Preliminary evidence that androgen signaling is correlated with men's everyday language.

OBJECTIVES: Testosterone (T) has an integral, albeit complex, relationship with social behavior, especially in the domains of aggression and competition. However, examining this relationship in humans is challenging given the often covert and subtle nature of human aggression and status-seeking. The present study aimed to investigate whether T levels and genetic polymorphisms in the AR gene are associated with social behavior assessed via natural language use. METHODS: We used unobtrusive, behavioral, real-world ambulatory assessments of men in partnered heterosexual relationships to examine the relationship between plasma T levels, variation in the androgen receptor (AR) gene, and spontaneous, everyday language in three interpersonal contexts: with romantic partners, with co-workers, and with their children. RESULTS: Men's T levels were positively correlated with their use of achievement words with their children, and the number of AR CAG trinucleotide repeats was inversely correlated with their use of anger and reward words with their children. T levels were positively correlated with sexual language and with use of swear words in the presence of their partner, but not in the presence of co-workers or children. CONCLUSIONS: Together, these results suggest that T may influence social behavior by increasing the frequency of words related to aggression, sexuality, and status, and that it may alter the quality of interactions with an intimate partner by amplifying emotions via swearing.

A classification of the verbal methods currently used to teach endoscopy.

BACKGROUND: As endoscopy does not lend itself well to assisting or exposure by the teacher, most of the teaching is, by necessity, done verbally. METHODS: The verbal teaching occurring during 19 colonoscopies and 14 gastroscopies was recorded by dictaphone and later transcribed. The resultant 53-page transcript was then analyzed using the Grounded Theory method. Teaching was compared between learners with less than one month versus more than one month of training and between teaching of colonoscopy versus gastroscopy. RESULTS: The process of iterative review and repeated testing yielded 6 types of verbal teaching: demonstration by the teacher, motor instructions, broad tips/tricks/pointers, verbal feedback, questioning, and non-procedural information. Inter-rater agreement was excellent (Fleiss's kappa = 0.76) between resident (DM), the non-medical educator (MP), and the medical teacher (MM). Overall, there was less non-procedural teaching (6.7% vs 23.7%, p = 0.01) and a trend towards more teaching moments per case (13.2 vs 7.9, p = 0.07) in the first month of the rotation compared to the later months. A greater proportion of the teaching for colonoscopy involved demonstration (13.7% vs. 2.7%, p = 0.040) and tips/tricks/pointers (26.6% vs. 12.4%, p = 0.012) compared to gastroscopy. CONCLUSIONS: We describe a means of categorizing verbal teaching in endoscopy that is simple and shows strong inter-rater agreement that will serve as a starting point for further studies aiming to improve how endoscopy is taught.

Do not count on me to imagine how I act: behavior contradicts questionnaire responses in the assessment of finger counting habits.

The directionality of finger counting (i.e., from left to right or right to left) is supposed to compete with the orientation of the mental number line in determining number mental representations. Indeed, Western individuals who count on their fingers from right to left present a weaker SNARC effect than do individuals for whom the directionality of counting is the same as the mental number line. Observations of natural behavior should be the preferred methodology for classifying individuals according to their counting habits. Yet, to perform such classification, researchers usually rely on questionnaires or reports of imagined behaviors. However, we show in a series of three experiments that, on average, 26% of a sample of adults reported the opposite behavior from the one they actually implemented spontaneously when tested with an original ecological task. In a fourth experiment, this new task proved reliable, using a test-retest method. These results suggest that future studies about counting habits could benefit from the use of more ecological and functional tasks, rather than depending on noncontextualized questionnaires.

The logopenic variant of primary progressive aphasia.

