Health-related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub-Saharan Africa: a systematic literature review.

INTRODUCTION: Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) have specific health needs that can be challenging to deliver. Sub-Saharan Africa (SSA) is home to 84% of the global population of ALHIV, of whom about 59% receive ART. Several studies in SSA have demonstrated health service gaps due to lack of synchronized healthcare for ALHIV receiving ART. We conducted a systematic review of health-related needs among ALHIV on ART in SSA to inform decisions and policies on care. METHODS: We searched MEDLINE, Web of Science, EMBASE, PsycINFO, Cochrane library and grey literature for studies reporting health-related needs among ALHIV receiving ART in SSA, between January 2003 and May 2020. RESULTS AND DISCUSSION: Of the 2333 potentially eligible articles identified, 32 were eligible. Eligible studies were published between 2008 and 2019, in 11 countries: Zambia (7), Uganda (6), Tanzania (4), South Africa (4), Kenya (3), Ghana (2), Zimbabwe (2), Rwanda (1), Malawi (1), Botswana (1) and Democratic Republic of Congo (1). Seven categories of health needs among ALHIV were identified. In descending order of occurrence, these were: psychosocial needs (stigma reduction, disclosure and privacy support, and difficulty accepting diagnosis); dependency of care (need for family and provider support, and desire for autonomy); self-management needs (desire for better coping strategies, medication adherence support and reduced ART side effects); non-responsive health services (non-adolescent friendly facility services and non-compatible school system); need for food, financial and material support; inadequate information about HIV (desire for more knowledge to fight misinformation and misconception); and developmental and growth needs (desire to experience sex, parenthood and love). Ecological analysis identified different priority needs between ALHIV, their caregivers and healthcare providers, including psychosocial needs, financial challenges and non-responsive health services, respectively. CONCLUSIONS: To respond effectively to the health needs of ALHIV and improve ART adherence, interventions should focus on stigma reduction, disclosure challenges and innovative coping mechanisms for ART. Interventions that address the health needs of ALHIV from the perspective of carers and providers, such as financial support schemes and adolescent-friendly healthcare strategies, should supplement efforts to improve adolescent ART adherence outcomes.

Labels and object categorization in six- and nine-month-olds: tracking labels across varying carrier phrases.

Language shapes object categorization in infants. This starts as a general enhanced attentional effect of language, which narrows to a specific link between labels and categories by twelve months. The current experiments examined this narrowing effect by investigating when infants track a consistent label across varied input. Six-month-old infants (N = 48) were familiarized to category exemplars, each presented with the exact same labeling phrase or the same label in different phrases. Evidence of object categorization at test was only found with the same phrase, suggesting that infants were not tracking the label's consistency, but rather that of the entire input. Nine-month-olds (N = 24) did show evidence of categorization across the varied phrases, suggesting that they were tracking the consistent label across the varied input.

Twelve to 24-month-olds can understand the meaning of morphological regularities in their language.

To learn a language infants must learn to link arbitrary sounds to their meaning. While words are the clearest example of this link, they are not the only component of language; morphological regularities (e.g., the plural -s suffix in English) carry meaning as well. Comprehensive theories of language acquisition must account for how infants build links between these other parts of language and their meaning. Here, we investigated the acquisition of morphology in infants learning Italian, a language with a rich inflectional morphology that marks both gender and number on both the article and final vowel of nouns. We demonstrate that infants can build these links between concepts and morphological regularities much earlier than previously thought. Italian-learning 12-18- and 24-month-olds were shown pairs of images of faces that differed either in number (1 female vs. 2 females; 1 male vs. 2 males) or gender (1 female vs. 1 male; 2 females vs. 2 males). On each trial infants were directed to look at one of the images with the morphological regularities as the only distinguishing cue. Overall, across all ages, the infants looked to the labeled image, indicating that they had at least some understanding of the morphology. While infants succeeded on both gender comparisons, they only showed evidence of understanding the feminine number distinction. These results indicate that in the early stages of language acquisition, infants are able to identify recurring morphemes and to map those morphological regularities to the concepts that they mark in the language. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Newborns are sensitive to multiple cues for word segmentation in continuous speech.

