Uso da história em quadrinhos como ferramenta de divulgação do conhecimento sobre Anisakis spp. e formas de prevenção da anisaquíase, em evento de divulgação científica / Use of comics as a tool to disseminate knowledge about Anisakis spp. and ways of preventing anisakiasis, in a scientific divulgation event / Uso del cómic como herramienta para difundir conocimientos sobre Anisakis spp. y formas de prevenir la anisakiasis, en un evento de divulgación científica

As narrativas visuais, como os quadrinhos, são ferramentas populares que podem contribuir para a edu-cação e a comunicação científica para diferentes públicos. Dentro dessa perspectiva, este trabalho discute o uso de quadrinhos na disseminação do conhecimento sobre a segurança alimentar de peixes em um evento de divulgação científica. Para a ocasião, foi criada uma história, que enfatizou o conceito sobre Anisakisspp. e as metodologias de prevenção da anisaquíase. O enredo envolveu participantes de todas as idades, sugerindo fortemente que os quadrinhos são cativantes e funcionam como uma ferramenta de aprendizado, podendo contribuir para a alfabetização científifica da população, levando à promoção da saúde em níveis individual e coletivo. Destaca-se aqui a importância da produção de novos conhecimentos, que ampliem o diálogo das áreas da saúde, da ciência e da tecnologia com a sociedade. Além disso, torna-se urgente aumentar os investimentos e promover a formação avançada e continuada de divulgadores da ciência.

Visual narratives, like comics, are popular tools that can contribute to science education and communi-cation for different audiences. Within this perspective, this work discusses the use of comics in the dis-semination of knowledge about fish food safety in a scientific dissemination event. For the occasion, a story was created, which emphasized the concept of Anisakis spp. and methodologies for the prevention of anisakiasis. The plot involved participants of all ages, strongly suggesting that comics are captivating and function as a learning tool, which can contribute to the scientific literacy of the population, leading to health promotion at an individual and collective levels. We highlight the importance of producing new knowledge that expands the dialogue between the areas of health, science and technology with society. Furthermore, it is urgent to increase investments and promote advanced and continuous training for science disseminators

Las narrativas visuales, como los cómics, son herramientas populares que pueden contribuir a la educación científica y la comunicación para diferentes públicos. Dentro de esta perspectiva, este trabajo discute el uso de las historietas en la difusión del conocimiento sobre la seguridad alimentaria de los peces en un evento de divulgación científica. Para la ocasión, se creó una historia, que enfatizó el concepto de Anisakis spp. y las metodologías para la prevención de la anisakiasis. La trama involucró a participantes de todas las edades, lo que sugiere fuertemente que los cómics son cautivadores y funcionan como una herramienta de aprendiza-je, que puede contribuir a la alfabetización científica de la población, lo que lleva a la promoción de la salud a los niveles individual y colectivo. Se destaca aquí la importancia de producir nuevos conocimientos, lo que amplía el diálogo entre las áreas de la salud, la ciencia y la tecnología con la sociedad, además, es urgente incrementar las inversiones y promover la formación avanzada y continua de los divulgadores de la ciencia

Severe Acute Malnutrition in Tribal Under-Five children in Javvadu Hills, Tamil Nadu

Background: Severe acute malnutrition (SAM) in under-5 children is an important public health problem that is associated with high mortality and long-term health consequences. Globally, 26 million children suffer from SAM, of these more than 8.1 million children are in India. National Family Health Survey-4 indicates a higher prevalence of SAM (7.5%) in the general population than the previous report (6.4%). Indeed the burden of malnutrition is expected to be higher among the tribal children in India. Hence this study aimed to explore the Severe Acute Malnutrition among the tribal under-five children in Javvadu Hills of Tamil Nadu. Methods: A community-based cross-sectional survey was conducted among 450 tribal under-five children and mothers residing in Javvadu Hills in Thiruvannamalai District, Tamil Nadu from September 2019 to Feb 2020 using PPS-Cluster sampling technique with semi-structured questionnaire with anthropometric measurements. Data were analyzed using SPSS. Chi-square test and logistic regression were used. Results: Out of 450 children, about 42(9.3%) had weight-for-Ht (M<-3S.D.) suggestive of SAM. Among those with SAM, 71% were females. About 66% had low birth weight, 79% were Anemic, 81% had calorie and protein inadequacy, 88.1% were partially immunized and 88% had food insecurity and 78% had the recurrent illness. Maternal illiteracy, poor awareness of nutrition, Food insecurity and poor access to health facilities were significant factors in SAM. Conclusions: SAM is highly prevalent among tribal children, a serious threat to child survival and morbidity. Improving literacy, Socioeconomic status, nutritional awareness, food security, health-seeking behaviour will alleviate this public health problem.