PURPOSE OF REVIEW: The aim is to explore the evolution of the logopenic variant of primary progressive aphasia as a distinct clinical entity and to outline recent advances that have clarified its clinical characteristics, neural underpinnings, and potential genetic and pathological bases. This is particularly relevant as researchers attempt to identify clinico-pathological relationships in subtypes of primary progressive aphasia in hopes of utilizing language phenotype as a marker of underlying disease. RECENT FINDINGS: Recent work has served to refine and expand upon the clinical phenotype of the logopenic variant. Logopenic patients show a unique pattern of spared and impaired language processes that reliably distinguish this syndrome from other variants of progressive aphasia. Specifically, they exhibit deficits in naming and repetition in the context of spared semantic, syntactic, and motor speech abilities. Further, there is a growing body of evidence indicating a possible link between the logopenic phenotype and specific pathological and genetic correlates. SUMMARY: Findings indicate that the logopenic variant is a distinct subtype of progressive aphasia that may hold value as a predictor of underlying pathology. Additional research, however, is warranted in order to further clarify the cognitive-linguistic profile and to confirm its relation to certain pathological and genetic processes.

Computerized analysis of speech and language to identify psycholinguistic correlates of frontotemporal lobar degeneration.

OBJECTIVE: To evaluate the use of a semiautomated computerized system for measuring speech and language characteristics in patients with frontotemporal lobar degeneration (FTLD). BACKGROUND: FTLD is a heterogeneous disorder comprising at least 3 variants. Computerized assessment of spontaneous verbal descriptions by patients with FTLD offers a detailed and reproducible view of the underlying cognitive deficits. METHODS: Audiorecorded speech samples of 38 patients from 3 participating medical centers were elicited using the Cookie Theft stimulus. Each patient underwent a battery of neuropsychologic tests. The audio was analyzed by the computerized system to measure 15 speech and language variables. Analysis of variance was used to identify characteristics with significant differences in means between FTLD variants. Factor analysis was used to examine the implicit relations between subsets of the variables. RESULTS: Semiautomated measurements of pause-to-word ratio and pronoun-to-noun ratio were able to discriminate between some of the FTLD variants. Principal component analysis of all 14 variables suggested 4 subjectively defined components (length, hesitancy, empty content, grammaticality) corresponding to the phenomenology of FTLD variants. CONCLUSION: Semiautomated language and speech analysis is a promising novel approach to neuropsychologic assessment that offers a valuable contribution to the toolbox of researchers in dementia and other neurodegenerative disorders.

Swiss Cancer League communication skills training programme for oncology nurses: an evaluation.

AIM: This paper is a report of an evaluation of the effectiveness of a communication skills training programme for oncology nurses. BACKGROUND: Clinical care for patients with cancer is increasingly being divided between nurses and physicians, with nurses being responsible for the continuity of patient care, and oncologists choosing and explaining the basics of anti-cancer therapy. Therefore, oncology nurses will profit from evidence-based communication skills training to allow them to perform in a professional way. METHODS: Between 2003 and 2006 pre- and post-intervention videos of interviews with simulated patients were compared using the Roter Interaction Analysis System. Patient centeredness was assessed by counting segments of appropriate mutual responding to cues and by calculating length of uninterrupted patient speech. FINDINGS: Appropriate empathic (1.6% vs. 3.2%), reassuring statements (2.3% vs. 3.4%), questions concerning psychosocial information (2.8% vs. 4.0%) increased statistically significantly; utterances containing medical information decreased on the part of nurses (17.8% vs. 13.3%) and patients (8.1% vs. 6.7%); and patients provided more psychosocial information (3.3% vs. 5.7%). The level of congruence and empathic responses to patients' emotional cues increased statistically significantly, as did the length of uninterrupted speech (3.7-4.3 utterances; all P < 0.05). CONCLUSION: The communication skills training of the Swiss Cancer League could be used as a model to achieve substantial improvements in patient-centred communication. Sequence analysis of utterances from patient-provider interaction should be used to assess the amount of patient-centred talk.

Frequency of GP communication addressing the patient's resources and coping strategies in medical interviews: a video-based observational study.

