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PubMed2005

Infants' symbolic comprehension of actions modeled with toy replicas.

While very young children's understanding of objects as symbols for other entities has been the focus of much investigation, very little is known concerning the emergence of comprehension for symbolic relations among actions modeled with toy replicas and their real counterparts. We used videotaped depictions of real actions in a preferential looking task to assess toddlers' ability to comprehend such connections for action categories aligned with familiar object concepts. Across two experiments, 16- and 18-month-olds provided no evidence of understanding such relations, even when action categories were highlighted with verbal prompts. Among 24- and 26-month-olds, comprehension of relations between certain actions modeled with toys and videos of their real-world counterparts began to emerge, independent of expressive vocabulary size. Implications of our results for theoretical conclusions drawn from use of the generalized imitation procedure to study early conceptual development are discussed.

Child Development↗

PubMed2006

Low literacy impairs comprehension of prescription drug warning labels.

BACKGROUND: Adverse events resulting from medication error are a serious concern. Patients' literacy and their ability to understand medication information are increasingly seen as a safety issue. OBJECTIVE: To examine whether adult patients receiving primary care services at a public hospital clinic were able to correctly interpret commonly used prescription medication warning labels. DESIGN: In-person structured interviews with literacy assessment. SETTING: Public hospital, primary care clinic. PARTICIPANTS: A total of 251 adult patients waiting for an appointment at the Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) Primary Care Clinic. MEASUREMENTS: Correct interpretation, as determined by expert panel review of patients' verbatim responses, for each of 8 commonly used prescription medication warning labels. RESULTS: Approximately one-third of patients (n=74) were reading at or below the 6th-grade level (low literacy). Patient comprehension of warning labels was associated with one's literacy level. Multistep instructions proved difficult for patients across all literacy levels. After controlling for relevant potential confounding variables, patients with low literacy were 3.4 times less likely to interpret prescription medication warning labels correctly (95% confidence interval: 2.3 to 4.9). CONCLUSIONS: Patients with low literacy had difficulty understanding prescription medication warning labels. Patients of all literacy levels had better understanding of warning labels that contained single-step versus multiple-step instructions. Warning labels should be developed with consumer participation, especially with lower literate populations, to ensure comprehension of short, concise messages created with familiar words and recognizable icons.

Adolescent↗

PubMed1999

A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations.

BACKGROUND: Although comprehensive geriatric assessment (CGA) has been demonstrated to confer health benefits in some settings, its value in outpatient or office settings is uncertain. OBJECTIVE: To assess the effectiveness of outpatient CGA consultation coupled with an adherence intervention on 15-month health outcomes. DESIGN: A randomized controlled trial. SETTING: Community-based sites. PATIENTS: 363 community-dwelling older persons who had failed a screen for at least one of four conditions (falls, urinary incontinence, depressive symptoms, or functional impairment) INTERVENTION: A single outpatient CGA consultation coupled with an intervention to improve primary care physician and patient adherence with CGA recommendations. MEASUREMENTS: Medical Outcomes Study Short Form-36 (MOS SF-36), restricted activity and bed days, Physical Performance Test, NIA lower-extremity battery. RESULTS: In complete case analysis (excluding the five control group subjects who died during the follow-up period), the adjusted difference in change scores (4.69 points) for physical functioning between treatment and control groups indicated a significant benefit of treatment (P = .021). Similar benefits were demonstrated for number of restricted activity days and MOS SF-36 energy/fatigue, social functioning, and physical health summary scales. In analyses assigning scores of 0 to those who died, these benefits were greater, and significant benefits for the Physical Performance Test and MOS SF-36 emotional/well being, pain, and mental health summary scales were also demonstrated. CONCLUSIONS: A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health-related quality-of-life decline among community-dwelling older persons who have specific geriatric conditions.

Accidental Falls↗

PubMedDate not supplied

Developing and implementing a comprehensive program for children and adolescents with eating disorders.