Analfabetismo da população brasileira nas análises de Giorgio Mortara sobre o censo de 1940 / Illiteracy of the Brazilian population in Giorgio Mortara's analyses of the 1940 census / Analfabetismo de la población brasileña en los análisis de Giorgio Mortara sobre el censo de 1940

Resumo Este artigo apresenta análises de Giorgio Mortara sobre as informações do recenseamento populacional brasileiro realizado em 1940 referentes especificamente ao analfabetismo no Distrito Federal (Rio de Janeiro) e no município de São Paulo. Mortara nasceu na Itália, onde se formou e se estabeleceu como reconhecido estatístico, e, em 1939, mudou-se para o Brasil, tendo colaborado decisivamente na constituição do IBGE (Instituto Brasileiro de Geografia e Estatística) e na produção demográfica brasileira. Vários de seus estudos dedicam-se à análise dos resultados dos levantamentos censitários brasileiros e são amplamente citados e conhecidos no país. No presente artigo, contudo, o foco são algumas análises elaboradas pelo autor sobre o analfabetismo, publicadas em 1945 na Revista Brasileira de Estudos Pedagógicos, que são pouco citadas na literatura sobre o tema. Nesses estudos, o autor identifica aspectos e tendências que ainda não compunham o repertório analítico no período. São os casos da observação do alfabetismo mais acentuado nas gerações mais jovens, da tendência de menor índice de analfabetismo entre as meninas e das diferenças de índice em relação à categoria cor.

Abstract This article presents analyses by Giorgio Mortara on the information from the Brazilian population census carried out in 1940 referring specifically to illiteracy in the Federal District (Rio de Janeiro) and in the municipality of São Paulo. Mortara was born in Italy, where he graduated and established himself as a recognized statistician, and in 1939 moved to Brazil, where he significantly contributed to the constitution of the IBGE (Brazilian Institute of Geography and Statistics) and to Brazilian demographic studies. Several of his studies are devoted to the analysis of results of the Brazilian census surveys and are widely cited and well known in the country. This article, however, focuses on some analyses elaborated by the author regarding illiteracy, which were published in the Revista Brasileira de Estudos Pedagógicos in 1945 and are rarely mentioned in the literature on the subject. In these studies, the author identifies aspects and trends that had not yet become part of the analytical repertoire in the period. This is the case of the observation of more pronounced literacy in younger generations, the lower illiteracy rate trend among girls and the index differences regarding the color category.

Resumen Este artículo presenta el análisis de Giorgio Mortara sobre las informaciones del censo poblacional brasileño de 1940 referentes específicamente al analfabetismo en el distrito federal de Rio de Janeiro y en el municipio de São Paulo. Mortara nació en Italia, donde se formó y se estableció como reconocido estadístico, y en 1939 se mudó a Brasil, para colaborar decisivamente en la constitución del Instituto Brasileño de Geografía e Estadística (IBGE) y en la producción demográfica brasileña. Varios de sus estudios se dedican al análisis de los resultados de los censos brasileños y son ampliamente citados y conocidos en el país. En el presente artículo, sin embargo, el foco se pone en algunos análisis del autor que se refieren al analfabetismo, que fueron publicados en la Revista Brasileira de Estudos Pedagógicos en 1945 y de los que se encuentra poca referencia en la literatura sobre el tema. En estos estudios, el autor identifica aspectos y tendencias que aún no componían el repertorio analítico en el período, como la observación del alfabetismo más acentuado en las generaciones más jóvenes, de la tendencia de menor índice de analfabetismo entre las niñas y de las diferencias de índice en relación a la categoría color.