BACKGROUND: There is increasing focus on patient-centred communicative approaches in medical consultations, but few studies have shown the extent to which patients' positive coping strategies and psychological assets are addressed by general practitioners (GPs) on a regular day at the office. This study measures the frequency of GPs' use of questions and comments addressing their patients' coping strategies or resources. METHODS: Twenty-four GPs were video-recorded in 145 consultations. The consultations were coded using a modified version of the Roter Interaction Analysis System. In this study, we also developed four additional coding categories based on cognitive therapy and solution-focused therapy: attribution, resources, coping, and solution-focused techniques.The reliability between coders was established, a factor analysis was applied to test the relationship between the communication categories, and a tentative validating exercise was performed by reversed coding. RESULTS: Cohen's kappa was 0.52 between coders. Only 2% of the utterances could be categorized as resource or coping oriented. Six GPs contributed 59% of these utterances. The factor analysis identified two factors, one task oriented and one patient oriented. CONCLUSION: The frequency of communication about coping and resources was very low. Communication skills training for GPs in this field is required. Further validating studies of this kind of measurement tool are warranted.

Communication of health in experimentally sick men and women: A pilot study.

The way people communicate their ill-health and the factors involved in ill-health communication remain poorly known. In the present study, we tested how men and women communicate their sickness and assessed whether sickness-related variables (i.e., body temperature, immune response, subjective sickness symptoms) predicted communicative behaviors. Twenty-two participants were filmed during experimentally induced sickness, triggered by lipopolysaccharide administration (2ng/kg body weight), and after placebo administration, in presence of female care providers. Two trained raters scored participants' communicative behaviors (verbal complaints, moaning and sighs/deep breaths). The physiological and subjective sickness responses were similar in both sexes. Participants were more likely to moan and complain when sick, although the frequency of these behaviors remained low and no clear sex differences was observed. Nevertheless, frequency of sighs/deep breaths was increased amongst sick men but not in women. Sickness-related variables did not predict sigh/deep breath frequency. In this setting, sick men appear to display a lower threshold of expressing their malaise as compared to similarly sick women.

Intelligence quotient in children with meningomyeloceles: a case-control study.

OBJECT: Meningomyelocele (MMC) is a common central nervous system birth defect. As one of many problems facing patients with MMC, learning disabilities are often overlooked. The aim of this study was to evaluate IQs in a group of children with MMCs and determine if a correlation exists between intelligence level and the presence of an MMC and/or its complications. METHODS: A case-control study was conducted at the Children's Hospital Medical Center in Tehran, Iran, from December 2004 through December 2005. The patient group included 50 children with MMC from 5 to 12 years of age who were referred to the authors' institution for treatment of complications or for follow up after surgery for MMC closure. The patient group was individually matched for age and sex with a control group of 50 children referred to the hospital for other reasons and who did not have MMC or other neurological abnormalities. The IQs in all children in this study were evaluated using the Ravens Progressive Matrices test. The children in both groups were similar in the socioeconomic status of the family (p = 0.347) and educational status of the father (p = 0.117) and mother (p = 0.439). Patient age at the time of surgery for MMC closure varied from 1 day to 96 months (mean 4.1 months). Only 20% of the patients with MMC could walk with a normal gait. Forty-six percent of the patients had undergone placement of a ventriculoperitoneal shunt, and half of these patients experienced shunt-related complications; 72% of the children in the patient group were completely incontinent for both urine and feces. The IQ results obtained in the patient group ranged from 73 to 134 with a mean (+/- standard deviation) of 96.62 +/- 13.01. In the control group the IQ range was 70 to 128, and the mean was 104.82 +/- 12.30. Compared with the control group there was a statistically significant correlation between having an MMC and having a lower IQ (p < 0.001, paired t-test). CONCLUSIONS: Although the average IQ in the patient group was significantly lower than that in the control group, it is important to note that all children in the patient group had an average or above-average IQ. In contrast with the results reported in other studies, earlier repair of the MMC, the presence of a shunt or shunt-related complications, walking difficulty, and the spinal level of the lesion did not correlate significantly with IQs. Therefore, the lower IQ and reduced cognitive levels noted in these patients result from the disease process itself and not from the associated complications.

