Clinical characteristics and diagnostic accuracy of the revised Addenbrooke Cognitive Examination (ACE-R) in older adults with a low educational level / Características clínicas e acurácia do Exame Cognitivo Addenbrooke Versão revisada (ACE-R) em idosos com baixa escolaridade

ABSTRACT Objective: To determine the diagnostic accuracy of the Addenbrooke's Cognitive Examination Revised (ACE-R) as a cognitive screening tool for older adults with low levels of schooling and healthy aging, MCI and dementia in Brazil. Methods: All participants underwent neurological and psychiatric examinations and were administered a validated version of ACE-R. Results: A total of 85 participants were evaluated; most were females (84.7%, n = 72). The post hoc analysis showed statistical differences in ACE-R total scores between older adults with mild cognitive impairment (MCI) and controls (p < 0.001) and in subitem scores including verbal fluency, language, visuospatial skills and attention (p < 0.001). The visual-spatial skills subitem was the most strongly correlated with schooling level (r = 0.509, p < 0.001), whereas late, immediate recall and recognition memory were not influenced by schooling. The ACE-R had the best diagnostic accuracy in discriminating between MCI and controls = 0.69 (<57.5; 80/66), MD and controls = 0.98 (<50; 100/96), MCI and MD = 0.86 (<49.5; 100/74). Conclusions: ACE-R and Mini-Mental State Examination (MMSE) scores for older adults with MCI and controls were significantly lower than those reported in similar studies. These preliminary findings support the need for establishing reliable cut-off scores for cognitive assessment of older Brazilian adults with low schooling at risk for dementia taking into consideration ecological and local variables.

RESUMO Objetivo: Determinar a precisão diagnóstica do Exame Cognitivo de Addenbrooke (ACE-R) como uma ferramenta de triagem cognitiva para adultos idosos com baixos níveis de educação e envelhecimento saudável, MCI e demência no Brasil. Métodos: Os indivíduos submeteram-se à avaliação clínica e psiquiátrica e foi administrada uma versão validada da versão revisada da bateria cognitiva ACE-R (ACE-R). Resultados: Oitenta e cinco indivíduos foram avaliados, predominando as mulheres (84,7%, n = 72). Na análise post hoc, controles e CCL exibiram diferenças estatísticas nos escores globais do ACE-R (p < 0,001) e seus subdomínios, incluindo fluência verbal, linguagem, habilidades visuoespaciais e atenção (p < 0,001). A habilidade visuoespacial foi o item mais correlacionado com a escolaridade (r = 0,509, p < 0,001), enquanto a memória tardia, de recordação e reconhecimento não foi influenciada pela educação. A precisão do ACE-R produziu melhores resultados para CCL versus controles = 0,69 (<57,5; 80/66), demência versus controles = 0,98 (<50; 100/96), CCL versus demência = 0,86 (<49,5; 100/74). Conclusões: Os escores de ACE-R e MMSE para controles e CCL foram consideravelmente inferiores aos encontrados em estudos semelhantes. Resultados preliminares confirmam a necessidade de estudos brasileiros estabelecerem pontos de corte confiáveis para baterias cognitivas em idosos com baixa escolaridade e em risco de demência, reconhecendo variáveis ecológicas e regionais.

Application of simulated family wards in training illiterate rural patients with peritoneal catheterization / 中国实用护理杂志

Objective@#To explore the effect of simulated family ward in training and management of illiterate rural peritoneal dialysis catheter patients.@*Methods@#Between January 2013 and December 2013 in our department, 80 patients with peritoneal dialysis catheter rural illiteracy as the research object, using the random number table method, the patients can be divided into the experimental group and control group, 40 cases of control group accepted traditional way standard training, the experimental group adopted simulation training family ward as the carrier, two groups of patients were carried out by the same pd specialist nurse training, the control group patients take traditional 7 days training courses for training, the experimental group according to the characteristics of the illiterate patients, an interactive learning mode of explanation-demonstration-imitation-case analysis-feedback and so on was established in the simulated family ward based on real objects and pictures. The training lasted for 5-7 days.After 12 months of observation, the changes of peritonitis and outlet infection cases, edema, blood pressure, outpatient follow-up compliance and laboratory examination indexes in the two groups were statistically analyzed.@*Results@#There were 5 cases of peritonitis, 2 cases of exit infection and 27 cases of edema in the experimental group, and 13 cases, 10 cases and 34 cases in the control group, respectively. The difference between the two groups was statistically significant (χ2=4.126, 5.847, Z=2.382, all P<0.05).The systolic blood pressure and diastolic blood pressure in the experimental group were (131± 13) and (86± 9) mmHg, respectively, and those in the control group were (140±15) and (92±11) mmHg, respectively. The differences between the two groups were statistically significant (t=2.789 and 2.595, all P<0.05). Compliance of outpatient follow-up was good in 33 cases in the experimental group and 27 cases in the control group, and the difference between the two groups was statistically significant (χ2=4.551, P<0.05).@*Conclusions@#The education and training of rural illiterate patients with peritoneal dialysis catheterization in simulated family wards has mobilized the patients' participation, improved their cognitive level, and improved their treatment compliance, thus effectively improving the patients' peritoneal dialysis effect and quality of life.

