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Resumen: Objetivo: Evaluar la asociación entre embarazo en la adolescencia y desarrollo del lenguaje (DL), en niños(as) residentes en zonas económicamente vulnerables de México. Material y métodos: Estimación y comparación del puntaje estandarizado de lenguaje de niños(as) de 12-59 meses participantes en la Ensanut 100k e hijos(as) de madres que al nacimiento fueron adolescentes (12-19 años) o adultas (>20 años). La asociación se estimó mediante regresión lineal multivariada y probamos una interacción entre condición materna y lugar de residencia. Resultados: Los hijos(as) de adolescentes que residen en áreas urbanas tuvieron un DL menor que los hijos(as) de madres adultas, (ß= -0.33 IC95%: -0.65 a -0.01; p interacción <0.01). Sin embargo, la disponibilidad de libros o apoyo materno al aprendizaje redujeron esta diferencia. Conclusiones: La presión sociocultural hacia las adolescentes en zonas urbanas podría explicar los resultados observados; no obstante, esta población podría ser susceptible de estrategias dirigidas a mejorar la relación madre-hijo y el apoyo al aprendizaje.
Abstract: Objetive: To evaluate the association between adolescent pregnancy and language development, in children living in socio-economic vulnerable areas of Mexico. Materials and methods: We estimated the standardized language score of children age 12-59 months who participated in the Ensanut 100k. Teenage mothers (TM) were those who at delivery was between 12-19 years old. The association was estimated using multivariate linear regression; moreover, we evaluated an interaction between type of mother and place of residence. Results: Children of TM who lived in urban areas had lower standardized language score than those children of adult mothers (ß= -0.33 95%CI: -0.65 a -0.01; p for interaction<0.01). However, book availability and/or mother's support for learning significantly reduce this difference. Conclusions: Sociocultural pressures towards TM in urban areas could explain the results; nevertheless, this population could be susceptible to strategies aimed to improve the mother-child relationship and support for learning.
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Resumen Se examinaron datos provenientes de la evaluación del lenguaje de 104 niños con edades entre 16 y 30 meses residentes en Lima con una versión preliminar de la adaptación de la Forma II de los reportes parentales MacArthur-Bates Communicative Development Inventories (CDI) al español del Perú. Se analizó el léxico productivo a partir de la lista de palabras del reporte y se realizaron análisis de regresión para evaluar si el nivel de vocabulario contribuía a predecir el desarrollo gramatical de los niños, empleando como variables de control la edad del niño y el nivel de escolarización materna (como indicador del nivel socioeconómico) y como variables dependientes la longitud media de los tres enunciados más largos (LME3) y la complejidad morfosintáctica (CM), obtenidas con el CDI. Los sustantivos fueron la clase de palabras más frecuente y que más aumentó con la edad, como en el italiano (Caselli et al., 1995; D'Odorico y Fasolo, 2007) y el español mexicano (Jackson-Maldonado et al., 1993). Además, el nivel de vocabulario predijo el nivel de desarrollo gramatical, como en el español peninsular (Mariscal y Gallego, 2012) y en el mexicano (Thal, Jackson-Maldonado y Acosta, 2000): una vez controlados los efectos de la edad y la escolarización materna, el vocabulario explicó el 20 % de la variabilidad de la LME3 y el 37 % de la variabilidad de la CM. Este estudio ofrece información sobre el desarrollo temprano del vocabulario y la gramática en el español del Perú, una etapa escasamente estudiada en esta variedad.