TOPIC: Treatment of eating disorders in children and adolescents across a continuum of care. PURPOSE: To describe the development and implementation of a comprehensive pilot program for children and adolescents with eating disorders. SOURCES: Published literature and clinical experience. CONCLUSIONS: The pilot program to provide comprehensive care to children and adolescents has been successful. As of November 2000, the inpatient modal eating disorder census has been 4 (highest = 10, lowest = 1). With the focus on prevention and early intervention, the multidisciplinary team continues to educate the public and providers.

Adolescent↗

PubMed1995

Developing comprehensive stroke services: an evidence-based approach.

The recent interest in the development of services for stroke patients reflects an increasing optimism about stroke management and the recognition that properly organised care can improve outcomes after stroke. A comprehensive stroke service should provide early assessment and investigation of stroke disease in both in-patient and out-patient settings, acute care for stroke in-patients to manage their medical and surgical problems, and rehabilitation for patients with persisting functional problems. Other components may include out-patient, day hospital or domiciliary rehabilitation facilities and continuing care and support facilities for patients discharged from hospital. This article discusses the evidence to support different components of a comprehensive stroke service and emphasises the need for flexible approaches to different local conditions.

Cerebrovascular Disorders↗

PubMed2004

Left but not right temporal involvement in opaque idiom comprehension: a repetitive transcranial magnetic stimulation study.

It has been suggested that figurative language, which includes idioms, is controlled by the right hemisphere. We tested the right hemisphere hypothesis by using repetitive transcranial magnetic stimulation (rTMS) to transiently disrupt the function of the frontal and temporal areas of the right versus left hemisphere in a group of normal participants involved in a task of opaque idiom versus literal sentence comprehension. Forty opaque, nonambiguous idioms were selected. Fifteen young healthy participants underwent rTMS in two sessions. The experiment was run in five blocks, corresponding to the four stimulated scalp positions ( left frontal and temporal and right frontal and temporal) and a baseline. Each block consisted of 16 trials-8 trials with idioms and 8 trials with literal sentences. In each trial, the subject was presented with a written sentence, which appeared on the screen for 2000 msec, followed by a pair of pictures for 2500 msec, one of which corresponded to the sentence. The alternative corresponded to the literal meaning for idioms and to a sentence differing in a detail in the case of literal sentences. The subject had to press a button corresponding to the picture matching the string. Reaction times increased following left temporal rTMS, whereas they were unaffected by right hemisphere rTMS, with no difference between idiomatic and literal sentences. Left temporal rTMS also reduced accuracy without differences between the two types of sentences. These data suggest that opaque idiom and literal sentence comprehension depends on the left temporal cortex.

Analysis of Variance↗

PubMed2005

Emotional and temporal aspects of situation model processing during text comprehension: an event-related fMRI study.

Language comprehension in everyday life requires the continuous integration of prior discourse context and general world knowledge with the current utterance or sentence. In the neurolinguistic literature, these so-called situation model building processes have been ascribed to the prefrontal cortex or to the right hemisphere. In this study, we use whole-head event-related fMRI to directly map the neural correlates of narrative comprehension in context. While being scanned using a spin-echo sequence, 20 participants listened to 32 short stories, half of which contained globally inconsistent information. The inconsistencies concerned either temporal or chronological information or the emotional status of the protagonist. Hearing an inconsistent word elicited activation in the right anterior temporal lobe. The comparison of different information aspects revealed activation in the left precuneus and a bilateral frontoparietal network for chronological information. Emotional information elicited activation in the ventromedial prefrontal cortex and the extended amygdaloid complex. In addition, the integration of inconsistent emotional information engaged the dorsal frontomedial cortex (Brodmann's area 8/9), whereas the integration of inconsistent temporal information required the lateral prefrontal cortex bilaterally. These results indicate that listening to stories can elicit activation reflecting content-specific processes. Furthermore, updating of the situation model is not a unitary process but it also depends on the particular requirements of the text. The right hemisphere contributes to language processing in context, but equally important are the left medial and bilateral prefrontal cortices.

Acoustic Stimulation↗

PubMed2006

Humor comprehension and appreciation: an FMRI study.

