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PubMed1999

Development of an activities of daily living scale to screen for dementia in an illiterate rural older population in India.

OBJECTIVE: to develop a measure of activities of daily living appropriate for use in assessing the presence of dementia in illiterate rural elderly people in India. DESIGN: identification of relevant items, pre-testing of items and refinement of administrative procedures and scoring in four successive groups of 30 subjects each, pilot testing in a group of 100 subjects comparable to those for whom the measure is intended, administration to a representative sample of 387 people aged 55 and older, and assessment of the reliability of the final measure. SETTING AND SUBJECTS: age-stratified random sample of older men and women in rural areas of Ballabgarh, Northern India. RESULTS: the original pool of 35 items covering mobility, instrumental and personal care activities was reduced to an 11-item unidimensional scale (to which an additional item on mobility was added) with internal consistency (Cronbach's alpha)=0.82, perfect inter- and intra-rater reliability, test-retest reliability (intraclass correlation)=0.82 (any disability) and 0.92 (unable to perform for 'mental' reasons). Women, older subjects, the totally illiterate and subjects with poorer cognitive function performed significantly more poorly (P < or = 0.02 for all). PRODUCT: a brief, reliable and valid activities of daily living measure, with norms, which is appropriate for use in assessing dementia in illiterate rural elderly people in India.

Activities of Daily Living↗
PubMed1993

Literacy and hemispheric specialization for language: dichotic listening in young functionally illiterate men.

The functional cerebral organization of young men who were defined as illiterate was studied by testing their dichotic listening for language stimuli. These functionally illiterate men showed greater right ear advantage for language stimuli than 50 educated subjects, a pattern already observed with completely illiterate persons of both sexes. This finding is consistent with the view that mastering written codes for language might be one of the most relevant parameters in hemispheric specialization when language is studied.

Acoustic Stimulation↗
PubMed1990

Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis.

The assessment of a measure of chronic pain, should be reliable, valid and sensitive to change. Our study evaluated the reliability of 3 pain scales, visual analogue scale (VAS), numerical rating scale (NRS) and verbal rating scale (VRS) in literate and illiterate patients with rheumatoid arthritis (RA). Patients with RA attending an outpatient rheumatology clinic were interviewed and asked to score their pain levels on the 3 pain scales. The scales were presented in random order, twice, before and just after a regular medical consultation. Ninety-one patients were studied (25 illiterate and 66 literate). The Pearson product moment correlation between first and second assessment was 0.937 for VAS, 0.963 for NRS and 0.901 for VRS in the literate patient group and 0.712 for VAS, 0.947 for NRS and 0.820 for VRS in the illiterate patient group. These results indicate that the NRS has the higher reliability in both groups of patients.

Arthritis, Rheumatoid↗
PubMed2000

The Bangla adaptation of Mini-Mental State Examination (BAMSE): an instrument to assess cognitive function in illiterate and literate individuals.

The Mini-Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly, requiring literacy as a prerequisite. Such a precondition is impractical for populations with widespread illiteracy. The present study aimed to adapt the MMSE for the cultural context of Bangladesh and for use in populations irrespective of literacy skills. In the Bangla Adaptation of Mini-mental State Examination (BAMSE), the MMSE items were changed in such a way that they would be applicable for illiterate individuals, as well as being culturally relevant in Bangladesh. Altogether 672 elderly, 262 literate and 410 illiterate individuals were tested with the BAMSE. To enable comparison between the BAMSE and MMSE, the literate elderly were tested with both instruments. Test-retest reliability of the BAMSE was assessed in 54 randomly selected individuals. The results showed that, in comparison to the MMSE, the BAMSE demonstrated satisfactory test properties, although reliable differences were found on some of the individual items when the two instruments were compared. The association between the two instruments was good (r=0.57) and the test-retest reliability was satisfactory (r=0.70). More importantly, the BAMSE was found to be less sensitive to age and education than the MMSE. Finally, our results suggest that in the socio-cultural context of Bangladesh, irrespective of literacy skills, the BAMSE is an instrument that can be used to assess cognitive function of the normal elderly.

Aged↗
PubMed1999

Effective auditory-verbal encoding activates the left prefrontal and the medial temporal lobes: A generalization to illiterate subjects.