Phonemic verbal fluency task in adults with high-level literacy.

OBJECTIVE:: To establish normative parameters for the F-A-S form of the phonemic verbal fluency test, in a population of Brazilian Portuguese speaking adults with high-level literacy. METHODS:: The sample comprised 40 male and female volunteers aged 19 to 59 years, and at least 8 years of formal education. Volunteers were first submitted to the Mini-Mental State Examination and the Clock Drawing cognitive screening tests, then to the F-A-S Verbal Phonemic Fluency Test; in this test, examinees were given 60 seconds to generate as many words as possible beginning with each of the three test letters. RESULTS:: The means for number of words beginning the letters F, A and S and for total number of words beginning with either letter generated per minute corresponded to 15.3, 14.4, 13.9 and 43.5, respectively. CONCLUSION:: Reference values obtained from young adults with high levels of literacy submitted to the F-A-S Verbal Phonemic Fluency Test in this study were similar to those reported in the international literature. These reference values can be used for clinical assessment of language disorder and neuropsychological evaluation. OBJETIVO:: Obter parâmetros de normalidade na tarefa de fluência verbal fonêmica, versão F-A-S, em uma população de alto letramento de adultos falantes do português brasileiro. MÉTODOS:: A amostra foi constituída por 40 voluntários, de ambos os sexos, com idade entre 19 e 59 anos, e com mais de 8 anos de estudo. Todos os voluntários foram inicialmente submetidos ao Miniexame do Estado Mental e ao Teste do Desenho do Relógio, para fins de rastreio cognitivo, e, então, ao Teste de Fluência Verbal Fonêmica F-A-S. Neste último, os indivíduos foram orientados a produzirem o maior número de palavras que conseguissem, iniciadas com cada uma das três letras ditas pelo examinador, em um intervalo de 60 segundos cada. RESULTADOS:: As médias das palavras produzidas com as letras F-A-S foram as seguintes: "F" = 15,3 palavras por minuto; "A" = 14,4 palavras por minuto; e "S" = 13,9 palavras por minuto. A média do total de palavras emitidas iniciada com todas as letras do teste foi de 43,5 palavras. CONCLUSÃO:: Foram obtidos valores de referência para o Teste de Fluência Verbal Fonêmica F-A-S para indivíduos adultos jovens de alto grau de letramento semelhantes aos de estudos internacionais. Tais valores podem ser utilizados na avaliação clínica de transtornos da linguagem e na avaliação neuropsicológica.

Cortical and subcortical influences on clustering and switching in the performance of verbal fluency tasks.

Impairments on lexical and semantic fluency tasks occur in both cortical and subcortical dementia. Recent reports that the average size of phonemic and semantic clusters is reduced in Alzheimer's disease (AD), but not in Parkinson's disease (PD) could support the hypothesis that in AD verbal fluency deficits arise from degraded memory storage while in PD the same impairments result from defective retrieval. In the present study, patients with AD, PD with dementia, or Huntington's disease produced fewer words, fewer switching responses and smaller semantic cluster sizes. Patients with multiple sclerosis, regardless of whether or not they were demented, produced fewer words and switching responses, but normal size clusters, and patients with PD without dementia performed normally on all fluency measures. These results indicate that reductions in cluster size on verbal fluency tests are best interpreted as changes in the efficiency of access to lexical and semantic memory stores. The findings are also consistent with the idea that patterns of cognitive impairment may differ among diseases that result in subcortical dementia.

Constructive anger verbal behavior predicts blood pressure in a population-based sample.

