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PubMed2000

Language processing modulated by literacy: a network analysis of verbal repetition in literate and illiterate subjects.

Previous behavioral and functional neuroimaging data indicate that certain aspects of phonological processing may not be acquired spontaneously, but are modulated by learning an alphabetic written language, that is, learning to read and write. It appears that learning an alphabetic written language modifies the auditory-verbal (spoken) language processing competence in a nontrivial way. We have previously suggested, based on behavioral and functional neuroimaging data, that auditory-verbal and written language interact not only during certain language tasks, but that learning and developing alphabetic written language capacities significantly modulates the spoken language system. Specifically, the acquisition of alphabetic orthographic knowledge has a modulatory influence on sublexical phonological processing and the awareness of sublexical phonological structure. We have suggested that developing an orthographic representation system for an alphabetic written language, and integrating a phoneme-grapheme correspondence with an existing infrastructure for auditory-verbal language processing, will result in a modified language network. Specifically, we suggest that the parallel interactive processing characteristics of the underlying language-processing brain network differ in literate and illiterate subjects. Therefore, the pattern of interactions between the regions of a suitably defined large-scale functional-anatomical network for language processing will differ between literate and illiterate subjects during certain language tasks. In order to investigate this hypothesis further, we analyzed the observed covariance structure in a PET data set from a simple auditory-verbal repetition paradigm in literate and illiterate subjects, with a network approach based on structural equation modeling (SEM). Based on a simple network model for language processing, the results of the present network analysis indicate that the network interactions during word and pseudoword repetition in the illiterate group differ, while there were no significant differences in the literate group. The differences between the two tasks in the illiterate group may reflect differences in attentional modulation of the language network, executive aspects of verbal working memory and the articulatory organization of verbal output. There were no significant differences between the literate and illiterate group during word repetition. In contrast, the network interactions differed between the literate and illiterate group during pseudoword repetition. In addition to differences similar to those observed in the illiterate group between word and pseudoword repetition, there were differences related to the interactions of the phonological loop between the groups. In particular, these differences related to the interaction between Broca's area and the inferior parietal cortex as well as the posterior-midinsula bridge between Wernicke's and Broca's area. In conclusion, the results of this network analysis are consistent with our previously presented results and support the hypothesis that learning to read and write during childhood influences the functional architecture of the adult human brain. In particular, the basic auditory-verbal language network in the human brain is modified as a consequence of acquiring orthographic language skills.

Adult↗

PubMed1988

Illiteracy and brain damage. 3: A contribution to the study of speech and language disorders in illiterates with unilateral brain damage (initial testing).

This report bears on the behavior of 188 unilateral stroke subjects when administered an aphasia screening test comprising a short interview as well as naming, repetition, word-picture matching and sentence-picture matching tasks. All subjects were unilingual lusophone adult (40 yr of age or older) right-handers. Furthermore, they were either totally unschooled illiterates or they had received school education and thereafter retained writing skills and reading habits. Subjects were tested less than 2 months after a first unilateral stroke. In all tasks, global error scores were greater among left and right brain-damaged illiterate and literate subjects than among their controls. In repetition and matching, these differences were statistically significant for the left but not for the right-stroke groups, irrespective of the literacy factor. In naming, on the other hand, significant differences were found not only for the two left-stroke groups but also for the right-stroke illiterate group although not for the right-stroke literate one. Likewise, some degree of word-finding difficulty and of reduction in speech output as well as sizeable production of phonemic paraphasias were observed in the interviews of several right-stroke illiterates, clearly less in those of right-stroke literates. These findings lead us to suggest that cerebral representation of language is more ambilateral in illiterates than it is in school educated subjects although left cerebral "dominance" remains the rule in both.

Aphasia↗

PubMed1998

The illiterate brain. Learning to read and write during childhood influences the functional organization of the adult brain.

Learning a specific skill during childhood may partly determine the functional organization of the adult brain. This hypothesis led us to study oral language processing in illiterate subjects who, for social reasons, had never entered school and had no knowledge of reading or writing. In a brain activation study using PET and statistical parametric mapping, we compared word and pseudoword repetition in literate and illiterate subjects. Our study confirms behavioural evidence of different phonological processing in illiterate subjects. During repetition of real words, the two groups performed similarly and activated similar areas of the brain. In contrast, illiterate subjects had more difficulty repeating pseudowords correctly and did not activate the same neural structures as literates. These results are consistent with the hypothesis that learning the written form of language (orthography) interacts with the function of oral language. Our results indicate that learning to read and write during childhood influences the functional organization of the adult human brain.

