Improving reading comprehension in reading and listening settings: the effect of two training programmes focusing on metacognition and working memory.

BACKGROUND: Metacognition and working memory (WM) have been found associated with success in reading comprehension, but no studies have examined their combined effect on the training of reading comprehension. Another open question concerns the role of listening comprehension: In particular, it is not clear whether training to improve reading comprehension must necessarily be based on processing written material or whether, as suggested in a recent study by Clarke et al. (2010, Psychol. Sci., 21, 1106), a programme based on verbal language could also be effective. AIMS: The study examined the feasibility of improving text comprehension in school children by comparing the efficacy of two training programmes, both involving metacognition and WM, but one based on listening comprehension, the other on reading comprehension. PARTICIPANTS: The study involved a sample of 159 pupils attending eight classes in the fourth and fifth grades (age range 9-11 years). METHOD: The listening and reading programmes focused on the same abilities/processes strictly related to text comprehension, and particularly metacognitive knowledge and control, WM (per se and in terms of integrating information in a text). The training programmes were implemented by school teachers as part of the class's normal school activities, under the supervision of experts. Their efficacy was compared with the results obtained in an active control group that completed standard text comprehension activities. RESULTS: Our results showed that both the training programmes focusing on specific text comprehension skills were effective in improving the children's achievement, but training in reading comprehension generated greater gains than the listening comprehension programme. CONCLUSIONS: Our study suggests that activities focusing specifically on metacognition and WM could foster text comprehension, but the potential benefit is influenced by the training modality, that is, the Reading group obtained greater and longer-lasting improvements than the Active control or Listening groups.

Cognitive evaluation of self-report questions for surveillance of periodontitis.

This paper describes the cognitive testing of eight self-report questions as part of a broader effort to evaluate and validate the use of these questions in estimating the prevalence of periodontitis in the United States population. This study examined how United States respondents understood and processed the proposed questions in English and Spanish, as well as identifying and correcting for possible response errors. The set of eight questions was selected by the Centers for Disease Control and Prevention Periodontal Disease Surveillance Workgroup for further testing after analytical assessments and field testing of an array of potential questions. Evaluation of these eight oral health questions was based on 40 in-depth, semi-structured cognitive interviews in English and Spanish. Results of this cognitive test study are presented. The recommendations from this cognitive testing evaluation served as the basis to improve the original questions in English and Spanish to be more inclusive and consistent and improve the estimation of periodontal disease in the United States population.

Riddle appreciation and reading comprehension in Cantonese-speaking children.

PURPOSE: Inference-making skills are necessary for reading comprehension. Training in riddle appreciation is an effective way to improve reading comprehension among English-speaking children. However, it is not clear whether these methods generalize to other writing systems. The goal of the present study was to investigate the relationship between inference-making skills, as measured by riddle appreciation ability, and reading comprehension performance in typically developing Cantonese-speaking children in the 4th grade. METHOD: Forty Cantonese-speaking children between the ages of 9;1 (years;months) and 11;0 were given tests of riddle appreciation ability and reading comprehension. Chinese character reading and auditory comprehension abilities were also assessed using tests that had been standardized in Hong Kong. RESULTS: Regression analyses revealed that riddle appreciation ability explained a significant amount of variance in reading comprehension after variance due to character reading skills and auditory comprehension skills were first considered. Orthographic, lexical, morphological, and syntactic riddles were also significantly correlated with reading comprehension. CONCLUSION: Riddle appreciation ability predicts reading comprehension in Cantonese-speaking 4th-grade children. Therefore, training Cantonese speakers in riddle appreciation should improve their reading comprehension.

Readability assessment of online ophthalmic patient information.

IMPORTANCE: Patients increasingly use the Internet to access information related to their disease, but poor health literacy is known to impact negatively on medical outcomes. Multiple agencies have recommended that patient-oriented literature be written at a fourth- to sixth-grade (9-12 years of age) reading level to assist understanding. The readability of online patient-oriented materials related to ophthalmic diagnoses is not yet known. OBJECTIVE: To assess the readability of online literature specifically for a range of ophthalmic conditions. DESIGN AND SETTING: Body text of the top 10 patient-oriented websites for 16 different ophthalmic diagnoses, covering the full range of ophthalmic subspecialties, was analyzed for readability, source (United Kingdom vs non-United Kingdom, not for profit vs commercial), and appropriateness for sight-impaired readers. MAIN OUTCOMES AND MEASURES: Four validated readability formulas were used: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFOG). Data were compared with the Mann-Whitney test (for 2 groups) and Kruskal-Wallis test (for more than 2 groups) and correlation was assessed by the Spearman r. RESULTS: None of the 160 webpages had readability scores within published guidelines, with 83% assessed as being of "difficult" readability. Not-for-profit webpages were of significantly greater length than commercial webpages (P = .02) and UK-based webpages had slightly superior readability scores compared with those of non-UK webpages (P = .004 to P < .001, depending on the readability formula used). Of all webpages evaluated, only 34% included facility to adjust text size to assist visually impaired readers. CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study to assess readability of patient-focused webpages specifically for a range of ophthalmic diagnoses. In keeping with previous studies in other medical conditions, we determined that readability scores were inferior to those recommended, irrespective of the measure used. Although readability is only one aspect of how well a patient-oriented webpage may be comprehended, we recommend the use of readability scoring when producing such resources in the future. Minimum readability policies and inclusion of facilities within webpages to maximize viewing potential for visually impaired readers are important to ensure that online ophthalmic patient information is accessible to the broadest audience possible.

