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Therapeutic communication has an important role to help the recovery process of People With Schizophrenia (ODS) who have symptoms of hallucinations and delusions that can lead to a tendency to have difficulty communicating to withdraw from the social environment. Therapeutic communication is a form of communication aimed at the therapeutic process and patient healing. Phenomenology is used as a method and therapeutic communication as a theory in this study. The data collection method was carried out through online interviews using WhatsApp voice calls to 6 ODS family caregiver informants. The results of this study indicate that the experience of therapeutic communication carried out by family caregivers in the form of interpersonal communication can help the ODS awareness process regarding schizophrenia as indicated by ODS' willingness to take medication regularly, as well as communication in the form of showing acceptance, listening carefully, and emotional regulation when communicating with ODS can provide appropriate treatment when ODS has relapse symptoms so that it can help the process of developing ODS.

Children with special needs (ABK) who have dyslexia can cause children to have difficulties in learning, including difficulties in spelling, reading, writing and communicating with others. The subjects in this study were dyslexic students with the initials DH at one of the Inclusive Elementary Schools in Sleman. The results showed that parents only realized dyslexic children when the children entered their teens, the environment also affects the learning motivation of dyslexic children, and the efforts made by teachers and parents in overcoming the learning difficulties of dyslexic students. From the results of the study, DH experienced dyslexia in the form of difficulty in speaking, hesitation when answering the interlocutor's questions, spelling word for word slowly with a soft or low voice or intonation, and difficulties in writing and difficulty communicating with the surrounding environment. The method used in this research is descriptive qualitative. Data collection techniques were carried out by indepth interviews, observation and literature review. By providing maximum learning assistance between teachers and parents, it will increase learning motivation for dyslexic children.Keywords: dyslexia children, learning motivation, learning difficulties

The hospital may be especially overwhelming to patients with Autism Spectrum Disorder (ASD) and their families. The characteristics and attributes inherently present in patients with ASD provide substantial challenges to nursing care if not recognized, identified and addressed. ASD is a complex disorder and requires preparation, education, and great assessment skills from the nurses for optimal outcomes. Nurses are often the front-line and direct care providers and need to attain the knowledge and skills necessary to understand, interact with and implement excellent care for these individuals. These patients with ASD can present with a range of social and behavioral challenges including difficulty with communication need for structure, and possible aggression and it is difficult to implement care at times. Nowadays the nursing professionals are being increasingly aware of their role in helping to ensure that patients with ASD receive the best possible care. These patients may have difficulty communicating or may find a break in their routine stressful. By understanding ASD-related challenges and devising ways to make patients as well as their parents or caregivers more comfortable, nurses can make a hospital stay, doctor visit or dental checkup less stressful and more effective. Outcomes improve dramatically when health care professionals obtain the education, expertise, and knowledge necessary to provide such care. In this paper we discuss the common challenges that the nursing staff face while dealing with patients with ASD as well as the difficulties families face. Emphasis will be on the role of nursing professionals in making hospital stay less stressful for individuals with ASD.

Purpose: The COVID-19 pandemic has introduced lifestyle changes that may negatively impact communication, including the pervasive use of face masks and videoconferencing technology. Here, we examine the effects of age and self-rated hearing on subjective measures of speech understanding via a survey accessed by adults residing in the United States. Method: Responses to an online survey were obtained from adults (21 years of age and older) during the summer and fall of 2020. The survey included questions about hearing and speech understanding in a variety of scenarios and different listening conditions, including when communicating with people using face masks in quiet and noisy environments and when using videoconferencing. Results: Data from 1,703 surveys were analyzed. In general, the use of face masks led to the perception of poorer speech understanding and greater need for concentration, especially in noisy environments. When responses from all participants were considered, poorer self-rated communication ability was noted as age increased. However, among people who categorized their overall hearing as “Excellent” or “Good,” younger adults rated their speech understanding ability in noisy situations as poorer than middle-age or older adults. Among people who rated their overall hearing as “Fair” or “Poor,” middle-age adults indicated having more difficulty communicating with people using face masks, as compared with older adults. Examination of open-ended responses suggested that the strategies individuals use when communicating with people wearing face masks vary by age and self-rated hearing. Notably, middle-age and older adults were more likely to report using strategies that could put them at risk (e.g., asking others to remove their face masks). Conclusions: Even younger adults with self-perceived good hearing are not immune to communication challenges brought about by face masks. Among individuals with similar degrees of self-rated hearing, the expected increase in communication difficulty with age was not noted among our respondents. Supplemental Material: https://doi.org/10.23641/asha.16528431

INTRODUCTION AND OBJECTIVE:Disabled patients are a unique minority population that may have lower literacy levels and difficulty communicating with physicians. Furthermore, their knowledge for canc...

Background: Cognitive impairment is a prominent feature of multiple sclerosis (MS). However, the impact that cognitive symptoms have on daily life, and the effect this has on persons with MS and their relationships with spouses/partners, remains unclear. This qualitative study sought information on the nature of cognitive impairments experienced and the impact of cognitive impairments on the daily lives of adults with MS and their partners to gain further insights into how health care professionals can best support families. Methods: Fifteen persons with MS and their spouses/partners participated in separate semistructured telephone interviews. Results: Six themes and several subthemes were identified: the social impact of cognitive impairments in MS, changes to daily living, relationship quality, communication, ways of coping with MS, and the desire for help in managing MS. Conclusions: These results identified types of support that couples needed and wanted; ways that MS affects couples’ social lives; that there are difficulties negotiating changes in roles due to cognitive challenges; that there are difficulties coping with the impact of cognitive challenges on daily living; that couples often have difficulty communicating about the impact of cognitive changes on daily living and related issues, which also contributes to relationship strain; and finally, that most participants felt that they did not understand enough about the cognitive symptoms of MS. We outline key areas to address these identified needs.

