Navigating intercultural misunderstandings: An examination of emotion brokering

OBJECTIVES

Communication difficulties are inevitable when individuals interact with members of a different culture. The experience of such communication barriers may be particularly salient for those from immigrant families who need to navigate multiple cultures. Youth from immigrant families are known to serve as cultural brokers to help their families navigate communication with those in the host culture. Most brokering research has examined language brokering (i.e., interpreting language for others). An unstudied brokering process and the focus of the present research is emotion brokering: the interpretation of emotion norms for others. In this investigation, we examined the occurrence of emotion brokering for close family members in a sample of Latinx college students.

METHOD

We conducted an exploratory survey to identify situations where participants perceived intercultural emotion-based misunderstandings and reported emotion brokering (Study 1). We then employed a more focused survey to further understand the contexts in which individuals brokered emotions (Study 2).

RESULTS

Results revealed that many participants encountered intercultural emotion-based misunderstandings and experienced brokering emotions (Studies 1 and 2). Furthermore, the findings illustrated the typical contexts and emotions involved in the emotion brokering experience.

CONCLUSIONS

The findings provide insight into a distinct form of cultural brokering. In addition, findings illustrate how cultural variation in emotion impacts daily social interactions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parent affective responses to observed adolescent disclosures in the context of type 1 diabetes management

Rates of Type 1 diabetes are rising, and diabetes management often deteriorates during adolescence. Adolescent disclosure to parents is a key factor for effective diabetes management, and parent affective responses to disclosures affect the timing of future disclosures in healthy populations, but no studies to our knowledge have examined parent affective behaviors that facilitate or inhibit disclosure in the context of managing Type 1 diabetes. The present study examined how observed parental affective responses to adolescent disclosures predict the timing of subsequent disclosures during a discussion task in a sample of adolescents with Type 1 diabetes and their parents (N = 66 dyads). Generalized linear mixed models were used to test whether increased or decreased levels of parent affect relative to their emotional baseline response to adolescent disclosures predicted the timing of subsequent disclosures. Adolescents took longer to disclose again when parents responded to prior adolescent disclosures with higher levels of anger and of positive affect relative to their baseline levels of these emotions. Findings suggest that parental affective responses to disclosures have implications for adolescent disclosure in the context of chronic illness management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Maternal psychological control and mother-adolescent conflict discussion quality: Different perceptions are key

Parental psychological control is associated with poor adolescent outcomes, but little research has examined discrepancies between observed and perceived psychological control in predicting conversational outcomes. The present study used a multimethod, multi-informant approach to examine whether independent and joint associations between observer, adolescent, and mother perceptions of maternal psychological control during mother-adolescent conflict discussions were associated with adolescents' and mothers' perceptions of the quality of these conversations. Mother-adolescent dyads (N = 123 dyads) participated in a conflict discussion and subsequently reported on their satisfaction with the process and outcome of the discussion. Mothers' behavior was coded for psychological control and mothers and adolescents separately reported on mothers' psychological control during the discussion. Findings indicate that higher adolescent-perceived psychological control was associated with poorer adolescent- and mother-reported discussion quality controlling for overall relationship discord. Central to our hypotheses, observer, adolescent, and mother perceptions of psychological control significantly interacted with one another to predict discussion quality, though the specific pattern of findings varied across mother- and adolescent-reported discussion quality. Findings suggest that adolescent perceptions of discussion quality are poorest when adolescents attribute psychologically controlling behavior to mothers, particularly when mothers and outside observers report relatively lower levels of psychological control. This study highlights the importance of adolescent perceptions of parents' behavior and of obtaining information about behavior during parent-adolescent conversations from multiple reporters (observers, adolescents, and parents) to develop targeted interventions with parents and adolescents managing conflict. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Empathy as a Flexible and Fundamentally Interpersonal Phenomenon: Comment on “Why we Should Reject the Restrictive Isomorphic Matching Definition of Empathy”