Aged↗

PubMed1989

Validation of an MMPI short form with literate and illiterate patients.

An Improved Readability Form (IRF) of the MMPI was orally administered to 100 literate and 119 illiterate patients, and 140 literate patients were given the full MMPI with standard instructions. Profile comparisons of the MMPI with the IRF given to literates or extracted from the full MMPI yielded only small differences. The much larger differences in the IRF profiles of the illiterates were removed by controlling statistically for sex, race, age, and education. The IRF, when given to literate patients, was a good substitute for the full MMPI in predicting Brief Psychiatric Rating Scale scores. For the illiterates, the two most salient relationships with scores on the Brief Psychiatric Rating Scale were preserved, but several weaker associations were qualitatively altered. When the IRF is administered to illiterate patients, the pattern of clinical correlates may differ from those obtained with literate patients given the IRF or MMPI.

Adult↗

PubMed1977

Vision screening of illiterate populations.

To assess the amount of reduced vision in a population is an important public health matter, especially in areas where blinding diseases are endemic. Testing visual acuity is, however, a complex problem when a major part of the population is illiterate. The best-known test of vision is the E-test, but this produces the problem of untestability in illiterate populations.The introduction of the Sjögren hand-test as an alternative to the E-test for vision screening of unselected illiterate populations in West Africa resulted in a highly significant reduction of untestability. For certain vision levels it is possible to correlate the results of the hand-test directly with those of the E-test. The hand-test is less well defined than the E-test, but has important advantages for the purpose of vision screening of illiterate populations.

Adolescent↗

PubMed1990

Use of antenatal cards for literate health personnel and illiterate traditional birth attendants: an overview.

A review of the existing literature on various risk-oriented antenatal cards developed during the last 15 years, makes apparent a multitude of action-oriented cards available for trained health personnel (obstetric nurses, midwives and doctors). Few antenatal cards, however, have been developed for use by illiterate traditional birth attendants (TBAs). A revised version of an illiterate antenatal card is presented, that has been developed over the past 3 years in Mali. It contains some important improvements, notably its use at the various levels of the health care pyramid both by illiterate TBAs and by trained midwives. It also includes specific 'standing orders', based on generally accepted 'at-risk' criteria. Suggestions for its adaptation elsewhere in Africa as part of current Safe Motherhood policies are discussed.

Educational Status↗

PubMed1987

Premenstrual syndrome in Sahelian Africa. A comparative study of 400 literate and illiterate women in Niger.

From March to November 1984, the authors examined 400 African women 14 to 30 years old. They were classed as urban or rural, literate or illiterate, wage-earning or not. Signs of premenstrual syndrome (PMS) were analysed and the intensity of symptoms evaluated. Only 5% of the women were asymptomatic. 31% described socially debilitating severe symptoms. The most common signs were painful breasts, lower abdominal pains and nervousness. Oedema of the legs was rare. PMS was more frequent in young, literate, urban women; illiterate rural women were more often asymptomatic and, when they were symptomatic, signs were less intense than in urban women. These differences are related to pregnancies and breast-feeding. Urban illiterate women were protected from PMS by the cycle of pregnancy-breast feeding-weaning-new pregnancy. In this group menstruation was rare because of the length of gravidic amenorrhea.

Adolescent↗

PubMed1999

A calculation and number processing battery for clinical application in illiterates and semi-literates.

Ten simple tasks assessing counting, number processing, elementary calculation and quantity estimation were proposed to 122 normal Brazilian adults aged between 18 and 58 years with 0, 1, 2, 3 or 4 years of education. Tasks such as counting the number of elements in small sets were almost perfectly mastered by these illiterate or semi-literate normal subjects; however in other tasks (e.g. those assessing knowledge of the correspondence between numbers and banknotes) a sizeable proportion of the sample showed errors. The pattern of errors was analysed to identify difficulty factors. A strong gender effect with better performance in men than women was observed, which was even greater than the expected effect of educational level. Results in normals allowed to propose cut-off scores for neuropsychological assessment in brain-damaged patients with very low levels of education, which were tested in a small sample of illiterate or semi-literate patients with cerebrovascular accident. It is argued that the relatively neglected area of neuropsychological assessment in illiterates is of great practical and theoretical interest.

Adolescent↗

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↗

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↗

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↗