Consciência fonológica, nomeação automática rápida e leitura em adultos analfabetos funcionais / Phonological awareness, rapid automatized naming, and reading of functionally illiterate adults

RESUMO Objetivo O presente estudo tem como objetivo descrever o perfil de adultos analfabetos funcionais em tarefas de leitura, consciência fonológica (CF), e nomeação automática rápida (NAR); bem como correlacionar o desempenho dessas tarefas. Além disso, buscou-se compreender quanto que o desempenho em CF e NAR predizem o resultado em leitura de palavras e pseudopalavras. Método Foram avaliados 23 adultos analfabetos funcionais em tarefas de inteligência, leitura, CF e NAR. Resultados Os participantes apresentaram dificuldades em CF, tendo pobre desempenho em tarefas que envolviam análise e manipulação de fonemas. Em NAR, apresentaram maior facilidade na nomeação de itens alfanuméricos. Em relação à leitura, houve dificuldades no processamento fonológico, apresentando erros por troca fonológica. Análises de correlação indicaram que a leitura apresentou maiores correlações com NAR do que com CF. Por fim, a análise de regressão indicou que o desempenho em NAR é capaz de explicar mais da metade do resultado em leitura dos participantes. Conclusão De modo geral, o perfil dos adultos analfabetos funcionais se caracteriza por apresentar prejuízos nas habilidades avaliadas, sendo esses prejuízos mais evidentes em CF ao nível dos fonemas, bem como na nomeação de itens não-alfanuméricos. Além disso, os resultados em NAR explicam melhor os resultados de leitura de palavras e pseudopalavras do que os resultados em CF.

ABSTRACT Purpose The study's purpose is to describe the cognitive profile of a sample of functionally illiterate individuals in reading, phonological awareness (PA) and rapid automatized naming (RAN), as well as to correlate the performance of these tasks. Moreover, it sought to understand how the performances in PA and RAN predict results in reading of words and pseudowords. Methods 23 functionally illiterate adults were assessed for intelligence, reading, PA and RAN tasks. Results Participants showed difficulties in PA, performing poorly in tasks involving phoneme analysis and manipulation. In RAN, they found it easier to name alphanumeric items. Regarding reading, they presented difficulties in phonological processing, with errors caused by phonological exchange. Correlation analyses indicated that reading presented higher correlations with RAN than PA. Finally, a regression analysis indicated that performance in RAN can account for more than half of participants' reading results. Conclusion In general, the profile of functionally illiterate adults presents impairment in the abilities assessed that are more evident in PA at phoneme levels as well as in naming of non-alphanumerical items. Moreover, the results in RAN explain those in word and pseudowords reading better than the results in PA.

A study to identify knowledge, attitude and practices prevalent amongst the caregivers of children below five years presenting with acute diarrhoea in a tertiary care centre

Background: Diarrhoeal infections are the second leading cause of death worldwide in under-five children covering 9% of the total deaths. The objective of the study was to assess and compare mothers' knowledge, attitude and practice regarding prevention and management of diarrhoea in children.Methods: A cross-sectional hospital-based observational study was conducted in a tertiary centre amongst all 356 children between age group 2 months to 60 months admitted with acute watery diarrhea. A pre-tested questionnaire and face-to-face interviews with the mothers was used as a data collection tool.Results: Most of the mothers 282 (79.2%) were 20-30-year-old, 51.4% were illiterate, 57.3% were unemployed and 27.2% were daily wage labourers. 44.6% people came from rural background and 78.9% belonged to lower socio-economic strata. 30.3% were exclusively breastfed and 69.7% were on top feeds. Animal milk was taken by 62.1%, 46.6% had dilution and 50.6% used bottles for feeding. 70.5% of mothers washed their hands at the time of feeding of their child, 93.8% mother covered food in their houses while only 26.7% of mothers gave freshly cooked food. Mother's outlook on various aspects of diarrhea was sought. Very few mothers considered poor sanitation (2.5%) andcontaminated water (12.6%) as a source of diarrhea. Only 8.7% mothers knew about the role of ORS in diarrhea and maximum (53.4%) considered that diarrhea could not be avoided by any measure.Conclusions: Mother's knowledge regarding causes, management and prevention of diarrhea needs to be upgraded to allow better utilisation of health resources by the families.

Preference for male child among married adults in rural and urban field practice areas of Narayana Medical College, Nellore, Andhra Pradesh, India

Background: Reduction of national fertility levels was directly proportional to the preference of male child in many families in India. We conducted this study on 214 married adults, in both sexes to find out whether this strong preference still exists in this decade or not, and if it does what could be the reasons.Methods: A community based cross-sectional study done by face to face interviews using a semi-structured questionnaire containing both qualitative and quantitative variables, among 214 married adults.Results: Upon analysing the results, we identified that higher son preference (61.23%) is seen in many rural families, and is strongly associated with low socio-economic status, literacy rate and caste. The reasons by which these families prefer male child were also broadly categorized and identified. Economic utility (78%) and old age security (61%) was found to be the major reasons most families has quoted in preferring a son.Conclusions: By improving the literacy rate and job opportunities in the community, fertility rate can be reduced, especially in rural areas where the other options are limited.