I strongly agree with the AUTHORS’ criticisms of the restrictive isomorphic (RIM) definition of empathy and largely agree with their conceptualization of empathy as a dynamic process best defined by its function. In this commentary, I extend this argument by emphasizing the relational, interpersonal aspects of empathy. It is my view that in order to understand the functions of empathy, we must take into account not only the internal experience of the individual empathizing, but also the individual (or group) whose perspective the empathizer is attempting to take. I highlight how the emotional needs of others are dynamic and require flexible adaptation and underscore the role of context in appreciating the function of empathy.

Horizontal Collectivism Moderates the Relationship Between in-the-Moment Social Connections and Well-Being Among Latino/a College Students

Sleep problems and poorer well-being may be particularly salient for Latino/a college students as they tend to experience sociocultural adjustments during this transitory time. Social connections, a correlate of health, change moment-to-moment for college students and may be experienced differently for people who more strongly endorse horizontal collectivist cultural values. We used ecological momentary assessment (EMA) to examine how in-the-moment social connections influence in-the-moment health, and how horizontal collectivism moderates the moment-to-moment associations. Self-identified Latino/a college students (n = 221) completed a demographic information and cultural values questionnaire and then responded to EMA measures on their social connections, affective and subjective well-being, and sleep for 14 consecutive days. Better in-the-moment social connections associated with better health. Horizontal collectivism moderated some, but not all associations between social connections and health. Social connections are multidimensional and differently predict in-the-moment health among Latino/a college students who more strongly endorse horizontal collectivistic values. We discuss implications for identifying vulnerable well-being moments among this understudied population.

Parents' Empathic Accuracy: Associations With Type 1 Diabetes Management and Familism

OBJECTIVE

To (1) test associations between parents' empathic accuracy for their adolescents' positive and negative emotions and adolescents' physical and mental health (HbA1c, diabetes self-care, and depressive symptoms) in a predominantly Latinx sample of adolescents with type 1 diabetes and their parents, and (2) explore how familism values were associated with parent empathic accuracy and adolescent physical and mental health in this population.

METHODS

Parents and adolescents engaged in a discussion about a topic of frequent conflict related to the adolescents' diabetes management. Parents and adolescents subsequently completed a video recall task in which they rated their own and their partner's emotions once per minute; parents' empathic accuracy was calculated from an average discrepancy between parent and adolescent ratings of the adolescent's emotions. Adolescents reported on their depressive symptoms and both parents and adolescents reported on adolescents' diabetes self-care and their own familism values; HbA1c was obtained from medical records.

RESULTS

Results from structural equation modeling revealed that parents' empathic accuracy for adolescents' negative (but not positive) emotions was uniquely associated with adolescents' HbA1c, self-care, and depressive symptoms. There was limited evidence that familism was related to parent empathic accuracy or adolescent physical and mental health.

CONCLUSIONS

Promoting parents' empathic accuracy for adolescents' negative emotions in the context of type 1 diabetes management may have important implications for adolescents' mental and physical health.

Associations Between Sleep and Mental Health Among Latina Adolescent Mothers: The Role of Social Support

Adolescent mothers experience poorer sleep than adult mothers, and Latina adolescent mothers are at greater risk of postpartum depression compared with other racial/ethnic groups. However, social support may be protective against the negative effects of poor sleep in this population. The current study examined (1) associations between the quality and quantity of Latina adolescent mothers’ sleep and mental health (depressive symptoms and anxiety), and (2) whether social support buffered the effects of poor sleep on mental health. A sample of Latina adolescent mothers (N = 84) from an agricultural region in the United States reported on their sleep duration/quality, social support from family, friends, and significant others, and their depressive and anxiety symptoms. Results showed that adolescent mothers reported poorer sleep than pediatric recommendations, and poorer sleep quality was associated with greater depressive and anxiety symptoms. Interestingly, when adolescent mothers reported better sleep, they had fewer depressive symptoms in the context of high support from friends compared with low support from friends. Sleep is important for mental health in Latina adolescent mothers, and better sleep combined with strong social support has positive associations with mental health in this population. Findings hold implications for improving mental health in adolescent mothers.