Readability assessment of Internet-based patient education materials related to endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Numerous professional societies, clinical practices, and hospitals provide Internet-based patient education materials (PEMs) to the general public, but not all of this information is written at a reading level appropriate for the average patient. The National Institutes of Health and the US Department of Health and Human Services recommend that PEMs be written at or below the sixth-grade level. Our purpose was to assess the readability of endoscopic sinus surgery (ESS)-related PEMs available on the Internet and compare readability levels of PEMs provided by three sources: professional societies, clinical practices, and hospitals. STUDY DESIGN: A descriptive and correlational design was used for this study. METHODS: The readability of 31 ESS-related PEMs was assessed with four different readability indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG). Averages were evaluated against national recommendations and between each source using analysis of variance and t tests. RESULTS: The majority of PEMs (96.8%) were written above the recommended sixth-grade reading level, based on FKGL (P < .001). Only one article (3.2%) had an FKGL at or below the sixth-grade level. The mean readability values were: FRES 47.1 ± 13.4, FKGL 10.7 ± 2.4, SMOG 13.7 ± 1.6, and Gunning FOG 12.4 ± 2.7. CONCLUSIONS: Current Internet-based PEMs related to ESS, regardless of source type, were written well above the recommended sixth-grade level. Materials from the hospitals/university-affiliated websites had lower readability scores, but were still above recommended levels. Web-based PEMs pertaining to ESS should be written with the average patient in mind.

Readability of patient-reported outcome questionnaires for use with persons who stutter.

OBJECTIVE: The purpose of this study was to examine the readability of several published patient-reported outcome (PRO) questionnaires for use with persons who stutter, and to compare the readability results to existing data about average reading levels for English-speaking adults living in the United States. DESIGN: Published PRO questionnaires were identified that are traditionally completed by persons who stutter in a self-administered format. METHOD: Reading grade levels were analyzed using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. Descriptive statistics were computed across the questionnaires. RESULTS: The results of this study demonstrate that many of the PRO questionnaires exceeded the fifth to sixth grade reading levels recommended by health literacy experts. CONCLUSIONS: The clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or their proxy. Likewise, developers of PRO questionnaires should consider reading level of respondents and include information about this when reporting psychometric data. EDUCATIONAL OBJECTIVES: The reader will get an overview over the literature on patient-reported outcome (PRO) questionnaires and their use with persons who stutter and will be able to: (1) define readability, (2) describe how reading levels are determined for a given PRO questionnaire, (3) list the strengths and limitations of readability assessment in the evaluation of persons who stutter and (4) analyze the role of readability assessment in future PRO questionnaire development.

Dificuldade na noção lógica de conservação de quantidade no estágio pré-operatório / Difficulty with the logical notion of conservation of quantity at preoperational stage / Dificultad en la noción lógica de conservación de la cantidad en la etapa pre-operativa

O artigo aborda a dificuldade na noção lógica de conservação de quantidade da criança, no estágio pré-operatório. Retoma essa análise presente na investigação de Piaget e Szeminska (1975). Argumenta que, a partir da abordagem lógica do sentido e da referência em Frege (1892), verificamos uma aproximação entre essa abordagem e a análise de Piaget e Szeminska e pensamos que a criança com acesso à noção lógica de conservação de quantidade se encontra sob o primado da referência. Ademais, argumenta que Lacan (1971), a partir da abordagem de Frege, reivindica que a referência é fálica e, nessa direção, podemos pensar que a referida criança, quando aprende a conservar quantidade, está sob o primado da referência fálica que diz da operacionalidade da função paterna. Propõe, nessa direção, que o argumento apresentado por Lacan contribui para a compreensão dessa dificuldade detectada por Piaget.

This article discusses the child’s difficulty with the logical notion of conservation of quantity at preoperational stage, with the aid of Piaget and Szeminska’s investigation on the matter. Based on Frege’s approach to sense and reference (1892), we can observe a close relationship between said approach and Piaget and Szeminska’s analysis, and consider that the child with access to the logical notion of conservation is under the rule of the reference. In addition, we argue that Lacan (1971), based on Frege’s approach, claims that the reference is phallic and, in this sense, we can think that when children learn to conserve they are under the rule of the phallic reference, which is closely related to the operability of the paternal role. As a result, we propose that Lacan’s argument contributes to the understanding of this difficulty detected by Piaget.

El artículo aborda la dificultad de la noción lógica de conservación de la cantidad de niños en la etapa pre-operativa. Recoge este análisis presente en la investigación de Piaget y Szeminska (1975). Argumenta que desde el enfoque de la lógica de sentido y referencia en Frege (1892), se pode ver una conexión entre este enfoque y el análisis de Piaget y Szeminska, y pensar que el niño con el acceso a la noción lógica de conservación de la cantidad se encuentra bajo el primado de la referencia. Además, argumenta que Lacan (1971) desde el enfoque de Frege reivindica que la referencia es fálica, y, por consiguiente, se pode pensar que ese niño cuando aprende a conservar la cantidad está bajo el primado de la referencia fálica diciendo la operatividad del padre simbólico. Propone, en este sentido, que el argumento presentado por Lacan contribuye a la comprensión de esta dificultad, detectada por Piaget.

How often is strength of recommendation indicated in guidelines? Analysis of the Yale Guideline Recommendation Corpus.

Recommendation strength, is important for informed clinical decision making as it describes the authors judgment of benefits, risks, harms, and costs of adherence. We examined how often guideline authors documented strength by analyzing a representative sample of 1275 recommendations, the Yale Guideline Recommendation Corpus. We found variability and inconsistency in the way strength is reported. Over half of the recommendations (52.7%), did not indicate strength, while 6.6% inaccurately indicated strength, when they reported evidence quality.