Humor is a unique ability in human beings. Suls [A two-stage model for the appreciation of jokes and cartoons. In P. E. Goldstein & J. H. McGhee (Eds.), The psychology of humour. Theoretical perspectives and empirical issues. New York: Academic Press, 1972, pp. 81-100] proposed a two-stage model of humor: detection and resolution of incongruity. Incongruity is generated when a prediction is not confirmed in the final part of a story. To comprehend humor, it is necessary to revisit the story, transforming an incongruous situation into a funny, congruous one. Patient and neuroimaging studies carried out until now lead to different outcomes. In particular, patient studies found that right brain-lesion patients have difficulties in humor comprehension, whereas neuroimaging studies suggested a major involvement of the left hemisphere in both humor detection and comprehension. To prevent activation of the left hemisphere due to language processing, we devised a nonverbal task comprising cartoon pairs. Our findings demonstrate activation of both the left and the right hemispheres when comparing funny versus nonfunny cartoons. In particular, we found activation of the right inferior frontal gyrus (BA 47), the left superior temporal gyrus (BA 38), the left middle temporal gyrus (BA 21), and the left cerebellum. These areas were also activated in a nonverbal task exploring attribution of intention [Brunet, E., Sarfati, Y., Hardy-Bayle, M. C., & Decety, J. A PET investigation of the attribution of intentions with a nonverbal task. Neuroimage, 11, 157-166, 2000]. We hypothesize that the resolution of incongruity might occur through a process of intention attribution. We also asked subjects to rate the funniness of each cartoon pair. A parametric analysis showed that the left amygdala was activated in relation to subjective amusement. We hypothesize that the amygdala plays a key role in giving humor an emotional dimension.

Adult↗

PubMed1975

Comprehensive drug programs: the Dade County example.

The authors present data from a survey of four methadone maintenance programs, five outpatient clinics, six nonresidential facilities, and nine therapeutic communities affiliated with the Dade County Comprehensive Drug Program. The treatment population included more blacks but fewer Latins than the general county population. Primary drugs of abuse were narcotics in methadone clinics and "softer" drugs in outpatient and nonresidential facilities. Most patients were either self- or court referrals. Direct per patient costs, which were lowest in the outpatient clinics, averaged $1,041. The authors suggest that their data may aid other comprehensive drug treatment programs in establishing guidelines.

Adolescent↗

PubMed2004

Informed consent for ankle fracture surgery: patient comprehension of verbal and videotaped information.

BACKGROUND: The purpose of our study was to evaluate the effectiveness of using a videotape to give patients information about the risks, benefits, alternatives, and treatment of a common orthopaedic procedure before they sign consent forms. METHODS: During a 9-month period, 48 patients with isolated closed ankle fractures requiring surgical intervention were randomized into two groups that received either videotaped or conventional verbal information regarding consent for surgery. The study group watched a videotape containing information about the risks, benefits, and treatment alternatives, while the control group obtained this information verbally. To determine comprehension and retention, all patients completed a multiple-choice questionnaire immediately after receiving the information, and 37 patients (77%) were available to complete a questionnaire at an average of 10 weeks later. RESULTS: The videotape group outperformed the verbal consent group by 40.1% on the initial questionnaire (p = .0002) and by 27.2% on the followup questionnaire (p = 0.0139). Patients with educational levels of less than or equal to the 12th grade performed 67.8% better on the initial questionnaire after watching the video than after receiving the information verbally. (p = .0001). CONCLUSION: Patients who received information about their surgery on a videotape before giving their consent demonstrated a significant increase in comprehension compared to patients who received this information verbally. The benefit was even greater for patients with lower education levels.

Adult↗

PubMed2006

Labels increase attention to novel objects in children with autism and comprehension-matched children with typical development.

This study used an intact group comparison to examine attention following in 34 children aged 2 years diagnosed with autism spectrum disorder (ASD) matched pairwise for vocabulary comprehension with a group of typically developing toddlers. For both groups of children, the presence of verbal labels during a referential task increased attention to a novel object over and above the attention-facilitating effect of child-directed talking without labeling. The typically developing children displayed more attention following than comprehension matched children with ASD across experimental conditions and there was no significant difference between the groups in the facilitative effect of hearing verbal labels. Implications for word-learning theory, intervention strategies and future research are considered.