Recent event-related FMRI studies indicate that the prefrontal (PFC) and the medial temporal lobe (MTL) regions are more active during effective encoding than during ineffective encoding. The within-subject design and the use of well-educated young college students in these studies makes it important to replicate these results in other study populations. In this PET study, we used an auditory word-pair association cued-recall paradigm and investigated a group of healthy upper middle-aged/older illiterate women. We observed a positive correlation between cued-recall success and the regional cerebral blood flow of the left inferior PFC (BA 47) and the MTLs. Specifically, we used the cued-recall success as a covariate in a general linear model and the results confirmed that the left inferior PFC and the MTL are more active during effective encoding than during ineffective encoding. These effects were observed during encoding of both semantically and phonologically related word pairs, indicating that these effects are robust in the studied population, that is, reproducible within group. These results generalize the results of Brewer et al. (1998, Science 281, 1185-1187) and Wagner et al. (1998, Science 281, 1188-1191) to an upper middle aged/older illiterate population. In addition, the present study indicates that effective relational encoding correlates positively with the activity of the anterior medial temporal lobe regions.

Aged↗
PubMed1999

An Arabic letter distance visual acuity test chart for young children and illiterate adults.

This paper describes the design of a kinetic response Arabic letter distance visual acuity test chart for young children and illiterate adults. An Arabic letter ein which has previously been used in the design of Arabic alphabet VA charts was employed. Four different orientations of the letter were constructed on a 5 x 5 unit format and graded according to log MAR principle of acuity scaling using an Apple computer. Inter-letter space in each row was made equal to the width of each letter in the row, and inter-row space was made equal to the height of letters in the next lower row. The chart has 14 acuity rows ranging from 4/40 to 4/2 (6/60 to 6/3) (20/200 to 20/10) (log MAR 1.0 to -0.3) at 4 metres. To establish the validity of the chart, acuity values obtained using the chart were compared with those from an existing Arabic log MAR distance VA chart and the Bailey and Lovie distance VA chart. Test retest reliability of the chart was also examined statistically. Results show that VA values from the new chart were significantly similar with those from which it was compared, and that values from the chart are reliable. The chart will be useful for evaluating vision, especially for young children and illiterate adults.

Adolescent↗
PubMed1990

Use of illiterate volunteer workers for malaria case detection and treatment.

We evaluated the use of illiterate community volunteers for malaria case detection and treatment in Guatemala. Volunteer workers, known as Volunteer Medicators, were selected by members of their communities and were trained and supervised by National Malaria Service (NMS) staff. Their responsibilities included recording basic demographic data and administering a three-day course of chloroquine (25 mg kg-1) to all febrile patients who visited their homes. Patient information was recorded on a special form which consisted of stick-figure drawings. During a one-year evaluation period, no differences were noted between literate and illiterate Volunteer Medicators with respect to the length of time required for their training or supervision, the average number of patients they treated per month, the frequency of errors in recording data or administering medication, or their acceptance by the community residents.

Community Health Workers↗
PubMed1998

Neuropsychological test performance in illiterate subjects.

The purpose of this study was to further analyze the effects of education across different age ranges on neuropsychological test performance. Two different analyses were performed. The first analysis was conducted in order to pinpoint the impact of school attendance on neuropsychological testing. A group of 64 illiterate normal subjects was selected in the Mexican Republic. Their performance was compared with two barely schooled control groups (1-2 and 3-4 years of schooling). The subjects' ages ranged from 16 to 85 years. In the second analysis, the illiterate subjects were further matched by age and sex with individuals with 1 to 4, 5 to 9, and 10 to 19 years of formal education. The Spanish version of the NEUROPSI neuropsychological test battery (Ostrosky, Ardila, & Rosselli, 1997) was used. Results indicated a significant educational effect on most of the tests. Largest educational effect was noted in constructional abilities (copying of a figure), language (comprehension), phonological verbal fluency, and conceptual functions (similarities, calculation abilities, and sequences). Aging effect was noted in visuoperceptual (visual detection) and memory scores. In the first subject sample, it was evident that, despite using such limited educational range (from 0-4 years of formal education), and such a wide age range (from 16-85 years), schooling represented a stronger variable than age. It is proposed that education effect on neuropsychological test performance represents a negatively accelerated curve, tending to a plateau.

Journal Article↗
PubMed2000

Dyspnea scales in the assessment of illiterate patients with chronic obstructive pulmonary disease.