The creation of an observational Constructive Anger Behavior-Verbal Style Scale (CAB-V) and its relation to resting blood pressure (BP) in an age- and sex-stratified, population-based sample is examined. Participants (N = 1,862) provided hypertension risk factor information, had resting BP assessed multiple times, and completed a videotaped interview, which was later coded for CAB-V and Hostile Style. High CAB-V scores remained a significant predictor of lower resting BP when controlling for the effects of standard hypertension risk factors (age, sex, body mass index, physical activity, alcohol use, smoking status, parental myocardial infarction history, education, and diabetic status) and psychosocial measures (anxiety, depression, hostility, social support, and Hostile Style). This relation also remained when excluding known hypertensive persons. Results suggest that constructive anger expression may have an independent beneficial association with resting BP.

Affective reactivity of speech in schizophrenia patients and their nonschizophrenic relatives.

This study compared levels of referential communication disturbance in speech samples from 41 stable schizophrenia outpatients, 46 parents of patients, and 23 nonpsychiatric control participants in affectively positive versus affectively negative conditions. The speech of the patients and parents showed elevated frequencies of reference failures in the affectively positive condition compared with control participants: the speech of the patients became more disordered in the affectively negative condition, whereas the speech of the parents did not. These results support the idea that referential communication disturbances reflect vulnerability, as well as overt illness, but that affective reactivity of these disturbances is associated mainly with the manifest illness. These findings are consistent with biological, cognitive, and psychological theories about the processes underlying stress responsiveness of schizophrenic symptoms more generally.

Family caregivers' criticism of patients with schizophrenia.

OBJECTIVE: Relationships were examined between patients' negative symptoms, family caregivers' knowledge of schizophrenia, caregivers' attributions about the cause of patients' symptoms, and caregivers' response to the symptoms. METHODS: A sample of 84 caregivers of patients with schizophrenia in Brisbane, Australia, were interviewed using a structured format and measures designed for the study. RESULTS: Results of regression analyses indicated that three variables significantly predicted caregivers' criticism of patients--a smaller proportion of negative symptoms in the patient's overall symptom pattern, the caregiver's low level of knowledge about the illness, and the caregiver's attributing the cause of negative symptoms to the patient's personality rather than to the illness. CONCLUSIONS: Overall, findings supported the utility of an attributional framework in enhancing conceptions about and research on schizophrenia and family caregiving.

Short test of semantic and phonological fluency: normal performance, validity and test-retest reliability.

Tests of verbal fluency, whether of Semantic Fluency (SF) or Phonological Fluency (PF), are often used as a standard method of neuropsychological assessment. However, very little normative data, standardized on a UK sample, is available, and little is known about the utility of popularly used 'short-forms' of these tasks. Additionally, very little is known about verbal fluency test-retest reliability. In this report we describe the performance of N = 365 normal participants on a version of SF requiring the generation of exemplars of the category 'animals' and a version of the PF task requiring participants to generate words beginning with the letter 'B'. From this data we have derived a percentile distribution for both tasks. We also addressed the impact of sex, age, years of education and IQ upon both SF and PF performance. No sex differences were found on either the PF or the SF tasks. A significant but small correlation between age and SF, but not PF, was observed. Modest correlations between both years of education and IQ and PF and SF performance were also seen. We also report test-retest reliability scores for performance on both SF and PF tasks. Performance on the longer 'FAS' version was found to correlate highly with scores obtained using just the letter 'B'. This suggests that little additional advantage obtains from administering three-letter versions of PF. An extremely high degree of correlation between SF tasks in which participants are given 1 minute and scores obtained when participants are given 1 minute 30 seconds was also observed. Finally, in order to assist users in deciding whether a changed retest score is due to error measurement or a real effect, we calculated Standard Error of Prediction (SEP) scores.

Vamos a Traducir los MRV (let's translate the VRM): linguistic and cultural inferences drawn from translating a verbal coding system from English into Spanish.

