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ABSTRACT Objective To determine the diagnostic accuracy of the Addenbrooke’s Cognitive Examination (ACE-R) for older adults with low education, without dementia, in two capitals in northeastern Brazil, compared to subjects with MCI. Methods 100 participants were collected from a previous neurological and psychiatric evaluation and were subsequently subjected to the ACE-R. Among them, 18 subjects with amnestic mild cognitive impairment (aMCI), 22 with non-amnestic mild cognitive impairment (naMCI), and 60 healthy controls. Results Optimal ACE-R accuracy yielded excellent values for the comparison between controls and naMCI [Area Under the Curve (AUC) = 0.919)] and controls and aMCI (AUC= 0.921); conversely, very fair accuracy was reported for the comparison between aMCI and naMCI (AUC= 0.578). Conclusions These findings support establishing reliable cutoff scores for cognitive assessment of elderlies with low schooling and cognitive decline, not dementia, taking into consideration ecological and regional variables.

Increasing life expectancy has been associated with higher rates of dementia. As illiterate/uneducated individuals are typically over-represented among older cohorts, it is imperative that we identify and/or develop appropriate, non-biased scales and psychometric tests for early detection of, and screening for, cognitive impairment in this group. Given that many traditional neuropsychological tests may underestimate cognitive abilities in illiterate/uneducated and low educated individuals, their use in these groups needs to be reappraised or their format adapted. One of the most commonly used screening tests worldwide is the Mini-Mental State Examination (MMSE). Level of education has been shown to be a significant predictor of performance on the MMSE, hence, there is dispute among researchers related to its applicability in populations with low or no schooling. A wide range of recommendations have been made by scholars for overcoming the education effect on the MMSE, as well as other sources of bias, but some methodological limitations remain, and new ones have emerged concerning its administration to illiterate/uneducated and low educated older individuals. In the present study, we present a theoretical discussion of the challenges inherent in the administration and interpretation of MMSE performance in illiterate/uneducated and low educated individuals, consider previous recommendations and address their limitations, and highlight the optimal methods for clinical assessment of these groups when the MMSE is used.

Purpose: This qualitative case study investigates the profound challenges hindering the social inclusion of illiterate deaf adults within Gujranwala city. Methodology: A sample of eight illiterate deaf adults and sixteen family members was meticulously selected through snowball sampling. Data collection utilized a tailored semi-structured interview schedule, validated by experts, and conducted in sign language. Findings: Thematic analysis revealed a multitude of challenges, including communication barriers, unfamiliarity with standardized sign language, low self-confidence, limited awareness of civil and legal rights, attitudinal barriers, shyness, and hesitance. These challenges collectively undermine the social inclusion of illiterate deaf adults. Implications: The study underscores the pressing need for adult education initiatives tailored to their unique needs to facilitate their independent integration into society.

ObjectiveTo establish and validate a targeted model for the prediction of cognitive impairment in elderly illiterate Chinese women.Methods1864 participants in the 2011–2014 cohort and 1,060 participants in the 2014–2018 cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this study. The Chinese version of the Mini-Mental State Examination (MMSE) was used to measure cognitive function. Demographics and lifestyle information were collected to construct a risk prediction model by a restricted cubic spline Cox regression. The discrimination and accuracy of the model were assessed by the area under the curve (AUC) and the concordance index, respectively.ResultsA total of seven critical variables were included in the final prediction model for cognitive impairment risk, including age, MMSE score, waist-to-height ratio (WHtR), psychological score, activities of daily living (ADL), instrumental abilities of daily living (IADL), and frequency of tooth brushing. The internal and external validation AUCs were 0.8 and 0.74, respectively; and the receiver operating characteristic (ROC) curves indicated good performance ability of the constructed model.ConclusionA feasible model to explore the factors influencing cognitive impairment in elderly illiterate women in China and to identify the elders at high risk was successfully constructed.