Before infants can learn words, they must identify those words in continuous speech. Yet, the speech signal lacks obvious boundary markers, which poses a potential problem for language acquisition (Swingley, Philos Trans R Soc Lond. Series B, Biol Sci 364(1536), 3617-3632, 2009). By the middle of the first year, infants seem to have solved this problem (Bergelson & Swingley, Proc Natl Acad Sci 109(9), 3253-3258, 2012; Jusczyk & Aslin, Cogn Psychol 29, 1-23, 1995), but it is unknown if segmentation abilities are present from birth, or if they only emerge after sufficient language exposure and/or brain maturation. Here, in two independent experiments, we looked at two cues known to be crucial for the segmentation of human speech: the computation of statistical co-occurrences between syllables and the use of the language's prosody. After a brief familiarization of about 3 min with continuous speech, using functional near-infrared spectroscopy, neonates showed differential brain responses on a recognition test to words that violated either the statistical (Experiment 1) or prosodic (Experiment 2) boundaries of the familiarization, compared to words that conformed to those boundaries. Importantly, word recognition in Experiment 2 occurred even in the absence of prosodic information at test, meaning that newborns encoded the phonological content independently of its prosody. These data indicate that humans are born with operational language processing and memory capacities and can use at least two types of cues to segment otherwise continuous speech, a key first step in language acquisition.

In vivo measure of neonate brain optical properties and hemodynamic parameters by time-domain near-infrared spectroscopy.

By exploiting a multichannel portable instrument for time-domain near-infrared spectroscopy (TD-NIRS), we characterized healthy neonates' brains in term of optical properties and hemodynamic parameters. In particular, we assessed the absolute values of the absorption and reduced scattering coefficients at two wavelengths, together with oxy-, deoxy- and total hemoglobin concentrations, and the blood oxygen saturation of the neonates' brains. In this study, 33 healthy full-term neonates were tested, obtaining the following median values: 0.28 and [Formula: see text] for [Formula: see text] at 690 and 820 nm, respectively; 5.8 and [Formula: see text] for [Formula: see text] at 690 and 820 nm, respectively; [Formula: see text] for [Formula: see text]; [Formula: see text] for [Formula: see text]; [Formula: see text] for [Formula: see text]; 72% for [Formula: see text]. In general, the agreement of these values with the sparse existing literature appears not always consistent. These findings demonstrate the first measurements of optical properties of the healthy neonate brain using TD-NIRS and show the need for clarification of optical properties across methods and populations.

Five-Month-Old Infants Have General Knowledge of How Nonsolid Substances Behave and Interact.

Experience puts people in touch with nonsolid substances, such as water, blood, and milk, which are crucial to survival. People must be able to understand the behavior of these substances and to differentiate their properties from those of solid objects. We investigated whether infants represent nonsolid substances as a conceptual category distinct from solid objects on the basis of differences in cohesiveness. Experiment 1 established that infants can distinguish water from a perceptually matched solid and can correctly predict whether the item will pass through or be trapped by a grid. Experiments 2 and 3 showed that infants extend this knowledge to less familiar granular substances. These experiments indicate that concepts of cohesive and noncohesive material appear early in development, apply across several types of nonsolid substances, and may serve as the basis of later knowledge of physical phases.

On the edge of language acquisition: inherent constraints on encoding multisyllabic sequences in the neonate brain.

To understand language, humans must encode information from rapid, sequential streams of syllables - tracking their order and organizing them into words, phrases, and sentences. We used Near-Infrared Spectroscopy (NIRS) to determine whether human neonates are born with the capacity to track the positions of syllables in multisyllabic sequences. After familiarization with a six-syllable sequence, the neonate brain responded to the change (as shown by an increase in oxy-hemoglobin) when the two edge syllables switched positions but not when two middle syllables switched positions (Experiment 1), indicating that they encoded the syllables at the edges of sequences better than those in the middle. Moreover, when a 25 ms pause was inserted between the middle syllables as a segmentation cue, neonates' brains were sensitive to the change (Experiment 2), indicating that subtle cues in speech can signal a boundary, with enhanced encoding of the syllables located at the edges of that boundary. These findings suggest that neonates' brains can encode information from multisyllabic sequences and that this encoding is constrained. Moreover, subtle segmentation cues in a sequence of syllables provide a mechanism with which to accurately encode positional information from longer sequences. Tracking the order of syllables is necessary to understand language and our results suggest that the foundations for this encoding are present at birth.