Translating a verbal coding system from one language to another can yield unexpected insights into the process of communication in different cultures. This paper describes the problems and understandings we encountered as we translated a verbal response modes (VRM) taxonomy from English into Spanish. Standard translations of text (e.g., psychotherapeutic dialogue) systematically change the form of certain expressions, so supposedly equivalent expressions had different VRM codings in the two languages. Prominent examples of English forms whose translation had different codes in Spanish included tags, question forms, and "let's" expressions. Insofar as participants use such forms to convey nuances of their relationship, standard translations of counseling or psychotherapy sessions or other conversations may systematically misrepresent the relationship between the participants. The differences revealed in translating the VRM system point to subtle but important differences in the degrees of verbal directiveness and inclusion in English versus Spanish, which converge with other observations of differences in individualism and collectivism between Anglo and Hispanic cultures.

A new measure of conversational experience: the speaking extent and comfort scale (SPEACS).

Few measures exist which directly assess aspects of conversational experience. We present and provide a psychometric assessment of the Speaking Extent and Comfort Scale (SPEACS), a new 20-item measure which assesses four aspects of past conversational experience: the extent and comfort of both general conversations and in conversations specifically about the self. All four SPEACS subscales exhibited good test-retest reliability. As predicted, the subscales related positively to social competence, disclosure, assertiveness, and perceived availability of someone to talk to, and negatively to social avoidance and social anxiety, providing support for their construct validity. Internal consistency data demonstrated that people tend to vary in how often and how comfortable they feel having conversations with different people. SPEACS offers a range of potential applications in areas with a focus on social networks, social experience and interaction, and the possibility of extension to other dimensions of conversational experience.

Norms for letter and category fluency: demographic corrections for age, education, and ethnicity.

Letter and category fluency tasks are used to assess semantic knowledge, retrieval ability, and executive functioning. They appear to be useful in detecting different types of dementia, but accurate detection of neuropsychological impairment relies on appropriate normative data. Multiple regression analysis was used to develop demographically corrected norms for letter and category fluency in 768 normal adults. T-score equations were developed on a base subsample of 403, and crossvalidated on a separate subsample (n = 365). Participants ranged in age from 20 years to 101 years; in educational level from 0 to 20 years; 55% were Caucasian and 45% were African American. Together, age, education, and ethnicity were significant predictors of letter and category fluency performance, accounting for 15% and 25% of variance, respectively. Formulas and tables for converting raw fluency scores to demographically corrected T scores are presented.

Dentists' verbal communication leads during an interview with geriatric patients.

A reliable method has been developed to describe dentists' verbal communication leads using closed circuit television. The purpose of this investigation was to compare these leads during the greeting and initial discussion portion of an initial dental interview for ten dentists with 20 patients older than 65 years. Leads were categorized as controlling, noncontrolling, or neutral. A controlling lead was defined as a lead that allowed the dentist to exert authority in a controlling manner. The most frequently used leads in this category were closed-ended questions and structuring. Leads were categorized as noncontrolling if the lead allowed patients to express themselves (acceptance, approval, clarification, interpretation, and open-ended question). Examples of frequently observed neutral leads included small talk and information giving. The frequency of noncontrolling, neutral, and controlling leads was 28%, 40%, and 32%, respectively. Correlations between these three categories were weak and indicated that they were measuring different qualities of the communication process. When the three categories of leads were analyzed by doctors and patients' gender, the mean numbers of leads were similar, although male dentists tended to be more controlling with male patients and less controlling with female patients. These differences were not statistically significant using the analysis of variance.

Role dimensions of patient and physician in medical interviews: relationship to patients' satisfaction.

We applied the Verbal Response Mode coding system to 80 medical interviews to characterize role dimensions of patient and physician and to assess the relation between physicians' role dimensions and patients' satisfaction. Role dimensions conformed closely to prior work. Physicians' acquiescence was positively correlated with satisfaction. This study suggests that the role dimensions generated by the Verbal Response Mode taxonomy are a useful measure of patients' and physicians' relationships.