Generasi Y merupakan generasi yang memiliki kecakapan dalam penggunaan teknologi, termasuk dalam penggunaan media sosial. Dalam penggunaannya, generasi Y menghabiskan lebih banyak waktunya untuk mengakses media sosial dibandingkan generasi sebelumnya. Penggunaan media sosial yang telalu sering dapat mengakibatkan hilangnya kemampuan berinteraksi secara langsung. Fenomena menunjukkan bahwa generasi Y mengalami kesulitan dalam berkomunikasi serta kurang memiliki pendekatan yang kurang pantas ketika berbicara. Penelitian ini bertujuan untuk mengetahui hubungan frekuensi penggunaan media sosial dengan komunikasi interpersonal pada karyawan generasi Y. Sampel dalam penelitian ini adalah 131 karyawan generasi Y berusia 22-38 tahun yang bekerja di DKI Jakarta dan memiliki media sosial lebih dari satu. Penelitian ini menggunakan alat ukur The Media and Technology Usage and Attitude Scale (Rosen, 2013) dan Interpersonal Communication Inventory (Graham, 1998) yang telah diadaptasi. Hasil uji korelasi menunjukkan bahwa frekuensi penggunaan media sosial memiliki hubungan negatif yang signifikan dengan dimensi awareness of others pada komunikasi interpersonal. Namun, frekuensi penggunaan media sosial tidak memiliki hubungan dengan kedua dimensi yang lainnya pada komunikasi interpersonal, yaitu awareness of self & self disclosure dan coping with feeling & differences.

O ruído consiste em um importante risco ambiental presente na rotina dos trabalhadores em uma Unidade de Beneficiamento e Armazenagem de Grãos (UBAG). Seus efeitos mais comuns sobre o trabalhador envolvem a perda de audição, problemas no sono, problemas cardíacos, estresse tanto em casa quanto no trabalho e a dificuldade de comunicação durante suas atividades. Sendo assim, buscou-se neste trabalho investigar os níveis de ruído aos quais estão expostos trabalhadores em uma empresa de médio porte, que atua na armazenagem de grãos na região sul do Rio Grande do Sul. Para tanto, realizou-se primeiramente o levantamento e caracterização do local objeto de estudo. A seguir, procedeu-se à coleta dos índices de ruído. Por fim, foi feito o tratamento dos dados coletados e a discussão dos resultados. As evidências indicam que encaminhamentos de melhorias voltadas à redução da exposição a ruídos devem considerar prioritariamente elementos externos à infraestrutura da empresa, neste caso representados pelo fluxo de veículos pesados (caminhões) em suas instalações.

Communication skills and moral education are key in social interaction with others. Mentally retarded students experience a disruption in developing communication and the need to provide moral education to retarded mental students. This study aims to analyze the communication skills and moral education of mental retardation students in elementary schools. This research is a descriptive study with a qualitative approach. This study used three types of data collection techniques, including observation, documentation, and interviews. The technique used to analyze data in this study is interactive data analysis consisting of the stages of data reduction, data presentation, and conclusion drawing. Based on the implementation of the study in addition to experiencing learning difficulties, mental retardation students also experience a disruption in communication. Retarded mental students have difficulty communicating with their friends and also with their teachers. The mentally retarded Shiva also has not received the maximum moral education.

Supplementary and replacement communication or augmentative and alternative communication (AAC) is needed to replace the voices of autistic pupils who have difficulty communicating throughout the learning and facilitating process (PdPC) in the classroom. The teacher’s proficiency in communication skills can enhance and develop positive learning behaviours of autistic pupils throughout the learning process. This research aims to identify augmentative and alternative communication skills among special education teachers for autistic pupils in the classroom. A total of 73 special education teachers throughout Malaysia were selected as the respondents for thy research. The data obtained in the form of percentage shows the knowledge and skills of teachers in implementing AAC. Overall, this research shows that the level of knowledge and skills of teachers in implementing AAC in the classroom is still moderate and requires training.

Resumo O avanço da medicina aprimorou o tratamento de enfermidades, modificando o padrão de morbimortalidade da população, com aumento de doenças crônicas. Esse fenômeno tornou urgente interpretar adequadamente a terminalidade da vida. Considerando essa necessidade, este estudo, de corte transversal, descritivo e analítico, analisou dados sobre a percepção de 111 estudantes do sexto ano de medicina acerca dos cuidados paliativos no fim da vida. Os dados foram coletados entre agosto e novembro de 2016, por meio de questionário e analisados por testes estatísticos com o programa Iramuteq. 37,3% dos estudantes relataram dificuldade em comunicar a morte do paciente à família; 60% sentem-se despreparados ou com dúvidas sobre como lidar com óbitos em serviço de urgência; 25% desconheciam o termo “eutanásia”, 53% “ortotanásia”, e 56% “distanásia”. Os resultados mostram que ainda há lacunas no conhecimento desses estudantes, explicitando a necessidade de que escolas médicas reforcem práticas pedagógicas sobre a morte. Abstract The advancement of medicine has improved the treatment of diseases, modifying the population’s morbidity and mortality pattern, with an increase in chronic diseases. This phenomenon made it urgent to properly interpret the termination of life. Considering this need, this cross–sectional, descriptive and analytical study analyzed data regarding the perceptions of 111 students from the sixth year of the medical school about end-of-life palliative care. Data were collected between August and November 2016 through a questionnaire and analyzed by statistical tests using the Iramuteq software. 37.3% of students reported difficulty communicating a patient’s death to their family; 60% of them felt unprepared or had doubts regarding how to deal with death in the emergency department; 25% of students reported not knowing the term Euthanasia; 53%, Orthothanasia; and, 56%, Dysthanasia. Results show that there are still gaps in the knowledge of medical students making evident the need for medical schools to reinforce educational practices regarding death. Resumen El avance de la medicina mejoró el tratamiento de enfermedades, modificando el patrón de morbimortalidad de la población, con un aumento de enfermedades crónicas. Este fenómeno tornó urgente interpretar adecuadamente la terminalidad de la vida. Considerando esta necesidad, este estudio, de corte transversal, descriptivo y analítico, analizó datos sobre la percepción de 111 estudiantes de sexto año de medicina acerca de los cuidados paliativos en el final de la vida. Los datos fueron recogidos entre agosto y noviembre de 2016, por medio de un cuestionario, y fueron analizados con pruebas estadísticas y con el programa Iramuteq. El 37.3% de los estudiantes informó dificultad para comunicar la muerte de un paciente a su familia, el 60% no se siente preparado o con dudas respecto de cómo lidiar con las muertes en el servicio de urgencia, el 25% desconocía el término “eutanasia”, el 53%, “ortotanasia”, y el 56%, “distanasia”. Los resultados muestran que aún existen lagunas en el conocimiento de estos estudiantes, explicitando la necesidad de que las facultades de medicina refuercen prácticas pedagógicas sobre la muerte.