Application of simulated family wards in training illiterate rural patients with peritoneal catheterization / 中国实用护理杂志

Objective To explore the effect of simulated family ward in training and management of illiterate rural peritoneal dialysis catheter patients. Methods Between January 2013 and December 2013 in our department, 80 patients with peritoneal dialysis catheter rural illiteracy as the research object, using the random number table method, the patients can be divided into the experimental group and control group, 40 cases of control group accepted traditional way standard training, the experimental group adopted simulation training family ward as the carrier, two groups of patients were carried out by the same pd specialist nurse training, the control group patients take traditional 7 days training courses for training, the experimental group according to the characteristics of the illiterate patients, an interactive learning mode of explanation-demonstration-imitation-case analysis-feedback and so on was established in the simulated family ward based on real objects and pictures. The training lasted for 5-7 days.After 12 months of observation, the changes of peritonitis and outlet infection cases, edema, blood pressure, outpatient follow-up compliance and laboratory examination indexes in the two groups were statistically analyzed. Results There were 5 cases of peritonitis, 2 cases of exit infection and 27 cases of edema in the experimental group, and 13 cases, 10 cases and 34 cases in the control group, respectively. The difference between the two groups was statistically significant (χ2=4.126, 5.847, Z =2.382, all P<0.05).The systolic blood pressure and diastolic blood pressure in the experimental group were (131± 13) and (86± 9) mmHg, respectively, and those in the control group were (140 ± 15) and (92 ± 11) mmHg, respectively. The differences between the two groups were statistically significant (t=2.789 and 2.595, all P<0.05). Compliance of outpatient follow-up was good in 33 cases in the experimental group and 27 cases in the control group, and the difference between the two groups was statistically significant (χ2=4.551, P<0.05). Conclusions The education and training of rural illiterate patients with peritoneal dialysis catheterization in simulated family wards has mobilized the patients' participation, improved their cognitive level, and improved their treatment compliance, thus effectively improving the patients' peritoneal dialysis effect and quality of life.

An Opinion Survey on Purchasing Nonprescription Drugs over the Internet in Remote Islands / 医薬品情報学

<b>Objective: </b>The revised Pharmaceutical Affairs Act that came into force in June 2009 prohibits the sale of nonprescription drugs via mail.  However, as a provisional measure, regular users and inhabitants of remote islands who do not have access to pharmacies or drug stores are allowed to purchase nonprescription drugs via mail until the end of May 2013.  This study involves a survey on the purchasing of nonprescription drugs by Internet-illiterate inhabitants of the remote Goto Islands, Nagasaki Prefecture, Japan.<br><b>Methods: </b>Our process began with the distribution of questionnaires via mail to inhabitants of the remote Goto Islands, of whom 3,819 were randomly selected.  The responses were sent between January 22 and February 26, 2011.  We analyzed problems presented by 522 inhabitants who were Internet-illiterate.<br><b>Results: </b>The results revealed that 57.3% of the respondents living on large islands—with pharmacies, drug stores, and pharmacists— (e.g., Fukueshima) and 85.3% of respondents living on small islands scattered around large islands—with none of the abovementioned amenities— (e.g., Maeshima) were Internet-illiterate.  Additionally, a majority of the respondents (more than 80%) felt no need to purchase nonprescription drugs over the Internet.  However, considering that a handful of these inhabitants do, or will at some time need to purchase nonprescription drugs over the Internet, we strive to establish an optimal system for supplying medications to these Internet-illiterate inhabitants.<br><b>Conclusion: </b>Community pharmacists need to establish close relationships with the Internet illiterate (particularly those living on small islands) and promote the overall appropriate use of medicinal products.

Study of socio demographic and health profile of child labourers.

Background and Objectives: Child labour is a critical problem, which in turn leads to many other problems like illiteracy, poverty, malnutrition etc. So detailed study is carried out with objectives of 1)To study the socio- demographic and health characteristics of child labourers and their relationship. 2) To identify the causal factors of child labour. Methods: a Cross sectional study in 30 slum areas of Rajkot city is carried out from May 2005 to July 2005. 372 child labourers were taken by cluster methodology. Data were collected using a pretested semi structured questionnaire from each child labourer during house-to-house visit. Statistical analysis was done by Z test, Chi – square test etc. Results: 95.03% of the child labourers belonged to social class 3 and 4. 9.1% never attended the school. Mean family size was 5.67. 35.7% child labourers suffered from some kind of morbidity in the last 15 days and 23.7% had harmful addiction. Conclusion and Interpretation: Poverty and dropouts are the important causes of child labour. There was no medical care facility at workplace in most cases. Harmful addiction was significantly associated with male child labourers, illiteracy of fathers and higher age group.