Why women with advanced carcinoma cervix do not seek medical help early: a tertiary hospital based Indian study

Background: Cervical cancer is a disease which claims maximum number of deaths in developing countries. Objective of this study was to understand the reason for delayed approach to medical help in women with advanced carcinoma cervix.Methods: It was a cross-sectional study. Information obtained from women with carcinoma cervix clinical stage IIb and above with proven histopathological diagnosis was recorded in the predetermined format.Results: Almost all the subjects were illiterate and were from lower socioeconomic strata and rural areas. None of them knew about the disease and its symptomatology. About 82% of the patients were symptomatic since 5-10 years however took no medical care during the period and 2/3rd of them even did not reveal their problem to any of the family members. About 79% of the subjects had never used any contraception and none had knowledge about its role in preventing infection. Majority of them (98%) had no idea about the role of PAP smear in screening carcinoma cervix. All of them said if they had knowledge about the disease, they would have sought medical help much earlier.Conclusions: The most important reason for delayed approach in our study was found to be lack of knowledge about the disease. Therefore, till such time that we have national screening program in place, these women who are at high risk of developing carcinoma of cervix should be targeted and educated through mass media so that these women could seek medical help in early stages.

Modelación espacial bayesiana del riesgo de embarazo adolescente a través de la aproximación anidada integrada de Laplace en Chiapas, 2015 / Bayesian spatial modeling of adolescent pregnancy risk through integrated nested Laplace approximation in Chiapas, 2015

Resumen El objetivo del trabajo es analizar la distribución espacial de la fecundidad adolescente municipal en Chiapas durante 2015. Método: a partir de la utilización de modelos aditivos estructurales estimados mediante la aproximación anidada integrada de Laplace. Resultados: Un primer modelo identifica los patrones espaciales no aleatorios de la fecundidad, mientras un segundo modelo analiza el efecto que ejercen cofactores como: pobreza, marginación y analfabetismo, sobre la distribución espacial de la fecundidad adolescente. Discusión: Los resultados parecen confirmar que los espacios donde se registran mayores índices de marginación, analfabetismo y pobreza incrementan el riesgo de configurar un clúster donde las tasas de fecundidad adolescente observadas son en promedio mayores que las presentadas por los municipios vecinos.

Abstract The objective of the study is to analyze the spatial distribution of adolescent municipal fertility in Chiapas during 2015. Method: from the use of estimated structural additive models through the integrated nested approach of Laplace. Results: A first model identifies the non-random spatial patterns of fertility, while a second model analyzes the effect of cofactors such as poverty, marginalization and illiteracy on the spatial distribution of adolescent fertility. Discussion: The results seem to confirm that the spaces where higher rates of marginalization, illiteracy and poverty are registered increase the risk of setting up a cluster where the adolescent fertility rates observed are on average higher than those presented by neighboring municipalities.

What do mothers of urban slum know about worm infestation? Does literacy play a role?

Background: In India, intestinal parasitic infestation is the most important problem of public health concern. Parasitic worm infestation among children is one of causes of undernourishment. The high prevalence may be due to poor sanitation, lack of awareness regarding transmission and treatment of disease and poor hygiene.Methods: This was a cross-sectional study, conducted during the month of December 2016. All women having at-least one child below six years of age residing in the field practice area attached to urban health training centre of our medical college were interviewed. Data collected were entered in Microsoft Office Excel 2007.Results: A total of 361 mothers were interviewed of whom, 81% were aware of the disease. Those mothers who had ever heard of the disease were further interviewed. Of these, 54% of them were literate and 46% were illiterate. Comparing the literacy status, 26% literate mothers and 36% of the illiterate gave correct answers. Twelve percent of the literate mothers had correct attitude toward prevention of worm infestation. Almost three-fourths (71%) of the women had incorrect attitude for prevention of the disease. Eighty eight percent mothers consulted doctors.Conclusions: Majority of the mothers was aware about occurrence of intestinal worm infestations but they had incorrect knowledge about its causes, symptoms, preventive measures and treatment. The literacy status of mothers does not make any difference in knowledge and practice regarding worm infestation.