Abstract We present results from the analysis of data from 104 children with ages ranging from 16 to 30 months, living in Lima, Peru. The data was collected using a preliminary version of the MacArthur-Bates Communicative Development Inventories (CDI), Form II, adapted to Peruvian Spanish. The CDIs are parental reports that assess language through the presentation of a series of items to the parents, mainly in the form of a checklist. We aimed to (1) describe the composition of Peruvian children's productive lexicon at this age, (2) identify whether nouns were the most frequent class in their vocabulary, and also the class which increased the most with age, as is the case in Italian (Caselli et al., 1995; D'Odorico y Fasolo, 2007) and Mexican Spanish (Jackson-Maldonado et al., 1993); and (3) assess whether vocabulary size explained the level of grammatical development as in Peninsular and Mexican Spanish (Mariscal & Gallego, 2012; Thal, Jackson-Maldonado & Acosta, 2000). In order to do so, we analyzed the following data: age; maternal education level (as an indicator of socioeconomic status); vocabulary (represented by a list of more than 500 words that parents recognized as produced or not by their children); the mean length of the three longest utterances produced by the child as reported by parents; and sentence complexity, a measure of the level of structures produced by the child based on the parent's report. To achieve the first and second goals, words in the vocabulary list were classified according to grammatical class. Then, the percentage of production of each class of words was calculated, as well as the correlation between this percentage and age. Children's vocabulary was composed mainly of nouns, which represented 57 % of the production, followed by predicates (verbs and adjectives) and function words (pronouns, determiners, prepositions, conjunctions and connectives). Noun was the class of words that increased the most with age, showing the highest correlation with such variable (r = .72). Correlations between other types of words and age varied: it was also high for adjectives; but moderate for some classes and low for others. This showed that each type of word increased at different rates. Regarding the third goal, to assess the relationship between vocabulary size and level of grammatical development, two regression analyses were conducted to predict the variables mean-length-of-the-three-longest-utterances and sentence-complexity. For both analyses, age and maternal education level were entered in the first step, in order to control for their effect; and vocabulary was entered in the second step. Both models accounted for substantial amounts of variance and showed an important effect on vocabulary. The model with the mean-length-of-the-three-longest-utterances as the dependent variable accounted for 56 % of the variance. The first step explained 37 % of the variance (due to the contribution of both age and maternal education level), and the second step explained an additional 20 %. The model with sentence-complexity accounted for a higher percentage of the variance, 75 %. The first step explained 38 % of the variance, exclusively due to age; while the second step explained an additional 37 %. These results suggest a strong relationship between vocabulary and grammar. Further research is needed to confirm these results with direct measures of child production and more representative samples of children acquiring Peruvian Spanish, including speakers of dialects of other parts of the country. However, these results, preliminary as they are, shed light on the composition of vocabulary and its relationship with grammar in a variety of Spanish scarcely studied during early stages of development.
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Resumen: Objetivo: Evaluar el desarrollo infantil temprano (DIT) y sus determinantes en niños/as de 12 a 59 meses residentes en localidades de menos de 100 000 habitantes. Material y métodos: La Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes (Ensanut 100k) evaluó el nivel de lenguaje, acceso a servicios de atención al DIT e indicadores de calidad del contexto de desarrollo. Se estiman prevalencias de indicadores y puntajes estandarizados de lenguaje según variables de interés. Resultados: 20.7% de los niños/as asistió a ocho consultas del niño sano en su primer año, 13.0% recibió evaluación de DIT, 75.0% recibe apoyo al aprendizaje, 23.4% cuenta con libros y 57.7% sufre disciplina violenta. Mejores niveles de lenguaje se asocian con las capacidades económicas, escolaridad materna, asistencia a preescolar, apoyo al aprendizaje y acceso a libros. Los niños/as expuestos a más factores protectores presentan nivel de lenguaje 1.5 DE mayor que en niños/as con más factores de riesgo. Conclusión: Se requiere aumentar la cobertura de atención al DIT y mejorar las oportunidades de desarrollo en hogares.