Parent-Child Conflict Profiles in Chinese American Immigrant Families: Links to Sociocultural Factors and School-Age Children's Psychological Adjustment

Research suggests that parent-child conflict is a salient family process in Asian immigrant families and often a stressful experience for Asian American youth due to value discrepancies between Asian and Western cultures. The present study examined ratings of parent-child conflict across conflict topics from parents' and children's perspectives in a sample of Chinese American immigrant families with school-age children (N = 239; age = 7.5-11 years). Latent profile analyses identified three parent-rated conflict profiles and four child-rated conflict profiles. Parent and child conflict profiles were unrelated to each other and differentially related to family sociocultural factors and children's psychological adjustment. Parents' moderate conflict profile scored highest on parent-rated child behavior problems and had the highest household density and lower parent Chinese orientation. Children's moderate-specific and high conflict profiles scored higher on child-reported behavior problems than the low conflict profile. These results highlight the need to assess family conflict from both parents' and children's perspectives and target parent-child conflict communication as a pathway to prevent or reduce behavioral problems in Chinese American children of immigrant families.

Relational Goes Beyond Interpersonal: The Development of Empathy in the Context of Culture

It is clear a relational approach to the study of empathy is gaining traction across multiple disciplines. Both commentaries on “A Relational Framework for Integrating the Study of Empathy in Children and Adults” underscored the need to expand the relational framework of empathy to incorporate the broader social and cultural context in which children and adults live. In the present reply we outline some specific ways that culture can inform the study of empathy in interpersonal contexts. We focus on how culture and context shape the meaning of empathy and its expression and highlight how a within-culture approach to the study of empathy will advance our understanding of this nebulous construct.

Mother-adolescent emotion dynamics during conflicts: Associations with perspective taking

Parent-adolescent emotion dynamics are central to psychosocial adjustment during this developmental period. Perspective taking-the ability to take another's point of view into consideration-develops significantly during adolescence and is important for successful interpersonal functioning in contexts such as conflicts between family members. We used grid-sequence analysis (Brinberg, Fosco, & Ram, 2017) to examine interdyad differences in mother-adolescent emotion dynamics during a conflict discussion, and whether interdyad differences were associated with maternal and adolescent perspective taking. Mothers and their typically developing adolescents (N = 49, M_age = 14.84 years) were video-recorded during a 10-min conflict discussion. We identified patterns of multistep chains of expressed emotions that unfolded during the conflict and how interdyad differences in those patterns were associated with maternal and adolescent perspective taking. Dyads differed with respect to whether they showed turn taking in validation and interest behaviors, or whether they showed patterns of reciprocated negative affect. Higher adolescent but not maternal perspective taking was associated with dyadic turn taking of validation and interest. Maternal and adolescent perspective taking were not associated with the pattern of reciprocated negative affect. Taken together, results highlight the importance of examining the complex process of emotion dynamics in parent-adolescent interactions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Relational Framework for Integrating the Study of Empathy in Children and Adults

The development of empathy is central to positive social adjustment. However, issues remain with integrating empathy research conducted with children, adolescents, and adults. The current article (a) provides an overview of how empathy is typically conceptualized and measured in child development and adult research, (b) describes outstanding issues concerning child development and adult research on empathy, and (c) outlines how a relational approach can provide clarity regarding how empathy develops over the course of development. We conclude by offering suggestions for future research on the development of empathy across the lifespan.