Objectives: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access. Methods: Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP. Results: Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one's name when called in the waiting room, hearing when the speaker's back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication. Conclusions: This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit. Clinical Implications: Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one's mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.

Background As patient advocates, oncology nurses must attend to varying levels of health literacy among patients and families. However, little is known about nurses' experiences and comfort with health literacy assessment and providing health literacy support. . Objectives The purpose of this study is to explore nurse communication and patient health literacy. . Methods A cross-sectional survey design (N = 74) was used to explore nurse communication challenges with low-literacy patients and to measure nurses' frequency of assisting with patient literacy needs, perceived degree of difficulty communicating with low-literacy populations, and perceived comfort with health literacy support. . Findings A majority of the nurses reported communication challenges with patients who spoke English as a second language. Oncology nurses did not identify patient communication behaviors that indicated low health literacy. Nurses were least comfortable identifying low-literacy patients and assessing a patient's health literacy level. More experienced nurses reported more difficulty with low-literacy populations than less experienced nurses. Providing health literacy support to patients should be a core nursing skill.

Reverberation is a source of acoustic degradation, present to varying extents in many everyday listening environments. The presence of reverberation decreases speech intelligibility, especially for listeners with hearing impairment. There is substantial variability in how susceptible individuals with hearing impairment are to the effects of reverberation (i.e., how intelligible reverberant speech is to a listener). Relatively little is known about the listener factors which drive that susceptibility.To identify listener factors that are associated with an individual’s susceptibility to reverberation. Another purpose was to investigate how these listener factors are associated with reverberant susceptibility in relation to the amount of reverberation. The listener factors investigated were degree of hearing loss, age, temporal envelope sensitivity, and working memory capacity.This study used a correlational design to investigate the association between different listener factors and speech intelligibility with varying amounts of reverberation.Thirty-three older adults with sensorineural hearing loss participated in the study.Listener temporal envelope sensitivity was measured using a gap detection threshold task. Listener working memory capacity was measured using the Reading Span Test. Intelligibility of reverberant speech was measured using a set of low-context sentence materials presented at 70 dB SPL without individual frequency shaping. Sentences were presented at a range of realistic reverberation times, including no reverberation (0.0 sec), moderate reverberation (1.0 sec), and severe reverberation (4.0 sec). Stepwise linear regression analyses were conducted to model speech intelligibility using individual degree of hearing loss, age, temporal envelope sensitivity, and working memory capacity. A separate stepwise linear regression model was conducted to model listener speech intelligibility at each of the three levels of reverberation.As the amount of reverberation increased, listener speech intelligibility decreased and variability in scores among individuals increased. Temporal envelope sensitivity was most closely associated with speech intelligibility in the no reverberation condition. Both listener age and degree of hearing loss were significantly associated with speech intelligibility in the moderate reverberation condition. Both listener working memory capacity and age were significantly associated with speech intelligibility in the severe reverberation condition.The results suggest that suprathreshold listener factors can be used to best predict speech intelligibility across a range of reverberant conditions. However, which listener factor(s) to consider when predicting a listener’s susceptibility to reverberation depends on the amount of reverberation in an environment. Clinicians may be able to use different listener factors to identify individuals who are more susceptible to reverberation and would be more likely to have difficulty communicating in reverberant environments.

Background Since few studies have characterized painful diabetic peripheral neuropathy (pDPN) symptoms in multicultural populations, this study fielded a survey to better understand pDPN and its impact in African-American, Caucasian, and Hispanic populations. Methods Kelton fielded a survey by phone or Internet, in English or Spanish, among adults with pDPN symptoms in the United States between August and October 2015; African-Americans and Hispanics were oversampled to achieve at least 500 subjects for each group. Patients were required to have been diagnosed with pDPN or score ≥ 3 on ID Pain validated screening tool. The survey elicited information on pDPN symptoms and interactions with healthcare providers (HCPs), and included the Brief Pain Inventory and pain-specific Work Productivity and Assessment Questionnaire (WPAI:SHP). Results Respondents included 823 Caucasians, 525 African-Americans, and 537 Hispanics; approximately half of African-Americans and Hispanics were

Despite recent advances in cancer control, numerous disparities exist in the areas of patient access to care, self-management, and quality of life. However, mobile health technology shows promise as a tool to reduce disparities among patients with cancer and cancer survivors by overcoming such barriers as limited access to providers, difficulty communicating with providers, and inadequate communication between patients and providers regarding symptoms. This narrative review draws on the literature in cancer and noncancer populations to identify factors that create or maintain disparities and to describe opportunities for mobile health technology to reduce disparities.

Mathematical communication skills are one of the important future competencies possessed by students. Based on a preliminary study conducted on students in one of the Madrasah Ibtidaiyah shows that most students have difficulty communicating mathematical ideas. This study aims to figure out students’ mathematical communication skills on the subject of the volume of cubes and cuboids for the students taught withe the Relating, Experiencing, Applying, Cooperating and Transferring (REACT) strategy were better than those who taught with conventional learning. The research method used was a quasi-experimental design of The Nonequivalent Pretest-Posttest Control Group Design conducted on fifth grade students in one of the Ibtidaiyah Madrasahs in Bandung Regency. Based on the results of the study concluded that the mathematical communication skills of students who get learning with REACT strategies are better than mathematical communication skills of students who obtain conventional learning.