BACKGROUND: Multiple physiological, psychological, social and environmental factors may affect the perception of dyspnea. Although different scales have been used to record the severity of dyspnea in subjects with chronic obstructive pulmonary disease (COPD), none has reported evaluating the properties of such tools in illiterate patients. The objective of this study was to evaluate the reliability and features of concurrent validity of 4 dyspnea scales in illiterate (IL) subjects with COPD. METHODS: One hundred COPD patients submitted to spirometry and were asked to score their breathlessness using a visual analogue scale (VAS), a numerical rating scale (NRS), the Borg scale (BS), and the basal dyspnea index (BDI). Each scale was presented to the patients before and after they had performed spirometry and measurement of residual volume. The obtained scores were analyzed according to the literacy status of the patients. RESULTS: Thirty-three patients were classified as IL and 67 as literate (L). Both groups showed similar respiratory impairment and median scores of dyspnea (VAS, L = 45.0, IL = 49.0; NRS, L = 5.0, IL = 5.0; BS, L = 3.0, IL = 3.0; BDI, L = 5.0, IL = 4.0). No significant differences were found between the dyspnea scores obtained before and after spirometry for all scales in both groups. The degree of correlation between forced expiratory volume in 1 second (FEV1) and usual dyspnea evaluated by BDI did not show a statistical difference between the two groups (L, r = 0.37; IL, r = 0.51). CONCLUSION: The employed dyspnea scales showed comparable reliability in both L and IL COPD subjects.

Adult↗
PubMed2001

Cognitive processing in literate and illiterate subjects: a review of some recent behavioral and functional neuroimaging data.

The study of illiterate subjects, which for specific socio-cultural reasons did not have the opportunity to acquire basic reading and writing skills, represents one approach to study the interaction between neurobiological and cultural factors in cognitive development and the functional organization of the human brain. In addition the naturally occurring illiteracy may serve as a model for studying the influence of alphabetic orthography on auditory-verbal language. In this paper we have reviewed some recent behavioral and functional neuroimaging data indicating that learning an alphabetic written language modulates the auditory-verbal language system in a non-trivial way and provided support for the hypothesis that the functional architecture of the brain is modulated by literacy. We have also indicated that the effects of literacy and formal schooling is not limited to language related skills but appears to affect also other cognitive domains. In particular, we indicate that formal schooling influences 2D but not 3D visual naming skills. We have also pointed to the importance of using ecologically relevant tasks when comparing literate and illiterate subjects. We also demonstrate the applicability of a network approach in elucidating differences in the functional organization of the brain between groups. The strength of such an approach is the ability to study patterns of interactions between functionally specialized brain regions and the possibility to compare such patterns of brain interactions between groups or functional states. This complements the more commonly used activation approach to functional neuroimaging data, which characterize functionally specialized regions, and provides important data characterizing the functional interactions between these regions.

Aged↗
PubMed2006

Sex differences in cognition among illiterate Bangladeshis: a comparison with literate Bangladeshis and Swedes.

We investigated the presence and magnitude of sex differences in late adulthood, assessing 426 illiterate Bangladeshis, 239 literate Bangladeshis, and 598 Swedes. The cognitive domains examined included calculation, episodic memory, spatial visualization, and global cognitive ability. In general, men performed at a higher level than women on tasks assessing calculation and spatial visualization, whereas women performed at a higher level than men on the episodic memory task. Notably, the pattern of cognitive sex differences was similar irrespective of nationality and literacy, although the magnitude of the male advantage was inversely related to level of education. Finally, the low performance of the illiterate women demonstrated the penalizing effect restrictions in public exposure might have on cognitive performance.

Adult↗
PubMed2003

A sociodemographic and neuropsychological characterization of an illiterate population.

The objectives of this article are to characterize the performance and to discuss the performance differences between literate and illiterate participants in a well-defined study population. We describe the participant-selection procedure used to investigate this population. Three groups with similar sociocultural backgrounds living in a relatively homogeneous fishing community in southern Portugal were characterized in terms of socioeconomic and sociocultural background variables and compared on a simple neuropsychological test battery; specifically, a literate group with more than 4 years of education (n = 9), a literate group with 4 years of education (n = 26), and an illiterate group (n = 31) were included in this study. We compare and discuss our results with other similar studies on the effects of literacy and illiteracy. The results indicate that naming and identification of real objects, verbal fluency using ecologically relevant semantic criteria, verbal memory, and orientation are not affected by literacy or level of formal education. In contrast, verbal working memory assessed with digit span, verbal abstraction, long-term semantic memory, and calculation (i.e., multiplication) are significantly affected by the level of literacy. We indicate that it is possible, with proper participant-selection procedures, to exclude general cognitive impairment and to control important sociocultural factors that potentially could introduce bias when studying the specific effects of literacy and level of formal education on cognitive brain function.

Aged↗
PubMedDate not supplied

[Cognitive evaluation in illiterate persons].