Intrusive Parenting in Chinese American Immigrant Families: Relations with Cultural Orientations and Children's Adjustment

This multi-method study examined associations between observed and parent- and child-reported intrusive parenting, parent and child cultural orientations, and children's adjustment in a socioeconomically diverse sample of Chinese American immigrant families. Participants were 239 Chinese American school-aged children (M age = 9.19 years, range = 7.49 to 10.96 years) and their parents from first- and second-generation immigrant families. Parents and children reported on parents' intrusive parenting, their own cultural orientations, and parents and teachers reported on children's internalizing and externalizing problems. Observed intrusive parenting behaviors were coded from videotaped parent-child conflict discussions. Findings from path analysis indicated that there was a unique positive association between child Chinese orientation and child-reported intrusive parenting, a unique negative association between parents' American orientation and child reported intrusive parenting, and a unique positive association between child American orientation and observed intrusive parenting. Intrusive parenting was negatively associated with child adjustment, but associations varied depending on measurement. Findings suggest that different measures of intrusive parenting are differentially associated with children's adjustment in Chinese American immigrant families.

Timing of adolescent emotional disclosures: The role of maternal emotions and adolescent age

Adolescent disclosure is a positive feature of parent-adolescent relationships, though disclosure to parents typically declines across adolescence. However, little is known about parental emotions that facilitate or inhibit real-time adolescent disclosures about their emotions and how parents respond to such disclosures during parent-adolescent interactions. The present study tested (1) whether maternal emotions were associated with the time to adolescents' spontaneous emotional disclosures and (2) whether these associations varied as a function of adolescent age. Adolescents (N = 49, M_age = 14.84 years) and their mothers participated in a 10-min conflict discussion. Adolescent emotional disclosures and maternal emotions were coded moment-to-moment. Results from survival analysis demonstrated that older adolescents whose mothers expressed high levels of negative affect or high levels of validation were more likely to make emotional disclosures earlier in the discussion than were older adolescents whose mothers expressed low negative affect or low validation. There were no differences in associations between maternal emotions and the timing of emotional disclosures for younger adolescents. Findings suggest that a range of maternal emotions (validation and negative affect) might be features of high-quality mother-adolescent relationships in older adolescence, when parent-adolescent relationships are more egalitarian and negative emotions may be more readily expressed. Implications for applying observational methodologies and dynamic statistical techniques to the adolescent disclosure literature are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Adolescent Information Management and Parental Knowledge in Non-Latino White and Latino Youth Managing Type 1 Diabetes

Objectives

The objective of this study is to examine associations between adolescents' regulation of information about their type 1 diabetes (adolescent disclosure, secrecy), parental knowledge about their adolescent's diabetes management, diabetes outcomes (adherence, HbA1c), and depressive symptoms in Non-Latino White and Latino families.

Methods

In all, 118 adolescents (56 = Latino, 62 = Non-Latino White) completed surveys of disclosure to and secrecy from parents, parental knowledge of adolescent diabetes management, adherence, and depressive symptoms, and mothers completed measures of maternal knowledge and adolescent adherence. Glycemic control was extracted from medical records. Adolescents also completed structured interviews about parental knowledge about their diabetes-related problems.

Results

Interviews revealed that adolescent disclosure is the primary method by which parents gain knowledge about adolescent diabetes management problems. Adolescent disclosure to and secrecy from parents were uniquely associated with diabetes management and depressive symptoms independent of parental knowledge across ethnic groups; maternal reports of knowledge about her adolescent's diabetes care activities were associated with diabetes management independent of adolescent disclosure and secrecy.

Conclusions

Adolescent information management strategies are a primary means by which parents gain knowledge about diabetes, which may facilitate more effective management.

The Interpersonal Functions of Empathy: A Relational Perspective

Empathy is an extensively studied construct, but operationalization of effective empathy is routinely debated in popular culture, theory, and empirical research. This article offers a process-focused approach emphasizing the relational functions of empathy in interpersonal contexts. We argue that this perspective offers advantages over more traditional conceptualizations that focus on primarily intrapsychic features (i.e., within the individual). Our aim is to enrich current conceptualizations and empirical approaches to the study of empathy by drawing on psychological, philosophical, medical, linguistic, and anthropological perspectives. In doing so, we highlight the various functions of empathy in social interaction, underscore some underemphasized components in empirical studies of empathy, and make recommendations for future research on this important area in the study of emotion.