One of the goals of mathematics is to communicate ideas by using symbols, tables, diagrams, or other media to explain problems or circumstances. Based on the objectives of mathematics learning, the mathematical communication skills of students need to be considered. But many students have difficulty communicating to their mathematical understanding. This is influenced by several factors, one of them is the emotional intelligence of students.This type of research is descriptive with a qualitative approach that aims to describe how students' mathematical communication skills in solving mathematical problems based on the level of emotional intelligence. The subjects of this research are the IVC grade students elementary school of Muhammadiyah Manyar in the academic year 2019 - 2020. This study consists of three students consisting of one student who has high emotional intelligence, one student who has moderate emotional intelligence, and one student who has low emotional intelligence. The methods used in this study are emotional intelligence questionnaire, students' mathematical communication skills test, and interviews. The results of the study indicate that students who have high emotional intelligence have high mathematical communication skills that are also able to illustrate the picture completely, solve coherently and correctly, and provide conclusions correctly. Students with a moderate level of emotional intelligence, have moderate mathematical communication skills, are able to illustrate almost exact and complete images, are able to finish coherently, and are not careful about answers that have been written. Students with low levels of emotional intelligence, have low mathematical communication skills, are able to illustrate almost exact images, find it difficult to write down information that is known and asked, and do not provide conclusions on answers.Keywords: Emotional Intelligence, Mathematical Communication Skills

An inability or difficulty communicating can have a profound impact on a child's future ability to participate in society as a productive adult. Over the past few years the number of interventions for children with speech and language problems has almost doubled; the majority are targeted interventions delivered by speech pathologists. In this paper we examine the distribution of speech pathology services in metropolitan Melbourne and how these are aligned with need as defined by vulnerability in language and social disadvantage. We identified three times as many private sector services compared to public services for the 0-5 year age group. Overall there was poorer availability of services in some of the most vulnerable areas. The profound and long-term impact of impoverished childhood language, coupled with the considerable limitations on public spending, provide a strong impetus to deliver more equitably distributed speech pathology services.

Despite providing a consistent and comprehensible format for over-the-counter (OTC) drug communication, research suggests important limitations in the communication effectiveness of the Drug Facts Label required on OTC drugs in the United States. This literature is reviewed and some of these critical limitations of the Drug Facts Label (DFL) highlighted. These include difficulty communicating complex information that requires integration of multiple pieces of label information and limited adaptability to serve the unique needs of individual populations (e.g., low literacy or older consumers). Potential ways to improve the DFL’s communication effectiveness are identified along with complementary opportunities to improve OTC drug communication by leveraging the role of pharmacists and use of adjunctive technologies.

ObjectiveRecently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists’ communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT.MethodRehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties.ResultsParticipants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001).Significance of resultsCommunication difficulty was linked to rehabilitation therapists’ ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.

Purpose Using a multi-dimensional measure of perfectionism: the Frost Multi-dimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990 ), this study investigates: (a) whether adults who stutter (AWS) display more perfectionistic attitudes and beliefs than those who do not stutter, and (b) whether, in AWS, more perfectionistic attitudes and beliefs are associated with greater self-reported difficulty communicating verbally and speaking fluently. Method In the first analysis, FMPS responses from 81 AWS and 81 matched, normally-fluent controls were analyzed using logistic regression to investigate the relative contributions of four FMPS perfectionism-subscale self-ratings to the likelihood of being in the AWS group. In the subsequent analyses, data from the 81 AWS were analyzed using linear multiple regression to determine which FMPS subscale self-ratings best predicted their Communication-Difficulty and Fluency-Difficulty scores. Results Both the likelihood of being a member of the AWS group, and also the magnitude of the AWS group's Communication-Difficulty and Fluency-Difficulty scores, were positively part-correlated to respondents’ Concern over Mistakes-Doubts about Actions (CMD) subscale self-ratings but negatively part-correlated to their Personal Standards (PS) subscale self-ratings. Conclusions The FMPS profiles of respondents who stutter suggest that, as a group, they are not abnormally perfectionistic overall, but may be (or perceive themselves to be) abnormally error-prone. Also, AWS who are more concerned about their errors and uncertain of their actions experience more difficulty communicating verbally and speaking fluently. Educational Objectives: After reading this article, participants will be able to: (a) describe the findings of previous research investigating the role of perfectionism in stuttering and psychopathologies; (b) discuss why a multidimensional assessment of perfectionism is important in relation to stuttering; (c) discuss ways in which data from perfectionism assessments can contribute to the planning of therapy for adults who stutter.

Some of the highest rates of sexually transmitted infections (STIs) are reported in the Arctic. For example, the Inuit youth of Greenland have the highest STI rates in the circumpolar region. In this study, we used a mixed method approach to examine parent/guardian–youth communication about STIs and other sexual health topics. The quantitative component of the study involved the parents/guardians completing a brief questionnaire while the qualitative component involved their participation in focus groups. Parents/guardians reported that, although they found little difficulty communicating with youth in general, this was not the case for sexual topics. Similarly, parents/guardians reported a lack of communication about topics such as masturbation, why people engage in sex, and what it feels like to have sex. In general parents/guardians stated that it is uncomfortable for them to talk with their youth about sexual matters. At the same time, they are concerned about the high rates of unwanted pregnancy in their communities, and they would like to see more collaborative partnerships aimed at increasing sexual health education for youth. Future STI prevention efforts in Greenland would benefit from involving Greenlandic youth and their families in the design of community-based sexual health education programs that increase communication skills in families about topics related to sex. Community based efforts that involve families and empower them to educate their youth around STI risk-prevention behaviours is a necessary area of future development in Greenland.

Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are atypical Parkinsonian disorders with extended morbidity and reduced lifespan, known to have marked and early impact upon quality of life (QoL). This study aimed to address the lack of studies in the literature regarding personal perspectives on QoL in MSA and PSP in both patients and carers. Participants took part in qualitative, in-depth interviews in the North East of England, exploring what impacts their QoL and their experiences of living with these complex conditions. Connection to others was found to be a prevailing theme, encompassing difficulty communicating, social isolation, impact on personal relationships, and stigma. This work is helpful in that it emphasises the personal experiences of these patients and carers, which can provide insights into important areas for clinical service planning and best clinical management of individual patients as well as considerations for future research into QoL in these rare disorders.

Education makes the needs of every human being, as an effort to maximize all the potential of the creator in order to become our human being. No exception for individuals who physically and psychologically have deficiencies and weaknesses called Children with Special Needs (ABK). To optimize the potential of these individuals, an appropriate learning pattern is needed, especially in the learning process of Islamic Religious Education. Al Aufa SDIT is an educational institution that provides Inclusive education services for ABK. Implement learning at SDIT Al Aufa using teacher and media learning patterns. Where this learning activity begins with compiling learning objectives, determining teaching material, establishing learning methods and media and evaluation instruments arranged simply. While learning activities in the classroom encountered several obstacles, namely the characteristics of ABK who were hyperactive, had difficulty communicating/ socializing and were slow in responding to the stimulus provided.

Individuals with autism spectrum disorders (ASDs) have difficulty communicating in ways that are primarily for initiating and maintaining social relatedness (i.e., social communication). We hypothesized that the way researchers measured social communication would affect whether treatment effects were found. Using a best evidence review method, we found that treatments were shown to improve social communication outcomes approximately 54% of the time. The probability that a treatment affected social communication varied greatly depending on whether social communication was directly targeted (63%) or not (39%). Finally, the probability that a treatment affected social communication also varied greatly depending on whether social communication as measured in (a) contexts very similar to treatment sessions (82%) or (b) contexts that differed from treatment on at least setting, materials, and communication partner (33%). This paper also provides several methodological contributions.

Parents often underestimate the degree to which their children engage in risky online activities such as cyberbullying, worrisome interactions with strangers, and exposure to sexual content. This study attempts to identify the underlying predictors of such parental misconceptions. A national sample survey nonrandom of 456 matched parent-child pairs revealed that a permissive parenting style, difficulty communicating about online risks, and household environmental variables such as having access to a private computing space play a role in parental underestimation of risky social interactions that their children encounter and experience online. Implications for scholars and caregivers are discussed.

The involvement of family factors in the problem of bullying is well documented, not only in terms of the various differential profiles presented by bullies and their victims in terms of parental socialization styles, but the implications are derived from the perception of family climate. Specifically, this study provides an analysis of the relationship between psychosocial perception of family social climate by a group of 550 adolescents of the Principality of Asturias (Spain) (278 girls and 272 boys 50.5%, 49.5%) and their attitudes to bullying according to a three-dimensional assessment model (planes cognitive, affective and dispositional) measures through Attitudes toward Social Aggression Scale constructed ad hoc by the authors (Moral, 2005). It has been confirmed that adolescents with more favorable attitudes to violence perceived peer more conflictual family climate, feel less affection in family relationships, express greater difficulty communicating with them, and less respect for their opinions and paternal highest demands and declared to be subject to physical and psychological punishment by their parents compared to those adolescents with more negative attitudes towards bullying violence.

People with learning disability can suffer from the full range of medical problems but may have difficulty communicating their experience. The authors give advice on diagnosis, responsibility for medicine taking, obtaining consent and ensuring that the medication is taken as intended. Copyright © 2011 Wiley Interface Ltd

Many profoundly deaf signers have difficulty communicating with hearing people. This article describes a therapy called ‘Strategies and Measurable Interaction in Live English’ (smiLE; Schamroth and Threadgill, 2007a), an approach used to teach deaf children skills to become successful communicators in real-life situations. This study evaluates the effectiveness of smiLE in helping deaf pupils develop their ability to make successful requests in a specific communication situation and whether this generalized to another communication situation. Sixteen severely and profoundly deaf primary school pupils (7.2—11.0 years old) received an 11-week programme of therapy. Their performances in a trained and an untrained communication situation were compared pre- and post-therapy. In the trained task, the pupils’ interactions improved significantly. No differences were found in the untrained task, suggesting that the learnt skills did not generalize. Anecdotal findings suggest that some carry-over into a similar situation had occurred and that trained skills were maintained. The smiLE therapy approach is effective in providing deaf children with the communication skills and confidence to interact with English speakers in targeted situations. The lack of generalization of these skills to similar situations may be overcome by a longer therapy programme that specifically promote these skills across different situations.

Farmers experience higher rates of noise-induced hearing loss (NIHL) than workers in most other industries. We developed a model of farmers' use of hearing protection, and tested it with a random sample (n = 532) of farmers from the upper Midwest. Barriers to using hearing protection (e.g., difficulty communicating; OR = .44, p

Irrespective of theoretical and skills laboratories training, clinical competencies need to be honed through real patient contacts. South African (SA) medical training takes place mainly in tertiary hospitals. Most patients come from disadvantaged backgrounds, are scientifically naïve, have difficulty communicating with medical staff and may be intimidated by their surroundings. These patients may be particularly vulnerable and resigned to insidious paternalism. The question is whether authentic informed consent is actually provided by these patients for their involvement in medical training. Implied consent for this purpose is invalid. I justify the demand for explicit consent on the grounds of ethical and regulative frameworks. The human rights of patients and the dictums of the SA National Health Act and the Health Professions Council of SA should actively be promoted and upheld. I conclude with practical suggestions intended to stimulate debate and action at institutional and clinical departmental levels.