Attention↗

PubMed2005

The effect of illustrations on patient comprehension of medication instruction labels.

BACKGROUND: Labels with special instructions regarding how a prescription medication should be taken or its possible side effects are often applied to pill bottles. The goal of this study was to determine whether the addition of illustrations to these labels affects patient comprehension. METHODS: Study participants (N = 130) were enrolled by approaching patients at three family practice clinics in Toronto, Canada. Participants were asked to interpret two sets of medication instruction labels, the first with text only and the second with the same text accompanied by illustrations. Two investigators coded participants' responses as incorrect, partially correct, or completely correct. Health literacy levels of participants were measured using a validated instrument, the REALM test. RESULTS: All participants gave a completely correct interpretation for three out of five instruction labels, regardless of whether illustrations were present or not. For the two most complex labels, only 34-55% of interpretations of the text-only version were completely correct. The addition of illustrations was associated with improved performance in 5-7% of subjects and worsened performance in 7-9% of subjects. CONCLUSION: The commonly-used illustrations on the medication labels used in this study were of little or no use in improving patients' comprehension of the accompanying written instructions.

Adult↗

PubMed2006

Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.

BACKGROUND: Clinical trials undertaken by industrialized nations in undeveloped nations pose several critical ethical dilemmas. One key potential problem concerns misunderstandings of the consent process by participants. Though other reports have begun to explore this area, needs remain to identify specific areas of misunderstanding. PURPOSE: To identify deficits in comprehension during consent processes in Mali, West Africa. METHODS: After obtaining informed consent for participation for a malaria vaccine trial being conducted in two West African villages, we administered to participants a nine-item questionnaire testing their understanding of information relevant for their consent. After testing their ability to understand a multiple choice format, 78 of 100 subjects were administered the questionnaire in one village and 85 of 100 in the other. RESULTS: Participants had difficulty comprehending several concepts relevant to informed consent: 90% of respondents did not understand withdrawal criterion, 93% did not understand the existence of study side effects, and 74% did not understand that they were enrolled in an investigation as opposed to receiving therapy. The response rate and percentage of correct answers was generally much higher in the village nearer an urban center than the more rural village. The percent of correct answers exceeded 50% for five questions in the urban village and for only two question in the more rural setting. LIMITATIONS: Potential limitations of this study are relating to translation, cultural differences in the notion of informed consent, staff differences between each village, the proportion who could not understand the survey instrument and the fact that the study explored participants' understanding of the consent process but did not observe the process itself. CONCLUSIONS: This study illustrates potential areas of miscomprehension in the consent process in a developing country. The degree of miscomprehension found in this study appeared to be more than that found in similar studies conducted in industrialized nations. Despite efforts to obtain truly informed consent, several factors make it more challenging in the developing world. This research highlights the need for more comprehensive studies of consent in developing countries. Such studies may eventually aid investigators in identifying, targeting and addressing specific areas of miscomprehension and thereby improve the informed consent process in the developing world.

Chi-Square Distribution↗

PubMed1998

Clinical and economic impact of implementing a comprehensive diabetes management program in managed care.

Diabetes mellitus places a significant burden on the U.S. healthcare system. Because of the potential to reduce diabetic complications and costs through intensive management, diabetes has become a primary target for disease management programs. We performed a retrospective analysis of short-term baseline and follow-up clinical, economic, and member and provider satisfaction data from approximately 7,000 people with diabetes being treated through seven managed care plans using Diabetes Treatment Centers of America's Diabetes NetCare, (Nashville, TN), a comprehensive diabetes management program. Our analysis indicates that Diabetes NetCare achieved gross economic adjusted savings of $50 per diabetic member per month (12.3%), with gross unadjusted savings of $44 (10.9%) per diabetic member per month. Hospital admissions per 1,000 diabetic member years decreased by 18%, and bed days fell by 21%. Patients with diabetes were more likely to get HbAlc tests, foot exams, eye exams, and cholesterol screenings while enrolled in the program. These data suggest that implementation of a comprehensive healthcare management program for people with diabetes can lead to substantial improvements in costs and clinical outcomes in the short-term. It is expected that improvements will increase over time, with continuing improvements in health status and a reduction in the number of future diabetic complications.