O conhecimento do nome das letras e a sua relação com o desenvolvimento da escrita: evidência de adultos iletrados / The relationship between letter name knowledge and the development of spelling: evidence from illiterate adults

Dezenove adultos que não haviam começado a ler foram solicitados a escrever uma lista de palavras da melhor maneira que pudessem. De modo geral, suas escritas foram compostas de letras cujo nome podia ser claramente detectado na pronúncia das palavras (e.g., a escrita IU para chinelo ). Esses resultados sugerem que adultos iletrados utilizam seu conhecimento do nome das letras para conectar a escrita à fala. Como parece ocorrer entre crianças, o uso dessa estratégia resultou, algumas vezes, em escritas "silábicas", isto é, escritas em que o número de letras corresponde ao número de sílabas na pronúncia da palavra.

Nineteen adults who did not know how to read were asked to spell a list of words as well as possible. In general, their spellings consisted of letters whose names could be clearly heard in the pronunciation of the word (e.g., the spelling I and U for chinelo, in which the names of the letters i and u can be detected in the pronunciation of the word). These results suggest that illiterate adults use their knowledge of letter names to connect print to speech. Similar to what has been observed among preschool children, the use of this strategy resulted, sometimes, in so-called "syllabic" spellings, that is, spellings in which the number of letters correspond to the number of syllables in the pronunciation of the word.

Relações emergentes após ensino de comportamento textual por meio do procedimento de discriminação simples em crianças / Emergent relattions after teaching textual responses with simple discrimanation procedure in children / Relaciones emergentes después de la enseñaza de comportamiento textual por medio del procedimiento de discriminación simple en niños

O repertório de leitura com compreensão tem sido verificado em testes de relações emergentes após o ensino por meio do procedimento de discriminação condicional. Este estudo teve o objetivo de verificar a emergência de relações após o ensino de comportamento textual por meio do procedimento de discriminação simples. Três crianças não alfabetizadas foram submetidas a pré-testes, ensino de comportamento textual de trinta palavras, pós-testes e testes de relações emergentes entre palavras faladas, escritas e figuras. Durante o ensino, cada palavra era apresentada e a nomeação correta era seguida de elogio. Quando ocorria erro, a experimentadora nomeava a palavra e a criança repetia. O ensino de comportamento textual por meio do procedimento de discriminação simples permitiu a emergência de relações. Um procedimento que minimiza a ocorrência de erros produziu aquisição de um repertório mais amplo do que o ensinado. Para crianças não alfabetizadas, esse tipo de ensino é de fundamental importância.

The repertoire of reading with comprehension has been found during emergent relations tests after teaching with conditional discrimination procedure. The present study aimed to evaluate whether emergent relations could be established after teaching textual responses with simple discrimination procedure. Three illiterate children were submitted to pretests, textual responses teaching to thirty words, post-tests and emergent relations tests between spoken and written words and pictures. During teaching, each word was presented and a correct response was followed by a compliment. When an incorrect response occurred, the experimenter named the word and the child repeated it. The results suggest that teaching textual responses with simple discrimination procedure produced emergent relations. A teaching procedure that minimizes the occurrence of errors produced a wider repertory than taught. For illiterate children, this kind of education is of paramount importance.

Se ha observado el repertorio de lectura comprensiva en pruebas de relaciones emergentes posteriores a un procedimiento de discriminación condicional. El objetivo de este estudio fue verificar la emergencia de relaciones luego de enseñar comportamiento textual con el procedimiento de discriminación simple. Tres niños analfabetas fueron sometidas a pre-tests, enseñanza del comportamiento textual de treinta palabras, post-tests y pruebas de relaciones emergentes entre palabras habladas, escritas y dibujos. Durante la instrucción, nombrar correctamente cada palabra presentada era elogiado por la experimentadora. Cuando un de los niños erraban, la experimentadora decía la palabra y el niño repetía. Los resultados sugieren que la enseñanza de comportamiento textual con el procedimiento de discriminación simple permitió la producción de relaciones emergentes y que un procedimiento para reducir la ocurrencia de errores produjo la adquisición de un repertorio más amplio que el enseñado. Para los niños analfabetos este tipo de enseñanza es de suma importancia.

Literacy and Neuropsychological Functions in the Older Korean Adults

OBJECTIVES: This study examined the effects of illiteracy on neuropsychological functions of older Korean adults. Illiteracy was evaluated with the Literacy Questionnaire which involved interview with the subjects. METHODS: The participants were 206 healthy people, ages between 55 and 84, who were sampled in the Seoul-Kyungki region and Chungnam province. RESULTS: The results revealed that verbal memory tests were not disadvantageous to illiterate people. Rather non-verbal tasks such as the copy condition of the Simple Rey Figure Test and the Clock Drawing Test proved disadvantageous. CONCLUSION: Literacy appears to be beneficial to the development of visuospatial abilities. Neuropsychological tests that involve visuospatial function may not be efficient in discriminating dementia patients who are illiterate.