Introduction. Clinical teaching is the means by which student nurses learn to apply the theory of nursing, facilitating integration of theoretical knowledge and practical skills in the clinical setting which becomes the art and science of nursing. Caring is values essential to professional practice and become socialized into the nursing profession. The purpose of this study was to explore nursing students’ experiences of caring for basic nursing skills during clinical practice in Rajawali hospital Bandung. Method. A qualitative research design was used and data were collected by in-depth interview. Six students from third semester who had completion of their fundamental of nursing clinical practice experience. Two instructors as key informants. Result. Analysis of collected information suggested that students do learn about caring in the clinical areas. Information analysis also revealed several common, such as feel fear and anxious, feel disgusted when helping defecation or bathing. Most students get the positive experience such as learning and respect of patients and their families. Most students were afraid to take nursing skills, poor theory-practice integration and feared looking foolish, had difficulty communicating and poor interpersonal relationships with the patients. The professional nurse challenges were to provide the best services and respect to the patients needs. Discussion. The results of the information analysis suggest some implications for nurse educators. Positive learning environments should be developed that enable students to retain clear caring values and to realize the potential of caring practice. Students require time to reflect about their clinical experience in order to integrate the experience with practicing sense of caring professional. Keywords: student nurses, caring, clinical practice

Hearing impairment affects a person’s ability to communicate effectively. People with hearing loss (HL) report difficulty communicating in noise, even when the HL is compensated by conventional amplification. This study aims to investigate factors that contribute to understanding speech in noise. Nine adults with HL and nine controls participated in the study. The test-battery include auditory, cognitive and linguistic tests. For the HL group, auditory stimuli were filtered with NAL-RP prescription to compensate for their HL. Results indicate a significant difference in performance between the groups on the Modulation Detection Threshold (MDT) test [F (1, 15) = 3.24, p =0.04] and the speech recognition in noise test [f (1, 15) = 25.6, p

Technology can improve the life of those with Autistic Spectrum Disorder (ASD). Specifically, some children with ASD are not fortunate enough to acquire the ability to communicate with language on their own. With language being an important method of communication, socialization, and interacting with the world, these children need researchers to develop new solutions to help teach vocalization and speech. Without speech, these children will have difficulty communicating their needs, wants, and emotions, as well as being able to function within society at large. This paper examines the existing HCI research on ASD, as well as proposes a new direction for investigation.

Since the 1980s both the United States and Europe have experienced a simultaneous expansion in social enterprise. However, little has been written comparing and contrasting American and European conceptions of social enterprise resulting in difficulty communicating on the topic and missed opportunities to learn and build on foreign experience. To address this need, this paper compares and contrasts American and European social enterprise through an extensive review of literature from the two regions and discussions with social enterprise researchers on both sides of the Atlantic. It outlines the definitions of social enterprise used by American and European academics and practitioners, identifies historical factors promoting and shaping different conceptions of social enterprise, and highlights the differing institutional and legal environments in which it operates. It concludes by identifying what Americans and Europeans can learn from each others’ experience with social enterprise.

Louis Hartz asked some very important questions in The Liberal Tradition in America. One that seems especially relevant in the aftermath of invasions of Afghanistan and Iraq, and to which I will point only briefly, concerns America's relationship with the rest of the world. Hartz wrote that America's “messianism is the polar counterpart of its isolationism,” and that it had “hampered insight abroad and heightened anxiety at home.” He contended that America had difficulty communicating with the rest of the world because the American liberal creed, even in its Alger form, “is obviously not a theory which other peoples can easily appropriate or understand,” and that absence of the experience of social revolution in America's history lies at the heart of our inability to understand how to lead others. Henry Kissinger contends that, in a post-cold war era, American exceptionalism with its rejection of history, extolling “the image of a universal man living by universal maxims, regardless of the past, of geography, or of other immutable circumstances,” is a kind of innocence ill-suited to successful diplomacy in the emerging world order. We talk a great deal about bringing freedom, democracy, and self-determination to the Middle East, but this hardly seems an apt description of what is happening on the ground. Do we have anything to teach? Hartz, who was quite skeptical about our ability to export the American liberal tradition, might still have something useful to say about our interactions abroad, even in a post-cold war world.

People with dementia living in the community interact with a range of people who provide services to the public. Within these interactions, there may be communication problems associated with symptoms of the person's dementia. Problems include memory loss, difficulty communicating clearly, inability to grasp complex ideas, and problems handling money. This article describes a project that set out to promote training in dementia awareness for public contact staff with the expectation that it would help them better cater to people living with dementia. We worked with a police service, members of a city council, and staff of community pharmacies. This report provides suggestions about appropriate learning outcomes and program content and recommends steps to help others set up similar education programs.

Catatonia is especially concerning in children and adolescents. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of neuroleptic medication or psychotic symptoms, presenting with first-episode catatonia in the presence of disorganized, psychotic thoughts. We then review the catatonia syndrome, citing examples in the literature supporting its underdiagnosis in children and adolescents, and discuss successful treatment modalities. It is important to diagnose and treat catatonia as efficiently as possible, to limit functional and emotional distress to the patient.

Threshold audiometry is currently the foundation of clinical audiology. Yet, many individuals with normal hearing thresholds (NHTs) have difficulty communicating in noisy settings. We previously documented that even among listeners with NHTs and no hearing complaints, large individual differences exist in the ability to perceive subtle temporal features of clearly audible sounds, and to selectively process target speech in the presence of competing sounds. Critically, we find that these suprathreshold differences in individual perceptual sensitivity correlate with physiological measures from the brainstem and auditory nerve. These measures, including brainstem envelope-following responses, auditory brainstem responses, and the middle-ear muscle reflex, show that some perceptually relevant physiological differences arise very early along the auditory pathway. Cochlear synaptopathy—a loss of afferent synapses and nerve terminals innervating the cochlea—is well documented in noise-exposed and aging animals (...