INTRODUCTION: Approximately a third of the world population is illiterate. The analysis of illiterate patients' performance in cognitive tasks is an important part of neuropsychology. OBJECTIVE: To show that cognitive evaluation tests, both psychological and neuropsychological, are extremely sensitive to the educational level of the subject. DEVELOPMENT AND CONCLUSIONS: It has been suggested that schooling may in some way modify the cerebral organization of cognitive activity. Although education does not alter the hemisphere dominance of language and other cognitive functions, there does seem to be increased lateralization of these functions in literate people. In neuropsychological testing, schooling is an even more significant variable than age. However, education does have a lineal effect on the scores obtained in neuropsychological tests. More precisely, the relationship between schooling and performance of neuropsychological tests shows an negatively accelerated curve.

Adolescent↗
PubMed1992

When the patient is illiterate: how nurses can help.

Nurses have a unique opportunity to provide help to illiterate patients. With good listening, observation, and teaching skills, nurses can contribute significantly to the quality of care illiterate patients receive. They can influence long term recovery and patient compliance. It is important to teach when a "teachable" moment has arrived. For instance, when patients ask questions, they are usually ready to learn and an environment conducive to learning can be created. "Teachable" moments can occur at any time during hospitalization. The discharge interview is not the point at which to begin instructions. Discharge teaching should be a review of all the teaching that has been going on during hospitalization.

Educational Status↗
PubMed1982

Pathogenic bacteria isolated from infant feeding teats: contamination of teats used by illiterate and educated nursing mothers in Ile-Ife, Nigeria.

We assessed bacterial contamination of infant feeding teats among nursing mothers and identified pathogenic organisms that might be associated with the incidence of diarrhea. The incidence of diarrhea among the infants of illiterate mothers was fivefold that of infants of educated mothers. The vast majority of the illiterate mothers poorly sterilized their infants' feeding utensils. The most prevalent pathogenic organism isolated from the teats was enteropathogenic Escherichia coli, followed by Staphylococcus aureus. Unhygienic handling of feeds is an important factor in infantile diarrhea.

Bacteria↗
PubMed1982

Prediction of achievement in reading, self-esteem, auding, and verbal language by adult illiterates in a psychoeducational tutorial program.

Examined the effectiveness of specific psychoeducational tutoring methods on achievement in reading, self-esteem, auding, and verbal language, Ss (N = 132) were youths and adults reading below fifth level who volunteered to participate in an adult tutorial project. After the assessment of entry level achievement, Ss received psychoeducational tutoring. Comparison of pre- with posttest scores scores indicated that Ss made significant improvement in reading, self-esteem, auding, and verbal language. Pretest scores were related most strongly to posttest scores. Initial verbal language scores were related significantly to posttest reading and auding scores. The study also tested the adequacy of a developmental reading model for adult illiterates. Auding and verbal language scores exceeded reading scores, as theorized. Further research is needed to determine whether gains in achievement continue and whether low intellectual levels or specific language disabilities are contributing to the low levels of reading, auding, and verbal language.

Achievement↗
PubMed1983

Intelligence and achievement of adult illiterates in a tutorial project: a preliminary analysis.

Reports the results of preliminary analyses of intelligence and achievement in an adult tutorial project. Incarcerated adult illiterates volunteered to participate in a peer tutoring program wherein they received 27 hours of structured tutoring. Significant achievement was demonstrated in all areas. Achievement and gains in achievement were analyzed in relation to Verbal, Performance, and Full Scale IQ scores using four sets of analyses. Significant correlations were noted between IQ scores and achievement, but not gains in achievement. Gains in achievement were not significantly different among Ss at different Verbal, Performance and Full Scale IQ levels, nor were gains in achievement different between Ss who had a significant Verbal-Performance discrepancy and those who did not. Gains in achievement were not significantly different across subgroups categorized according to both IQ level and Verbal-Performance discrepancy.

Achievement↗
PubMed1988

An easily comprehensible MMPI short form for rapid assessment of illiterate patients.

An abbreviation of the MMPI was constructed from a 167-item, highly comprehensible MMPI short form. Scales MF and SI were omitted, and item analyses of data from 101 illiterate patients, who had been read the 167 items, were used to shorten the other scales. Estimation equations for the resulting 79-item test were calculated on MMPI data from 200 psychiatric inpatients, and the new form was compared with the Mini-Mult in literate samples of psychiatric inpatients, psychiatric outpatients, male alcoholics, and male prisoners. Correspondence of the new abbreviated form with the full MMPI was respectable in all groups, and in comparison to the Mini-Mult, there were no strong reasons for preferring one form over the other. The new test was poorer than the Mini-Mult in predicting K and HY, but better in estimating SC. It was concluded that the abbreviation has potential usefulness with cognitively impaired patients.

Adolescent↗