Impact of severe anemia during pregnancy on maternal outcome

Background: Anemia is a global problem. Its prevalence in India is about 60%. Anemia directly or indirectly contributes to a significant proportion (40%) of maternal deaths in developing countries. The present study aimed to determine maternal outcome among pregnant women with severe anemia.Methods: This was a prospective study conducted in the department of obstetrics and gynecology, Mc Gann teaching district hospital, Shimoga, over a period six months i.e from January 2019 to June 2019. The study population included all pregnant women who were in their third trimester and with severe anemia (Hb%</=7g%) attending for routine care at our hospital. The interviews were conducted in regional language. The information collected was, social demographic characteristics, economic characteristics and reproductive health history. After the interviews, clinical examinations were conducted and clinical samples such as blood, urine and stool were collected to perform investigations.Results: A total of 94 study participants were included in the study. All study participants were belonged to the low socio-economic strata of the society. 68.1% of women in anemia group were from a rural background. Unbooked and referred cases constituted nearly 4/5th of all anemic subjects (84%). In study group, preponderance of illiteracy was reported and accounted for 60.64% followed by primary and secondary education 23.04% and 14.90% respectively. Common maternal complications noted in the severely anemic group was PPH (14.9%), post-partum febrile morbidity (5.3%), CCF (3.2%) and sepsis (4.2%) while in the control group only one woman had post-partum febrile morbidity.Conclusions: In our study, common maternal complications noted in the severely anemic group were post-partum hemorrhage, postpartum febrile morbidity, congestive cardiac failure and puerperal sepsis.

The dilemma of delayed presentation in breast cancer: a perspective from the Radiology department of a developing country of Asia

Background: In Asia, Pakistan has the highest incidence of breast cancer with 1 in 8 women will develop breast cancer at some stage of their life. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Pakistan.Methods: A cross-sectional study was done from June 2017 till October 2018 at Radiology department of Bolan medical complex hospital in Quetta, Pakistan. Patients with breast cancer above the age of 18 and below 70 years were interviewed who were diagnosed with breast cancer. The time interval between self-detection and deciding to seek care was defined as delayed if the woman presented to a health care professional three months or more after detecting an abnormalityResults: A total of 86 breast cancer patients fulfilling the criteria were included in the study. Of these, 34% presented to physician within 3 months of appearance of symptoms, 68% patients presented with a delayed of more than 3 months. Presentation delay was due to financial issues which were seen in 30 patients. 18 patients (20.9%) showed delayed to due difficulty in reaching hospitals, 16 patients (18%) stated delay due to prior use of alternative therapies. Embarrassment and spiritual belief constituted 4.6% cases. 51% and 36% presented with stage III and IV disease out of which majority belonged to poor socio-economic status.Conclusions: The findings suggest that majority of the patients with breast cancer presented late and this has significant effect on their disease prognosis. Most cases of breast cancer presented in advanced stage probably due to poor economic status, difficulty in reaching hospital, illiteracy and negligence by patient or family.

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients' database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7�9 vs. 59�2 and 58.1�6 per cent in middle and lower strata (P =0.026). Five year overall survival was higher in the higher SE group; being 91.2�5, 78.3�6 and 78.8�9 per cent (P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P =0.015); 1.98 (P =0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.

Adesão de hipertensos e diabéticos analfabetos ao uso de medicamento a partir da prescrição pictográfica / Hypertensive and diabetic patient drug use compliance based on the pictographic prescription / Adhesión de hipertensos y diabéticos analfabetos al uso de medicamento a partir de la prescripción pictográfica

Resumo A baixa adesão ao tratamento medicamentoso constitui grave entrave para o sucesso do controle de doenças como o diabetes e a hipertensão arterial. Este artigo trata de um estudo que partiu da identificação do analfabetismo como importante causa de não adesão ao tratamento medicamentoso para diabéticos e hipertensos participantes do programa Hiperdia em unidade de saúde do município de Colombo, no estado do Paraná. Teve como objetivo avaliar o impacto de prescrição pictórica na adesão ao tratamento. Analisou-se um grupo de 63 diabéticos e hipertensos que participavam do Hiperdia, para os quais aplicou-se uma entrevista estruturada, com posterior análise do conteúdo, antes e depois da implantação de uma prescrição pictográfica. Como resultado, entre os analfabetos, observou-se a elevação da adesão de 60% para 93,33% em relação ao tratamento medicamentoso. No grupo de alfabetizados não houve mudança na adesão. Conclui-se, no entanto, que esse tipo de intervenção é limitado para a melhora da condição de saúde dos pacientes, pois o aumento da adesão se dá em relação tanto ao tratamento medicamentoso quanto à precariedade.