Abstract: Objective: To evaluate early childhood development (ECD) and its determinants in 12 to 59 months old children residents of communities <100 000 inhabitants. Materials and methods: The Encuesta Nacional de Salud y Nutrición of communities <100 000 inhabitants (Ensanut 100k) evaluated language level, access to ECD care services and standardized indicators of the eight quality of the development environment. We report indicator prevalence and standardized language scores according to variables of interest. Results: 20.7% of children attended eight well-child care visits within the first year of life, 13.0% received an ECD assessment, 75.0% receive support for learning, 23.4% have books and 57.7% experiment violent discipline. Improved language levels are associate with socioeconomic capacities, maternal education, preschool attendance, support for learning and household books. Children exposed to more protective factors present a language level 1.5 standard deviations higher than their peers exposed to more risk factors. Conclusion: There is a need to increase the coverage of ECD care services and to improve early development opportunities within households.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Desarrollo Infantil , Servicios de Salud del Niño/estadística & datos numéricos , MéxicoRESUMEN
Objective:To analyze related factors to the informed consent competency of patients with schizophrenia.Methods:Subjects were divided into two groups,namely one group including 100 patients with schizophrenia and the other group including 28 heathy controls.Patients with schizophrenia were administrated from community rehabilitation units and The Sixth Hospital of Peking University,diagnosed with the Diagnostic and Statistical Manual of mental disorder,Fourth Edition (DSM-Ⅳ).Informed consent competency of subjects were evaluated with the Chinese Mandarin Version of MacArthur Competence Assessment Tool for Clinical Research.Psychiatric symptoms,intelligence quotient and severity of disease were accessed individually with the Positive and Negative Symptom Scale (PANSS),Wechsler Abbreviated Scale of Intelligence (WASI) and Clinical General ImpressionSeverity Scale (CGI-S).Logistic regression analysis model was used to analyze the risk factors of impaired informed consent competency in schizophrenia.Retsrts:The rates of absent,impaired and adequate informed consent competency were 26.0％ (26/100),47.0％ (47/100) and 27.0％ (27/100) in schizophrenia group,and 3.6％ (1/28),57.1％ (16/28) and 39.3 ％ (11/28) in control group.Rate of absent informed consent competency was higher in schizophrenia group than that in control group (26.0％ vs.3.6％,P ＜0.01).There were no statistic significant differences in rates of impaired and adequate informed consent competency between two groups (both P ＞ 0.05).Results of logistic regression analysis showed that schizophrenic patients with higher scores of positive subscale (OR =1.15),negative subscale (OR =1.23) and CGI-S (OR =1.57) had more tendency to impaired capacity.Higher education level (OR =0.73) and higher scores of IQ (OR =0.92) had less risks for that.Conclusion:Competency of informed consent in schizophrenia may be worse than that in health control.Patients with schizophrenia with impaired informed consent competency may have more serious of positive,negative psychiatric symptoms and higher severity of disease.Higher level of education and IQ scores may reduce the risk of impaired informed consent competency.
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INTRODUCTION: The MacArthur scale of subjective social status (SSS), which combines verbal instruction and an image of a 10-steps ladder, aims to capture the common sense perception that an individual has about his/her own position in social hierarchies, in three different contexts: society, community and work. OBJECTIVE: To conduct a concurrent and face validity analysis of the MacArthur scale (Paper 1) and to investigate whether individuals who perceive themselves as having a low SSS in adult life, in the society context, were more exposed to low objective socioeconomic positions (SEP) in childhood and youth, after adjusting for current SEP. METHODS: The article 1 included 159 participants from the Longitudinal Study of Adult Health (ELSA-Brasil), from Minas Gerais Investigating Center, selected by convenience during the 2nd wave of interviews and examinations between 11/2012 and 02/2014. The MacArthur scale was compared with a Status scale, created for this study based on the cognitive metaphor theory, which used the same image of a ladder as an indicator of the status and a very similar but more direct instruction. The concurrent validity was examined by comparing the answers to both scales (MacArthur and Status) using weighted kappa statistics. The face validity was assessed by qualitative methods from corpus linguistics. Ordinal logistic regression was used to investigate whether sociodemographic factors were associated with differences of 1, or 2 or more steps in the choices made using the MacArthur and the Status ladders. In the paper 2, 15.105 participants from the base line of ELSA-Brasil (2008-2010) were included. Low SSS was in the society was defined by the choice of a step lower than 5 out of 10. Multivariate logistic regression analysis was used to investigate whether exposures to low objective indicators of SEP in the childhood (maternal education), youth (occupational social class of the household head; occupational social class of the first job; nature of occupation of household head; nature of occupation in the first job) and adult life (current occupational social class; current nature of occupation; current education) increased the chances of being at low SSS. RESULTS: Agreement between the answers to the MacArthur and Status scales moderated in the society context (kw=0,55) and good in the community (kw=0,60) and work (kw=0,67). Face validity analysis showed that MacArthur scale captures beyond the classic socioeconomic indicators, encompassing elements from collective health, as home, transport, health, leisure, merit etc. Although individuals without college education (in the society context) and women (in the community ambience) had greater chances of differing by 1, or 2 or more steps from those with college education or who were women, qualitative differences were not identified by the corpus linguistics, suggesting that the MacArthur scale has good face validity. In paper 2, after adjustments, low SSS in adult life remained statistically associated with low SEP in all stages of the life course, being the magnitude of the associations strong in adult life, moderate in youth and weak in childhood, showing dose response gradients in all associations. CONCLUSION: The MacArthur scale seems to be a valid instrument to measure the SSS in the Brazilian sociocultural context, thus they can be used in studies of social inequality in health. In addition, results suggest that the scale may capture a summary of exposures and experiences of present and past SEP, both intra and intergenerational, allowing to expand the interpretations of findings of health inequalities based on the MacArthur scale.