A taxonomy was developed a) to describe surgical procedures with sufficient detail to review differences among surgeons, b) to examine the relationship between individual technique and outcomes, c) to enable surgeons to standardize technique around best practices and d) to identify clinical-evidence-based key points of teaching and assessment for surgical training. Sixty-seven microvascular anastomoses were recorded through video cameras mounted in the dissecting microscope. A hierarchical task analysis was used to decompose the observed procedures into successive levels of detail. The results were then presented to individual and small groups of microvascular surgeons to help define steps and step attributes necessary to describe a procedure so that other surgeons can perform the procedure exactly the same way. Coincidently, it was found that because the surgeons' attention is confined to a very small field of view in which they can see only the veins and arteries and the ends of their instruments, they often have difficulty communicating with others in the operating room. Analyses of selected cases using the proposed taxonomy shows how subtle details are revealed that may affect outcomes, and indicate specific training needs. By comparing different methods and outcomes, it should be possible to identify best practices for given conditions.

Summary Anecdotally, middle-aged listeners report difficulty conversing in social settings, even when they have normal audiometric thresholds [1–3]. Moreover, young adult listeners with "normal" hearing vary in their ability to selectively attend to speech amid similar streams of speech. Ignoring age, these individual differences correlate with physiological differences in temporal coding precision present in the auditory brainstem, suggesting that the fidelity of encoding of suprathreshold sound helps explain individual differences [4]. Here, we revisit the conundrum of whether early aging influences an individual's ability to communicate in everyday settings. Although absolute selective attention ability is not predicted by age, reverberant energy interferes more with selective attention as age increases. Breaking the brainstem response down into components corresponding to coding of stimulus fine structure and envelope, we find that age alters which brainstem component predicts performance. Specifically, middle-aged listeners appear to rely heavily on temporal fine structure, which is more disrupted by reverberant energy than temporal envelope structure is. In contrast, the fidelity of envelope cues predicts performance in younger adults. These results hint that temporal envelope cues influence spatial hearing in reverberant settings more than is commonly appreciated and help explain why middle-aged listeners have particular difficulty communicating in daily life.

Background Stroke symptoms are common among people without a history of stroke or transient ischemic attack; however, it is unknown if particular attention should be focused on specific symptoms for subgroups of patients. Methods Using baseline data from 26,792 REasons for Geographic And Racial Differences in Stroke (REGARDS) participants without a history of transient ischemic attack or stroke, we assessed the association between age, sex, race, current smoking, hypertension, and diabetes and the 6 stroke symptoms in the Questionnaire for Verifying Stroke-Free Status. Results The mean age of participants was 64.4 ± 9.4 years, 40.7% were black, and 55.2% were women. After multivariable adjustment, older persons more often reported an inability to understand (odds ratio [OR] 1.16 per 10 years older age; 95% confidence interval [CI] 1.07-1.25) and unilateral vision loss (OR 1.09; 95% CI 1.01-1.18) and less often reported numbness (OR 0.83; 95% CI 0.79-0.87) and weakness (OR 0.85; 95% CI 0.80-0.90). Women reported difficulty communicating more often than men (OR 1.36; 95% CI 1.19-1.56). The OR for blacks compared to whites for each of the 6 stroke symptoms was increased, markedly so for unilateral numbness (OR 1.97; 95% CI 1.81-2.16), unilateral weakness (OR 1.96; 95% CI 1.76-2.18), and inability to understand (OR 1.87; 95% CI 1.61-2.18). Current smoking, hypertension, and diabetes were associated with higher ORs for each stroke symptom. Conclusions The association of risk factors with 6 individual stroke symptoms studied was not uniform, suggesting the need to emphasize individual stroke symptoms in stroke awareness campaigns when targeting populations defined by risk.

Objective: After the displacement of students following Hurricanes Kat- rina and Rita, schools in several states enrolled many students with po- tential mental health needs. This study sought to understand how schools perceived the mental health needs of these students and what mental health programs they implemented. Methods: Mental health personnel at 19 public schools or school systems and 11 private or parochial schools in Louisiana, Alabama, Texas, and Mississippi were interviewed at two time points (spring and fall-winter of 2006). Results: Schools undertook diverse approaches to interventions, depending on the preexisting mental health infrastructure and personnel, the perceived needs of students, and the barriers or facilitators in each system. Interviewees described a rapid and comprehensive approach to the crisis in the immediate aftermath. Short- ly afterward, some schools perceived little need for mental health servic- es and refocused on their academic missions. Other school systems per- ceived student need but were unable to implement trauma-focused pro- grams because staff were not prepared to deliver such services and fund- ing was lacking. However, some systems and schools were able to imple- ment new programs or extend programs to displaced students. Imple- mentation challenges included difficulty communicating with parents, burnout among staff and program implementers, and efforts to balance the needs of the displaced students with those of the preexisting student population. Conclusions: Despite significant efforts to support students affected by the hurricanes, schools were limited in their ability to imple- ment disaster-focused programs. Extension of crisis plans to include pre- crisis training in mental health programming for students and staff who have ongoing difficulties after a disaster or crisis may be beneficial. (Psy- chiatric Services 58:1339-1343, 2007)

Noise and whole-body vibration measurements were made in the following Canadian Forces vehicles: LAV III, Bison and M113A2 ADATS (air defence anti-tank system). Measurements were made at different crew positions while the vehicles were driven at different speeds over rough terrain and paved roads. The participants completed a questionnaire at the end of each measurement session on their reactions to the noise and vibration. Noise levels were as high as 115 dBA in the ADATS, 102 dBA in the Bison and 96 dBA in the LAV III, exceeding the Canada Labour Code exposure limit of 87 dBA for 8 h(1)). A communications headset was found to be sufficient to reduce the noise exposure to safe levels in most cases. The vector sum vibration magnitudes for the LAV III and Bison were relatively low during highway driving (0.3 m/s(2) for both vehicles) compared to rough terrain (0.71 and 1.36 m/s(2), respectively). The ADATS vibration increased with driving speed (0.62 m/s(2) at 8 km/h and 1.26 m/s(2) at 32 km/h). The questionnaire responses indicated that half the crewmembers had difficulty communicating in vehicle noise, but were generally unaffected physically by vibration. The latter result may have been due to the relatively short exposure duration.