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 (

The concept of physical literacy is continuing to gain traction internationally. This increasing interest has also given rise to concerns about the use, interpretation and meaning of the term “literacy” within the context of physical literacy. This paper explores the development of the terms literate, illiterate, literacy, and illiteracy identifying their historical origin and contemporary meaning. This provides the backdrop to explore the use of the term literacy within the context of physical literacy. In the final part of this introductory section the recent popularity of the literacies movement is explored. Our discussion identifies key intersections and areas of tension associated with the use, interpretation and meaning of literacy in the context of physical literacy. We adopt Whitehead's philosophy of physical literacy and discussion is informed further by Derrida's notion of differance, and Barad's challenge to singular representations of concepts. Once harnessing these concepts, we reach a juncture of an in-between space; entry points of nonidentity (sameness) and points where multiple effects of difference are created. Key discussion topics include: discourse, language and interpretations of literacy; in/tangibility of literacy; capturing literacy; literacy as a process or a product; connotations of the terms literate and illiterate; neoliberalism and literacy and finally literacy as learning. We believe that when understood as the productive and meaningful interaction with/in/through the world, literacy is still the appropriate term within the context of physical literacy. Our discussion leads us to conclude that as embodied individuals, physical literacy is often the literacy through which other literacies have to pass. Through physical activity individuals can not only nurture their own physical literacy but also contribute toward a global or holistic literacy that helps us navigate, connect and make sense of ourselves, others and the world around us. However, the paper acknowledges that this meaning is not always grasped with the historical understanding of literacy as well as it's translations into other languages presenting challenges in articulating the intended use, meaning and connotations of the contemporary understanding of physical literacy.

Background: Health literacy is a determinant of health and assessed globally to inform the development of health interventions. However, little is known about health literacy in countries with one of the poorest health indicators worldwide, such as Afghanistan. Studies worldwide demonstrate that women play a key role in developing health literacy. Hence, this study's purpose is to explore health literacy of women in Afghanistan and the associated factors.Methods: From May to June 2017, we randomly recruited 7–10 women per day at the hospital in Ghazni, a representative province of Afghanistan. Two trained female interviewers interviewed 322 women (15–61 years old) orally in Dari or Pashto on a voluntary basis and assessed their health literacy using the HLS-EU-Q16, associated socio-demographics, and health behavior.Results: Health literacy of women (among educated and illiterates) is low even compared to other Asian countries. Health literacy is linked to age and education. We found mixed evidence of the relationship between health literacy and contextual factors, help-seeking, and health-related behavior.Conclusion: This study provides novel data on health literacy and astonishing insights into its association with health behavior of women in Afghanistan, thus contributing to health status. The study calls for recognition of health literacy as a public health challenge be addressed in Afghanistan and other low-income countries affected by crises.

Abstract Background Delirium is a common complication after cardiac surgery in older adult patients. However, risk factors and the influence of delirium on patient outcomes are not well established. We aimed to determine the incidence, predisposing and triggering factors of delirium following cardiac surgery. Methods One hundred seventy-three consecutive patients aged ≥60 years were studied. Patients’ characteristics and two cognitive function assessment tests were recorded preoperatively. Perioperative variables were blood transfusion, orotracheal intubation time (OIT), renal dysfunction, and hypoxemia. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. The composite outcome consisted of death, infection, and perioperative myocardial infarction until hospital discharge or 30 days after surgery, and for up to 18 months. Results One hundred six patients (61.27%) were men and the age was 69.5 ± 5.8 years. EuroSCORE II index was 4.06 ± 3.86. Hypertension was present in 75.14%, diabetes in 39.88%, and 30.06% were illiterate. Delirium occurred in 59 patients (34.1%). Education level (OR 0.81, 0.71–0.92), hypertension (OR 2.73, 1.16–6.40), and mitral valve disease (OR 2.93, 1.32–6.50) were independent predisposing factors for delirium, and atrial fibrillation after surgery (OR 2.49, 1.20–5.20) represented the potential triggering factor. Delirium (OR 2.35, 1.20–4.58) and OIT ≥ 900 min (OR 2.50; 1.30–4.80) were independently associated with the composite outcome. Conclusions In older adult patients submitted to cardiac surgery, delirium is a frequent complication that is associated with worst outcome. Independent risk factors for delirium included education level, hypertension, mitral valve disease, and atrial fibrillation after cardiac surgery.

The aim of this article was to recognize the educational needs and interests of literates and illiterates in the age group of 10-49 years old in order to find the operational solutions to meet their needs and educational interests. The method of this research was survey and its statistical population included scholars, local reference groups, managers and experts of literacy movement organization, education departments, educators, literates and illiterates in Iran. The research sample included 391 persons who were selected through stratified-random sampling method. The research tools included a researcher-made questionnaire, open and semi-structured interviews and the focus group. The data was analyzed using one sample t-test and the qualitative content analysis method. The results showed that literates and illiterates in the age group 10-49 years old have good inner motivation for learning, therefore when developing the educational content, their interests, attitude, knowledge and skills should be considered.