INTRODUCTION: The MacArthur scale of subjective social status (SSS), which combines verbal instruction and an image of a 10-steps ladder, aims to capture the common sense perception that an individual has about his/her own position in social hierarchies, in three different contexts: society, community and work. OBJECTIVE: To conduct a concurrent and face validity analysis of the MacArthur scale (Paper 1) and to investigate whether individuals who perceive themselves as having a low SSS in adult life, in the society context, were more exposed to low objective socioeconomic positions (SEP) in childhood and youth, after adjusting for current SEP. METHODS: The article 1 included 159 participants from the Longitudinal Study of Adult Health (ELSA-Brasil), from Minas Gerais Investigating Center, selected by convenience during the 2nd wave of interviews and examinations between 11/2012 and 02/2014. The MacArthur scale was compared with a Status scale, created for this study based on the cognitive metaphor theory, which used the same image of a ladder as an indicator of the status and a very similar but more direct instruction. The concurrent validity was examined by comparing the answers to both scales (MacArthur and Status) using weighted kappa statistics. The face validity was assessed by qualitative methods from corpus linguistics. Ordinal logistic regression was used to investigate whether sociodemographic factors were associated with differences of 1, or 2 or more steps in the choices made using the MacArthur and the Status ladders. In the paper 2, 15.105 participants from the base line of ELSA-Brasil (2008-2010) were included. Low SSS was in the society was defined by the choice of a step lower than 5 out of 10. Multivariate logistic regression analysis was used to investigate whether exposures to low objective indicators of SEP in the childhood (maternal education), youth (occupational social class of the household head; occupational social class of the first job; nature of occupation of household head; nature of occupation in the first job) and adult life (current occupational social class; current nature of occupation; current education) increased the chances of being at low SSS. RESULTS: Agreement between the answers to the MacArthur and Status scales moderated in the society context (kw=0,55) and good in the community (kw=0,60) and work (kw=0,67). Face validity analysis showed that MacArthur scale captures beyond the classic socioeconomic indicators, encompassing elements from collective health, as home, transport, health, leisure, merit etc. Although individuals without college education (in the society context) and women (in the community ambience) had greater chances of differing by 1, or 2 or more steps from those with college education or who were women, qualitative differences were not identified by the corpus linguistics, suggesting that the MacArthur scale has good face validity. In paper 2, after adjustments, low SSS in adult life remained statistically associated with low SEP in all stages of the life course, being the magnitude of the associations strong in adult life, moderate in youth and weak in childhood, showing dose response gradients in all associations. CONCLUSION: The MacArthur scale seems to be a valid instrument to measure the SSS in the Brazilian sociocultural context, thus they can be used in studies of social inequality in health. In addition, results suggest that the scale may capture a summary of exposures and experiences of present and past SEP, both intra and intergenerational, allowing to expand the interpretations of findings of health inequalities based on the MacArthur scale.