Abstract The low levels of compliance with drug therapy is a serious obstacle to the successful control of diseases such as diabetes and hypertension. This article addresses a study that was based on the identification of illiteracy as a major cause of non-compliance with a drug treatment among diabetic and hypertensive patients participating in the Hiperdia program at a health unit in the city of Colombo, state of Paraná, Brazil. The goal was to assess the impact of pictorial prescriptions on compliance with treatment. A group of 63 diabetic and hypertensive patients participating in Hiperdia was analyzed. They answered a structured interview, the content of which was subsequently analyzed before and after the implementation of a pictographic prescription. As a result, compliance with the drug treatment among the illiterate rose from 60 percent to 93.33 percent. There was no change in compliance in the literate group. It was concluded, however, that this type of intervention is limited to the improvement of the patients' health condition, because the increase in compliance occurs both with regard to the drug treatment and precariousness.

Resumen La baja adhesión al tratamiento medicamentoso constituye un grave obstáculo para el éxito del control de enfermedades como la diabetes y la hipertensión arterial. Este artículo trata de un estudio que partió de la identificación del analfabetismo como importante causa de la no adhesión al tratamiento medicamentoso para diabéticos e hipertensos participantes en el programa Hiperdia en una unidad de salud del municipio de Colombo, estado de Paraná, Brasil. Éste tuvo como objetivo evaluar el impacto de la prescripción pictórica en la adhesión al tratamiento. Se analizó un grupo de 63 diabéticos e hipertensos que participaban en el Hiperdia, para los cuales se aplicó una entrevista estructurada, con posterior análisis del contenido, antes y después de la implantación de una prescripción pictográfica. Como resultado, entre los analfabetos, se observó la elevación de la adhesión del 60% para el 93,33% con relación al tratamiento medicamentoso. En el grupo de alfabetizados, la adhesión no presentó cambios. Se concluyó, sin embargo, que este tipo de intervención es limitado para la mejora de la condición de salud de los pacientes, pues el aumento de la adhesión se da con relación al tratamiento medicamentosos en cuanto a la precariedad.

The Clinical Characteristics according to the Educational Level in the Elderly Patients with Mild Alzheimer's Disease Dementia

BACKGROUND AND PURPOSE: Cognitive reserve is important for the individual susceptibility to dementia. Among the various determinants of cognitive reserve, the number of years of formal education would be of prime importance. We performed this study to explore its contribution to the clinical characteristics of dementia. METHODS: We included consecutive mild Alzheimer's disease (AD) dementia patients (clinical dementia rating, CDR=0.5 or 1) who visited our memory clinic and were older than 70 years at the evaluation from October 2013 to September 2015. According to the number of years of education, the corresponding subjects was grouped into two extreme educational groups, low education (illiterate or partially illiterate, LE, n=43) vs. high education (more than 9 years of education, HE, n=34). Among these patients, we compared various demographic, neuropsychological and neuroimaging characteristics. RESULTS: The groups were comparable in terms of age, frequency of hypertension and diabetes, and CDR and its sum of box. However, female gender was more frequent in the LE group (p=0.000). Also this group showed a more depressive mood on the geriatric depression scale (p=0.007). The raw scores on Korean Version of Mini-Mental State Examination and well-validated neuropsychological tests were lower in the LE group. However, the cognitive performance was found to be more preserved in the LE group than in the HE group when assessed using the z-score in certain specified tests on univariate and multivariate analyses (p<0.05). The Schelten's grade of medial temporal atrophy was similar between the two educational groups. Also, the degree of combined ischemic burden did not differ between the two groups. CONCLUSIONS: We identified that the prevalence of depressive mood and the extent of decline from the corresponding norm in a particular neuropsychological performance differ according to the educational level of mild AD patients.

Literacy Independent Cognitive Assessment: Assessing Mild Cognitive Impairment in Older Adults with Low Literacy Skills

OBJECTIVE: Comprehensive neuropsychological tests are important in the diagnosis and follow-up of patients with MCI; however, most were developed without consideration of illiteracy. We developed the Literacy Independent Cognitive Assessment (LICA) as a comprehensive neuropsychological assessment battery applicable to older adults who are either literate or illiterate. This study aimed to assess the reliability and validity of the LICA for diagnosis of MCI. METHODS: Normal controls (n=634) and patients with MCI (n=128) were recruited from 13 centers were included in this study. Participants were divided into illiterate or literate groups, based on their performance on a brief reading and writing test. The LICA, Korean Mini-Mental State Examination (K-MMSE), and Seoul Neuropsychological Screening Battery (SNSB) were administered. RESULTS: Total LICA scores distinguished MCI patients from controls (p<0.001). They were closely and positively correlated to the K-MMSE scores (r=0.632, p<0.001) but negatively correlated to clinical dementia rating (CDR) (r=-0.358, p<0.001) and CDR sum of boxes (r=-0.339, p<0.001). Area under the receiver operating characteristic curve for patients with MCI by total LICA score was 0.827 (0.783-0.870), superior to that presented by the K-MMSE. For the classification of MCI subtypes, inter-method reliability of LICA with the SNSB was good (kappa 0.773; 0.679-0.867, p<0.001). CONCLUSION: The results of this study show that the LICA may be reliably used to distinguish MCI patients from cognitively intact adults, to identify MCI subtypes and monitor progression toward dementia, regardless of illiteracy.