Adolescent Disclosure to Parents and Daily Management of Type 1 Diabetes

Objective

To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management.

Methods

A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters.

Results

Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence).

Conclusions

Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.

An exploratory analysis of emotion dynamics between mothers and adolescents during conflict discussions

Dynamic patterns of influence between parents and children have long been considered key to understanding family relationships. Despite this, most observational research on emotion in parent-child interactions examines global behaviors at the expense of exploring moment-to-moment fluctuations in emotions that are important for relational outcomes. Using recurrence quantification analysis (RQA) and growth curve analysis, this investigation explored emotion dynamics during parent-adolescent conflict interactions, focusing not only on concurrently shared emotional states but also on time-lagged synchrony of parents' and adolescents' emotions relative to one another. Mother-adolescent dyads engaged in a 10-min conflict discussion and reported on their satisfaction with the process and outcome of the discussion. Emotions were coded using the Specific Affect Coding System (SPAFF) and were collapsed into the following categories: negativity, positivity, and validation/interest. RQA and growth curve analyses revealed that negative and positive emotions were characterized by a concurrently synchronous pattern across all dyads, with the highest recurrence rates occurring around simultaneity. However, lower levels of concurrent synchrony of negative emotions were associated with higher discussion satisfaction. We also found that patterns of negativity differed with age: Mothers led negativity in dyads with younger adolescents, and adolescents led negativity in dyads with older adolescents. In contrast to negative and positive emotions, validation/interest showed the time-lagged pattern characteristic of turn-taking, and more highly satisfied dyads showed stronger patterns of time-lagged coordination in validation/interest. Our findings underscore the dynamic nature of emotions in parent-adolescent interactions and highlight the important contributions of these moment-to-moment dynamics toward overall interaction quality. (PsycINFO Database Record

Chinese American immigrant parents' emotional expression in the family: Relations with parents' cultural orientations and children's emotion-related regulation

The present study examined 2 measures of Chinese American immigrant parents' emotional expression in the family context: self-reported emotional expressivity and observed emotional expression during a parent-child interaction task. Path analyses were conducted to examine the concurrent associations between measures of emotional expression and (a) parents' American and Chinese cultural orientations in language proficiency, media use, and social affiliation domains, and (b) parents' and teachers' ratings of children's emotion-related regulation. Results suggested that cultural orientations were primarily associated with parents' self-reported expressivity (rather than observed emotional expression), such that higher American orientations were generally associated with higher expressivity. Although parents' self-reported expressivity was only related to their own reports of children's regulation, parents' observed emotional expression was related to both parents' and teachers' reports of children's regulation. These results suggest that self-reported expressivity and observed emotional expression reflect different constructs and have differential relations to parents' cultural orientations and children's regulation.

Secrecy From Parents and Type 1 Diabetes Management in Late Adolescence

OBJECTIVES

This study examined (a) associations of parent-adolescent relationship characteristics and adolescent problem behavior with late adolescents' secrecy from parents about type 1 diabetes management, and (b) whether secrecy was associated with diabetes and psychological outcomes independently of these factors.

METHODS

Adolescents (N = 247, Mage = 17.76 years) completed survey measures of diabetes-related secrecy from parents, disclosure, parental acceptance, parental knowledge, and conduct problems. Mothers and adolescents reported on adolescent adherence to diabetes regimens and adolescents reported their depressive symptoms. Glycemic control was obtained from HbA1c test kits.