This film is a classic portrayal of a doctor's transformation as a result of his own experience of illness. Like a lot of Hollywood movies, it shows the hero overcoming adversity and coming out a better person; it also a reflection on the different aspects of being a doctor. William Hurt plays Dr Jack McKee, a cardiac surgeon, who is lively and technically competent, but also arrogant, and who has appalling doctor-patient communication skills. Why is it always the surgeons that seem to be this way? Maybe there is some truth in what Dr McKee says on his ward round with his subservient junior staff, that a surgeon needs to be quick and decisive, and that concentrating on the patient's agenda can be distracting. His big fear seems to be that if he becomes sensitive to the patients' needs and fears, he will be paralysed into inactivity. Dr McKee develops an irritating cough, and eventually after coughing up blood he goes to see an ear, nose, and throat surgeon in his own hospital, the glamorous Dr Lesley Abbott. There is brilliant acting here by William Hurt, as he portrays a patient having a laryngoscope shoved down his choking throat and then being told bluntly by Dr Abbott, “You've got a growth, doctor.” She, rather like Margaret Thatcher, seems to feel that she has to be as tough as the men to survive in her professional world. We follow Jack McKee trying to come to terms with his illness, while also carrying on his work as a heart surgeon, and we see just how difficult it is to be both a doctor and a patient, especially when you are playing both roles in the same hospital. The best scenes show the powerlessness and frustrations of being a patient, from nearly being given a barium enema intended for a neighbouring patient, to the endless waiting around and poor staff communication. The film is much less effective when straying away from the medical arena to portray Jack's close relationships. Finding difficulty communicating with his wife, he seeks solace with a fellow radiotherapy patient, who is dying from a brain tumour. Despite being terminally ill, she is beautiful and elegant with her shaven hair, and they run away together, dancing into the sunset in the Nevada desert. Pure Hollywood schmaltz! Jack discards his female ENT surgeon for a more sensitive male colleague whom he had previously ridiculed for being a nerd, but now clearly recognises as the sort of doctor he needs. He survives surgery and the temporary loss of his voice, and is finally reconciled with his long suffering wife. He returns to work as a much more caring and effective doctor, able to successfully combine the technical and human qualities of being a doctor. I use this film extensively when teaching medical students, but it has a lot to teach all doctors, at all stages of their careers.

Introduction Transfer to hospital in the last weeks of life is common for older adults. It is imperative to better understand factors associated with transition to enable older people to remain in their usual place of care. Aim(s) and method(s) To explore possible determinants of transition from home to institutional care settings in last weeks of life. Post-bereavement survey of carers to people aged over 75 who died in 2012 in the South of England (n=883). Main outcome is death at home versus hospital/care home (hospice deaths excluded) for decedents whose usual place of care was home. Exploration of socio-demographic factors and illness factors using multivariate modified Poisson regression. Results 235 decedents spent most of the last 3 months of life at home. The majority died from non-malignant conditions (71.9%) with mean age 86 years. 51.1% died at home and 48.9% transitioned in the last 3 months to a hospital (44.7%) or care home (4.3%). Death outside usual place of care was independently associated with increasing age (85–90 years [PR=3.4; 95% CI 1.9–6.1] compared with 75–80 years), and severity of breathlessness (PR=1.9; 95% CI 1.2–3.4) and difficulty communicating (PR=2.0; 95% CI 1.5–2.8). Conclusion(s) Transition to hospital at the end of life is common for older adults living at home. Transition occurs most frequently for the oldest old and those with severe symptoms of breathlessness and difficulty communicating. To reduce reliance on hospital care at the end of life requires timely services responsive to increasing symptom distress and wider anticipation of end of life for adults of advanced age.

Little is known about how people with pain seek relief. To estimate the proportion of the population reporting recent pain, to identify ways people seek pain relief, and to report the perceived effectiveness of pain relief methods, we conducted a secondary analysis of results from a nationwide survey of the general U.S. population. Of the 1204 respondents, 31% had experienced moderate to very severe pain within the past 2 weeks and 75% of these had sought medical attention. Only 56% of those who sought medical attention got significant pain relief. Although seeking medical attention was the primary pain relief strategy, almost all of those with pain had tried multiple alternative methods for pain control, with 92% of pain sufferers having tried 3 or more alternative strategies. People who did not seek medical attention were more likely to report pain relief from prayer and going to a chiropractor than were those who sought medical attention. Factors leading to inadequate pain relief included difficulty communicating with a health professional and lack of health insurance. People who perceive that their pain is not understood by medical providers and those without health care insurance coverage are at greater risk for poor pain control. Perspective This article presents an analysis of data from a national survey on pain and the effectiveness of ways people seek pain relief. Difficulty communicating with health professionals and lack of health insurance contributed to inadequate pain relief. Almost all people with pain used multiple methods to control their pain.

In an investigation of the impact of family visits on the behavior of 30 residents in dementia special care units, we found on direct observation that agitation decreased significantly during visits, but returned to the previous level within 30 minutes. No significant differences were found between visits by spouses or adult children. The premorbid quality of relationship was unrelated to family visitor enjoyment of visits or to differences between agitation level before and after visits. While 70 percent of visitors reported that they found visits pleasant (mean number of visits: 12.72 per month), 20 percent found visits unpleasant. Visitors' enjoyment or displeasure was significantly related to the difference between the number of pre-visit and post-visit agitated behaviors. Visitors indicated that the resident's mental status (33 percent) or difficulty communicating with the resident (30 percent) had the most negative impact on their visits. However, these factors appear amenable to education, suggesting that the quality of visits can be improved for visitor and resident with possibly greater positive impact on both.