Cognitive impairment in individuals with low educational level and homogeneous sociocultural background / Comprometimento cognitivo em indivíduos com baixo nível educacional e homogêneo contexto sociocultural

ABSTRACT: Prevalence studies of dementia and cognitive impairment in different cultures and environments are necessary. OBJECTIVE: To verify the prevalence of cognitive impairment and dementia in a rural homogeneous population from flooded areas in the Amazonian Basin. METHODS: A total of 163 subjects were interviewed with neurological, cognitive and functional evaluation. The individuals were classified as demented or cognitive impairment no dementia (CIND). RESULTS: cognitive impairment was observed in 11.4% (n=18 individuals). Ten out of the 18 were diagnosed as CIND and eight with dementia. The prevalence rate of dementia was 4.9% in subjects aged 50 years or over and of CIND was 6.1%. Considering only the elder group (>64 years of age), there was a 12.3% prevalence of dementia and 7.7% of CIND. CONCLUSION: In a homogeneous population, we observed a similar prevalence of dementia to rates reported by studies in Brazil and in other developed and developing countries.

RESUMO: Estudos de prevalência de demência e de comprometimento cognitivo em diferentes culturas e ambientes são necessários. OBJETIVO: Verificar a prevalência de comprometimento cognitivo e demência numa população rural homogênea de áreas alagadas da bacia Amazônica. MÉTODOS: Entrevistamos 163 indivíduos e avaliação neurológica, cognitiva e funcional. Foram classificados em dementados e comprometimento cognitivo sem demência (CCSD). RESULTADOS: Comprometimento cognitivo foi observado em 11,4% (n=18 indivíduos). Dez deles foram diagnosticados como CCSD e oito com demência. A taxa de prevalência foi de 4,9% em sujeitos com idade igual ou superior a 50 anos e 6,1% de CCSD. Considerando-se somente os idosos (>64 anos) a prevalência foi de 12,3% para demência e 7,7% para CCSD. CONCLUSÃO: nesta população homogênea nós observamos uma prevalência de demência similar a outros estudos em nosso país e em outros desenvolvidos e em desenvolvimento.

Features associated with cognitive impairment and dementia in a community-based sample of illiterate elderly aged 75+ years: the Pietà study / Fatores associados a comprometimento cognitivo e demência em uma amostra comunitária de idosos analfabetos com 75+ anos: estudo Pietà

A higher level of educational attainment constitutes a protective factor against cognitive decline in the elderly. Nevertheless, the elements underpinning this association are yet not fully understood. OBJECTIVE: The primary aim of this study was to compare cognitively impaired illiterate elderly subjects with cognitively preserved counterparts, according to demographics, comorbidities, lifetime habits and APOE genotype. METHODS: This is a cross-sectional analysis of the illiterate subset of participants (n=174) from the Pietà study, a community-based survey of successful brain aging conducted in Caeté (MG), Brazil. Subjects were categorized into three diagnostic groups: cognitively normal (CN), cognitive impairment no-dementia (CIND) and dementia. The groups were then compared according to selected variables. RESULTS: Subjects with dementia were older and had an increased prevalence of reported stroke or transient ischemic attack. The three groups did not differ in relation to demographics, prevalence of comorbidities, socioeconomic level, previous occupation profile and APOE-?4 allele frequency. Qualitatively evaluated lifetime habits, such as alcohol consumption, smoking and physical activity engagement were also similar across groups. CONCLUSION: No associations were found between cognitive impairment/dementia and the variables evaluated in this community-based sample of illiterate elderly.