Prelinguistic Relational Concepts: Investigating Analogical Processing in Infants.

This research asks whether analogical processing ability is present in human infants, using the simplest and most basic relation-the same-different relation. Experiment 1 (N = 26) tested whether 7- and 9-month-olds spontaneously detect and generalize these relations from a single example, as previous research has suggested. The attempted replication failed. Experiment 2 asked whether infants could abstract the relation via analogical processing (Experiment 2, N = 64). Indeed, with four exemplars, 7- and 9-month-olds could abstract the same-different relation and generalize it to novel pairs. Furthermore, prior experience with the objects disrupted learning. Facilitation from multiple exemplars and disruption by individual object salience are signatures of analogical learning. These results indicate that analogical ability is present by 7 months.

Nonhuman primate vocalizations support categorization in very young human infants.

Language is a signature of our species and our primary conduit for conveying the contents of our minds. The power of language derives not only from the exquisite detail of the signal itself but also from its intricate link to human cognition. To acquire a language, infants must identify which signals are part of their language and discover how these signals are linked to meaning. At birth, infants prefer listening to vocalizations of human and nonhuman primates; within 3 mo, this initially broad listening preference is tuned specifically to human vocalizations. Moreover, even at this early developmental point, human vocalizations evoke more than listening preferences alone: they engender in infants a heightened focus on the objects in their visual environment and promote the formation of object categories, a fundamental cognitive capacity. Here, we illuminate the developmental origin of this early link between human vocalizations and cognition. We document that this link emerges from a broad biological template that initially encompasses vocalizations of human and nonhuman primates (but not backward speech) and that within 6 mo this link to cognition is tuned specifically to human vocalizations. At 3 and 4 mo, nonhuman primate vocalizations promote object categorization, mirroring precisely the advantages conferred by human vocalizations, but by 6 mo, nonhuman primate vocalizations no longer exert this advantageous effect. This striking developmental shift illuminates a path of specialization that supports infants as they forge the foundational links between human language and the core cognitive processes that will serve as the foundations of meaning.

Categorization in 3- and 4-month-old infants: an advantage of words over tones.

Neonates prefer human speech to other nonlinguistic auditory stimuli. However, it remains an open question whether there are any conceptual consequences of words on object categorization in infants younger than 6 months. The current study examined the influence of words and tones on object categorization in forty-six 3- to 4-month-old infants. Infants were familiarized to different exemplars of a category accompanied by either a labeling phrase or a tone sequence. In test, infants viewed novel category and new within-category exemplars. Infants who heard labeling phrases provided evidence of categorization at test while infants who heard tone sequences did not, suggesting that infants as young as 3 months of age treat words and tones differently vis-à-vis object categorization.

Five-month-old infants have different expectations for solids and liquids.

Many studies have established that 2-month-old infants have knowledge of solid objects' basic physical properties. Evidence about infants' understanding of nonsolid substances, however, is relatively sparse and equivocal. We present two experiments demonstrating that 5-month-old infants have distinct expectations for how solids and liquids behave. Experiment 1 showed that infants use the motion cues from the surface of a contained liquid or solid to predict whether it will pour or tumble from a cup if the cup is upended. Experiment 2 extended these findings to show that motion cues lead to distinct expectations about whether a new object will pass through or remain on top of a substance. Together, these experiments demonstrate that 5-month-old infants are able to use movement cues and solidity to discriminate a liquid from an object of similar appearance, providing the earliest evidence that infants can reason about nonsolid substances.