Adult↗

PubMed2002

How comprehensive are the basic packages of health services? An international comparison of six health insurance systems.

OBJECTIVES: Interest in the composition of the health care menu has grown. Its outwardly comprehensive nature is as rhetorical as the slogans of universal access and affordability. This paper summarizes the international part of a report to the Swiss government, in which we explored the basic package of services covered by social health insurance in France, Germany, Israel, Luxembourg, The Netherlands and Switzerland. The aim of the initial report was to check the appropriateness of the Swiss catalogue, with special attention to the risk of unequal access to health care by rationing of effective services. In this paper, we highlight the major differences in service coverage between the countries and address the possible factors explaining those differences. METHODS: The contents of the basic packages of the six countries were compared using data from government ministries and sickness funds. RESULTS: Coverage is most comprehensive in Germany and Switzerland; these are also the countries with the greatest total health expenditure. Three countries separated nursing care from other types of health care by creating an independent insurance scheme. Some health care benefits are also covered under the heading of social care. High out-of-pocket payments are increasingly used as hidden rationing instruments. CONCLUSIONS: The present comparison highlights the multi-factorial character of the choices made in six countries in order to keep their health care menu within the possibilities offered by available resources.

Comprehensive Health Care↗

PubMed1982

Creating comprehensive gero-psychiatric care in the community.

The aged increasingly need a comprehensive system, a central access point, and coordinated care in order for their acute and chronic, health and mental health needs to be met. This research reviews and analyzes the structure, function, and operation of a model demonstration geriatric emergency service which functioned as an access point and coordinator of care for the elderly in a network of health, mental health, and long term care services. The findings of this study indicate the important contribution a geriatric emergency service can make to creating comprehensive gero-psychiatric care in the community.

Aged↗

PubMed2006

Association between differentiated processing of syllables and comprehension of grammatical morphology in children with Down syndrome.

Our purpose in this exploratory investigation was to examine the relationship between degree of impairment in grammatical morpheme comprehension and event-related potential measures of differentiated processing of speech syllables in 10 children with Down syndrome. Results strongly support the hypothesized association. Graphs of the association indicate that children with less impaired grammatical comprehension had greater amplitude differences in event-related potentials to contrast of syllables within preselected poststimulus latency ranges. The theoretical and clinical ramifications of these results are discussed.

Cerebral Cortex↗

PubMed1976

How to deliver a comprehensive preventive dentistry service that dental insurance carriers can underwrite.

The successful practice management of preventive dentistry requires that it be comprehensive and include both chairside and counseling procedures. The chairside clinical procedures are a prophylaxis, topical application of fluorides, application of pit and fissure sealants, and fabrication of mouth-guards and space maintainers. The counseling procedures include plaque control and nutritional guidance. The caries activity test can be used as a means of monitoring excessive sugar intake. It is the responsibility of the dentist to determine the preventive dentistry needs of his patient based on the latter's caries score, periodontal, gingival, and plaque indexes, and diet evaluation. Since patients are prone to certain dental problems during particular age periods, the preventive management procedures must consider the existing and anticipated dental problems on the basis of the patient's age. Each of the preventive services is objective in nature because it involves either chairside or counseling procedures. During the counseling service,worksheets and clinical case notes are kept as part of the patient's dental record. The progressive effectiveness of the home-care preventive dentistry counsling procedures can be measured by scores and indexes. The frequency of repeating the service depends on proven clinical merit and the individual needs of the patient. The delivery of preventive dentistry services can be monitored by dental insurance carriers through peer review of clinical services, data sheets, case notes, a preventive dentistry record, and by patient questionnaire. A method for managing, measuring, and monitoring an objective, comprehensive preventive dentistry service has been presented so that the insurance carrier can underwrite this type of coverage as part of its dental insurance plan.

Colorimetry↗