Um alcance educacional mais elevado constitui um fator protetivo contra o declínio cognitivo em idosos. Todavia, os elementos subjacentes a esta associação ainda são pouco compreendidos. OBJETIVO: O principal objetivo deste estudo foi comparar indivíduos analfabetos com comprometimento cognitivo com analfabetos cognitivamente normais, de acordo com aspectos demográficos, morbidades, hábitos de vida e genótipo APOE. MÉTODOS: Este é um estudo transversal da amostra de participantes analfabetos (n=174) do Estudo Pietà, um levantamento de base comunitária sobre envelhecimento cerebral bem sucedido, conduzido em Caeté (MG), Brasil. Os sujeitos foram categorizados em três grupos diagnósticos: cognitivamente normais, comprometimento cognitivo não demência e demência. Os grupos foram então comparados conforme variáveis selecionadas. RESULTADOS: Indivíduos com demência eram mais idosos e apresentaram uma maior prevalência de relato de acidente vascular encefálico ou ataque isquêmico transitório. Os três grupos não se mostraram diferentes em relação à demografia, prevalência de comorbidades, nível socioeconômico, perfil ocupacional prévio e frequência do alelo APOE-?4. A avaliação qualitativa de hábitos de vida, como o consumo de bebida alcoólica, fumo e engajamento em atividade física também foi semelhante entre os grupos. CONCLUSÃO: Não encontramos associações entre comprometimento cognitivo/demência e as variáveis investigadas nesta amostra comunitária de idosos analfabetos.

Procedures for successful data collection through psychological tests in the elderly / Procedimentos para uma recolha de dados bem-sucedida junto de idosos

Drawing on the experience of sampling and assessing thousands of elders, who dwell both in rural and urban areas, from all socio-economic strata, we present data collection procedures recommended to assess elderly populations. Based on International Test Commission's Guidelines (2010) for test translation and adaptation, we propose the administration of psychological tests to older adults in an interview format arguing that it is better suited for such population. We provide and discuss practical examples and common problems of data collection regarding: the need of adapting the translation to make cultural and psychological sense; the lack of familiarity of most elders with the psychological assessment setting and process; and, ethical concerns for this specific population. (AU)

Baseados na experiência de seleção e avaliação de milhares de idosos residentes em meio rural e urbano, pertencentes aos diversos estratos socioeconómicos, apresentamos procedimentos de recolha de dados recomendáveis para esta população. Considerando as diretrizes de tradução e adaptação de testes da International Test Commission (2010), propomos a administração de testes psicológicos a idosos sob a forma de entrevista, argumentando que esta é a forma mais adequada. Apresentamos e discutimos exemplos práticos e problemas comuns relativos à recolha de dados, considerando: a necessidade de nas traduções ser atendido o significado cultural e psicológico; a falta de familiaridade da maioria dos idosos com o cenário e o processo de avaliação psicológica; e, aspetos éticos vis-à-vis esta população. (AU)

The Limits of Medical Interventions for the Elimination of Preventable Blindness

Background: Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education. Objectives: The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages. Methods: In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata’s district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1–10 years) from 6 villages were examined by trained staff. Results: The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors. Discussion: The heterogeneity of methods described for clinical trials makes it inappropriate to conduct meta-analysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against <i>Chlamydia sp</i>. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological and surgical interventions for people infected with susceptible bacteria could be understood as the hidden side of a passive attitude toward basic education actions.

A study of the nature and causes of domestic violence among the attendees of a domestic violence counseling center of a tertiary level hospital of a city of central India.

Background: Domestic violence against women is widely recognized as important public health problem, owing to its substantial consequences for women’s physical, mental and reproductive health. This study tried to assess the frequency and patterns of domestic violence against women experienced by attendees of Domestic Violence counselling centre Department of Psychiatry, MY Hospital, Indore. Aims & Objective: To study the nature and causes of domestic violence. Material and Methods: Cross sectional study using a pre designed pre tested semi structured questionnaire was carried out and the data were analyzed using MS excel. Results: Most common type of domestic violence faced is physical (80%) followed by mental (8%), social (8%) and sexual (4%). Monetary issues (26%) and alcoholism (22%) are the two most important causes of domestic violence, other causes being extra marital affair (6%), Family conflicts (6%) and dowry (6%). 64% victims were either illiterate or primary pass; 34% were skilled workers; 56% victims had their per capita income between ` 980 and 2935; 76% had their modified Kuppuswami score between 5-10. 56% victims face domestic violence daily. Conclusion: Monetary problems, alcoholism, illiteracy, extramarital affairs and dowry are the major causes of domestic violence. The victims most commonly face physical violence by their partners daily. There is an urgent need of more and more domestic violence counselling centers throughout the country.