RESULTS

Adolescent-reported disclosure to parents was uniquely negatively associated with secrecy from parents. Controlling for relationship variables, conduct problems, and sociodemographic and illness-related variables, secrecy from mothers was uniquely associated with poorer glycemic control and secrecy from both parents was associated with lower adherence.

CONCLUSIONS

Secrecy about type 1 diabetes management is uniquely associated with diabetes outcomes independent of other relationship characteristics and problem behaviors.

Neighborhood characteristics, parenting styles, and children's behavioral problems in Chinese American immigrant families

Using data from a socioeconomically diverse sample of Chinese American children (n = 258, aged 6-9 years) in immigrant families, we examined the concurrent relations among neighborhood economic disadvantage and concentration of Asian residents, parenting styles, and Chinese American children's externalizing and internalizing problems. Neighborhood characteristics were measured with 2000 U.S. Census tract-level data, parents (mostly mothers) rated their own parenting styles, and parents and teachers rated children's behavioral problems. Path analysis was conducted to test two hypotheses: (a) parenting styles mediate the relations between neighborhood characteristics and children's behavioral problems, and (b) children's behavioral problems mediate the relations between neighborhood and parenting styles. We found that neighborhood Asian concentration was positively associated with authoritarian parenting, which in turn was associated with Chinese American children's higher externalizing and internalizing problems (by parents' reports). In addition, neighborhood economic disadvantage was positively related to children's externalizing problems (by parents' reports), which in turn predicted lower authoritative parenting. The current results suggest the need to consider multiple pathways in the relations among neighborhood, family, and child adjustment, and they have implications for the prevention and intervention of behavioral problems in Chinese American children.

Performance of the LHCb RICH detector at the LHC

The LHCb experiment has been taking data at the Large Hadron Collider (LHC) at CERN since the end of 2009. One of its key detector components is the Ring-Imaging Cherenkov (RICH) system. This provides charged particle identification over a wide momentum range, from 2-100 GeV/c. The operation and control, software, and online monitoring of the RICH system are described. The particle identification performance is presented, as measured using data from the LHC. Excellent separation of hadronic particle types (π, K, p) is achieved.

Parent-child cultural orientations and child adjustment in Chinese American immigrant families

Direct and indirect/mediated relations of (a) children's and parents' cultural orientations and (b) parent-child gaps in cultural orientations to children's psychological adjustment were examined in a socioeconomically diverse sample of 258 Chinese American children (age = 6-9 years) from immigrant families. Parents reported on children's and their own Chinese and American orientations in language proficiency, media use, and social relationships. Parents and teachers rated children's externalizing and internalizing problems and social competence. Using structural equation modeling, we found evidence for both the effects of children's and parents' cultural orientations and the effects of parent-child gaps. Specifically, children's American orientations across domains were associated with their better adjustment (especially social competence). These associations were partly mediated by authoritative parenting. Parents' English and Chinese media use were both associated with higher authoritative parenting, which in turn was associated with children's better adjustment. Furthermore, greater gaps in parent-child Chinese proficiency were associated with children's poorer adjustment, and these relations were partly mediated by authoritative parenting. Together, the findings underscore the complex relations between immigrant families' dual orientations to the host and heritage cultures and children's psychological adjustment.

Reconceptualizing Emotion Regulation

Emotion regulation is one of the major foci of study in the fields of emotion and emotional development. This article proposes that to properly study emotion regulation, one must consider not only an intrapersonal view of emotion, but a relational one as well. Defining properties of intrapersonal and relational approaches are spelled out, and implications drawn for how emotion regulation is conceptualized, how studies are designed, how findings are interpreted, and how generalizations are drawn. Most research to date has been conducted from an intrapersonal perspective, and the shortcomings of this approach for understanding emotion regulation are highlighted. The article emphasizes major conceptual and methodological steps required for a fuller description of the process of emotion regulation.

