening among a primary care population of men and women and examined the association of characteristics of the patient-physician relationship, the healthcare facility, and type of health insurance. Findings suggest that prevalence of comprehensive cancer screening is low, particularly among men. Characteristics of the patient-physician relationship are an important predictor of screening among women but not men. Among men, however, greater contact with the medical care system is important.

Aged↗

PubMed2005

Development of an epilepsy comprehensive care center: a Japanese model.

PURPOSE: To review the requirements of a comprehensive care center for people with epilepsy. METHODS: Twenty-seven years have passed since the foundation of the Japanese Epilepsy Center in Shizuoka. The development of this center is presented as a model of an epilepsy comprehensive care center. RESULTS: Between 1926 and 1947, the Shizuoka Higashi Hospital (the former name of SMIND) served as a tuberculosis hospital. In 1975, a proposal for a special center for the care of people with epilepsy was submitted to the Japanese government. An epilepsy center (the Center) was soon built, and the tuberculosis sanatorium ended its 50-year history. The facilities of the Center include an outpatient clinic, four inpatient wards with 200 beds, a day-care center for medical rehabilitation, and classrooms for elementary and junior high school children. The Center has modern diagnostic tools such as electroencephalography (EEG), closed-circuit TV-EEG (CCTVEEG), computed tomography (CT) scan, magnetic resonance imaging (MRI), single-photon emission CT (SPECT), and magnetoencephalography (MEG). Neurosurgery for intractable seizures has been conducted at the Center since 1983. Approximately 25,000 patients with epilepsy from all over Japan have been registered since 1975. Annually, approximately 5,000 outpatients and 600 inpatients attend the Center. As of March 2002, 500 patients had received resective surgery for epilepsy. Other activities in the Center include research and specialized training of professionals, including foreign nationals, in the treatment of epilepsy. CONCLUSIONS: The experience in Shizuoka suggests that management of epilepsy should be oriented toward psychological well-being, social rehabilitation, and seizure control.

Adolescent↗

PubMed2005

Child health care centres: an academic model for comprehensive child health care in the community.

The challenge of the discipline of paediatrics in the 21st century is to promote health and development of children in a way that will enable them to maximize their biological and social potential. The community child health centre (CHC) in Israel is a model of community health care service built to provide comprehensive health care to children and adolescents, as well as an academic setting for under- and postgraduate paediatric training. Today there are 34 CHCs in Israel, serving a population of 220 000 children from birth to 18 years of age. The CHC combines the advantages of group practice with those of an academic medical centre and enables flexibility and mutual learning. Further expansion and development are required to realize the CHC's mission of a true comprehensive academic centre for paediatric community health.

Adolescent↗