Management by nurses of primary headache: a pilot study

Primary headache is a very common condition and one that nurses encounter in many different care settings. Yet there is a lack of evidence as to whether advice given to sufferers is effective and what improvements may be expected in the condition. The aim of this study was to evaluate the advice given by a nurse to primary headache sufferers. The design was quasi-experimental. An experimental group (n = 19) and a control group (n = 25) of primary headache sufferers had their headache parameters of frequency, severity duration and disability (Migraine Disability Assessment) over the previous six months assessed. The experimental group then received advice in the form of health education from a nurse. Both groups kept a headache diary for six months. After six months both groups had their headache parameters assessed again. Compared to the control group, there was a significant reduction in the severity of headaches experienced by the experimental group (p = 0.006). Although there were reductions in frequency and duration of headaches experienced by the experimental group compared to the control group, these were not significant (p = 0.664 and p = 0.235, respectively). The Migraine Disability Assessment showed a trend towards reduced scores in the experimental group compared to controls which were not significant (p = 0.535). This pilot study suggests that health education can be effective in reducing the severity of headaches. However, a larger study over a longer period is needed to evaluate improvements in headache parameters.

The wavelength of light causing photophobia in migraine and tension-type headache between attacks

OBJECTIVE

To ascertain the wavelength of light that patients with migraine and tension-type headache find uncomfortable between attacks.

BACKGROUND

Photophobia is an abnormal perceptual sensitivity to light experienced by most patients with headache during and, also, between attacks.

METHODS

We examined the discomfort threshold to light of low, medium, and high wavelengths in a group of patients with migraine (n=21), patients with tension-type headache (n=19), and healthy controls (n=21).

RESULTS

The results indicate that the migraine group had significantly lower discomfort thresholds at the low (P=.001) and high (P=.031) wavelengths compared with both the tension-type headache and control groups; the latter two groups had similar average discomfort levels at these two wavelengths. With the medium wavelength, the control group had significantly higher discomfort thresholds than the migraine (P=.002) and tension-type headache (P=.031) groups; the latter two groups had similar discomfort levels at this wavelength. With unfiltered (white) light, the migraine group had the lowest discomfort threshold and the control group the highest (P=.026), whereas the tension-type headache group had an intermediate discomfort threshold.

CONCLUSIONS

There were significant differences between migraineurs, patients with tension-type headache, and healthy controls in the wavelengths that are uncomfortable between attacks.

Electropalatography and the Linguagraph system

This paper describes the technique of electropalatography and the development of Linguagraph, which is a user-friendly, clinical instrument, for measurement of tongue/palate contact, during speech. Linguagraph allows objective assessment of tongue function; appropriate targeting of therapy is therefore possible. Visual feedback is also provided, for therapy, and an objective measurement of outcome is easily obtained. Linguagraph was used, for both therapy and assessment, in a clinical trial. Technical aspects of Linguagraph and of the trial results are presented here. These suggest that the instrument will prove useful in the assessment and management of many speech disorders. Full clinical details of the trial are reported elsewhere.

An instrument for the multiparameter assessment of speech

This paper describes the development of SNORS+, a clinical, user-friendly instrument for measurement of the articulators during speech. The design criteria for the instrument were based upon a wide-ranging review of current practice and available techniques. SNORS+ allows objective assessment of the function and co-ordination of key articulators. Appropriate targeting of therapy is therefore possible. Visual feedback is provided, for therapy, and an objective measurement of outcome is easily obtained. Preliminary results are presented. These suggest that the instrument will prove extremely useful in the assessment and management of many speech disorders.

Instrumental assessment and treatment of hypernasality, following maxillofacial surgery, using SNORS: a single case study

The super nasal oral ratiometry system (SNORS) is a commercially available system which measures both nasal and oral airflow during speech, allowing the very rapid movement of the velum to be measured. SNORS uses a modified oxygen mask, which houses the airflow sensors and microphones, and a standard personal computer. By calculating nasalance (the percentage of airflow that is nasal), an estimation of velopharyngeal closure, which is independent of speech intensity, is achieved. SNORS can be used for objective assessment, where the subject is required to speak a number of words selected to demonstrate velopharyngeal function. SNORS also provides biofeedback, using a simple realtime display of nasal and oral airflow. Velopharyngeal insufficiency (VPI) is the inability to make adequate velpharyngeal closure, and may be the result of either neurological or, as in this case, structural abnormalities. It results in abnormal speech characteristics, such as omissions, substitutions or weak articulation of consonants, and hypernasality. T.W., a 52 year old male, had very hypernasal speech following extensive maxillofacial surgery, for the removal of a tonsillar carcinoma. SNORS was successfully used as both an assessment and a therapy tool in the treatment of this patient. The effectiveness of conventional speech and language therapy vs. SNORS biofeedback therapy was compared. Initially, while there was some movement of the velum, the patient could not achieve velopharyngeal closure. Conventional therapy aimed to strengthen and improve the function of the velum and following this there was some minimal improvement: the patient could now achieve, but not maintain, closure. Reassessment, following a non-treatment period, showed little further change. SNORS biofeedback therapy was then given. This raised the patient's awareness of his velopharyngeal function, thus helping him to maintain closure, thereby reducing hypernasality. SNORS therapy proved significantly more effective than conventional speech and language therapy, in this case. Further intervention is outlined, and the benefits of multiparameter assessment of speech are discussed.

Photophobia and phonophobia in migraineurs between attacks

This study investigated whether migraineurs are more sensitive to light and sound while headache-free than are healthy people. Fifty-two migraineurs (mean age 39 years) were selected using the International Headache Society diagnostic criteria for migraine. Forty-eight healthy controls were matched for age, sex, and race (mean age 36 years). Visual and auditory discomfort thresholds were measured by exposing subjects to increasing light and sound until they complained of discomfort. There were significant differences between groups in both the light discomfort threshold (P < 0.00005) and the hearing discomfort threshold (P < 0.0005). The thresholds for both were lower in the migraineurs. Overall, for both groups together, there was a significant negative correlation between light discomfort threshold and age (correlation coefficient -0.2276, P = 0.011), but not for the hearing discomfort threshold and age (P = 0.275). The results show that the migraineurs were significantly more sensitive to light and sound when headache-free than were healthy controls. The apparent increased intolerance to light in both groups together noted with increased age, did not apply to the migraine group.

Interpleural analgesia in the management of esophageal perforation

BACKGROUND AND OBJECTIVES

Interpleural analgesia was used in a case of esophageal perforation due to surgical mishap. The medical literature cites no reference to use of this technique in this condition.

METHOD

Interpleural bupivacaine analgesia was used along with conventional forms of pain relief.

RESULTS

Superior analgesia was obtained, and the method proved to be safe and complication free on a general surgical ward over the period of several days that it was used.

CONCLUSION

Interpleural analgesia is safe and effective for management of pain due to esophageal perforation.

Casemix for the elderly inpatient: Resource Utilization Groups (RUGs) validation project. Casemix for the Elderly Inpatient Working Group

Current methods of contracting for patient treatment in the health service are not suitable for elderly patients with multiple pathology and functional impairment. This study examines Resource Utilization Groups (RUGs) for use in geriatric medicine in England and Wales, based on 1675 patients from 26 hospitals in eight health districts in England and Wales. Nurses completed a questionnaire on the clinical characteristics of patients required to allocate them to one of 44 RUG groups. Nurse/patient contact times were recorded over a 24-hour period. Therapist/patient contact times were recorded for a week. Data were analysed using analysis of variance with time as independent and RUG group as dependent variable. Variance explanation in excess of 45% was achieved in acute and rehabilitation wards. In long-stay wards, variance explanation (23%) was no better than ADL score alone. RUG-III could form the basis of a casemix system for geriatrics in England and Wales in acute and rehabilitation settings.