Aging can lead to functional and cognitive alterations, sometimes limiting older adults in their social development, especially illiterate groups of older adults who receive poor attention from healthcare systems. In this context, the present investigation proposes the cognitive training program “MENTE SANA [HEALTHY MIND]” to improve the cognitive functions of illiterate older adults in Arequipa (Peru). It is a type of quasi-experimental research with a pre-test/post-test design with a homogenous control group. The sample was made up of adults 60 years old and above and of female gender. The Montreal Cognitive Assessment (MoCA) test was used to detect the level of cognitive decline in illiterate older adults. The 50-sessions program was applied to all the older adults with mild cognitive impairment that were selected for the study, on a daily basis. It was found that the tested group improved their cognitive functions compared to the control group. These results help to propose adapted cognitive training programs for illiterate people.

Introduction: A considerable segment of the elderly population in Iran is illiterate, and it seems the existing neuropsychological screening tests are not very useful for detecting dementia in illiterate participants. The purpose of this study was to develop and validate a tool called Persian test of Elderly for Assessment of Cognition and Executive function (PEACE) for detecting dementia in both illiterate and literate participants. Methods: First, in order to design some of the cognitive aspects of the PEACE assay, we considered other prevalent neuropsychological instruments, such as the General Practitioner assessment of Cognition (GPCOG), Functional Assessment Staging (FAST), Mini Mental State Examination (MMSE), and Wechsler Memory scale. The other domains of PEACE were designed according to our clinical proficiencies and the culture of the society. In the next step, the participants were classified into three distinct groups, i.e., the control group (n=33), the Mild Cognitive Impairment (MCI) group (n=30), and the Alzheimer’s group (n=38). All of the participants in each group were divided according to their educational level, i.e., illiterate, semi-literate, and literate. Results: We developed PEACE consisting of 14 items, each of which represents a specific cognitive function, with a maximum score of 91. The 14 items are Orientation, Praxis, Attention and Concentration, Attention and Calculation, Memory, Similarity, Abstract Thinking, General Information, Language, Judgment, Gnosis, Planning (Sequencing), Problem Solving, and Animal Naming. PEACE scores are highly correlated with those of the MMSE (r=0.78). The optimal cut-off point of PEACE chosen for diagnosis of Alzheimer’s disease was 67.5 (sensitivity: 75.8%, specificity: 97.4%). The PEACE scores showed a significant difference between Participants with Alzheimer’s disease and the control group (p=0.0000) and the MCI group (p=0.003). In addition, there was no significant difference between illiterate and literate participants in the Alzheimer’s group. However, the PEACE scores differed significantly (p=0.0000) between illiterate and literate participants in the control group. Conclusion: The PEACE addresses the limitations of existing tests and is appropriate for use in countries that have high rates of illiteracy. It is a valid screening mechanism for the detection of dementia in both illiterate and literate participants.

The main thesis of the paper is that knowledge of illiteracy must address the methodological and political oblivion of current methods of objectification and prevention of illiteracy with an approach that reveals what it actually means to be illiterate. Indeed, illiteracy lies in part in the way categories of public action built it and also in the modes of objectification of the ‘problem’. The first part of this paper offers a criticism of these methods of objectification of illiteracy. We then return to the scientific controversy surrounding illiteracy and to the two ways of its insertion in the political agenda. The paper suggests a third way in order to insist on the provision of a comprehensive approach in addition to quantitative surveys, and also to speak about people with literacy problems in a different way.

Introduction. Traumatic brain injury (TBI) is affected by multiple factors. Patient’s education, manifesting symptoms and surgical management play a significant role on discharge outcome. The literature of same from developing country is limited. The present pilot study aims to describe patient characteristics, presenting symptom and management aspects of TBI patients from a tertiary hospital. Methods. The present study is a prospective study, where TBI patients were selected and data of injury was entered on standard proforma on electronic data base. The study was approved by institute ethical board. The data was analyzed using Stats Direct version 3.0.150 software. Results. Three hundred and thirty three patients were evaluated. Eighty percent of patients were from rural areas. About 75% of patients were illiterates and married. Patient employment was significant with discharge outcome. All the patients manifested with symptoms loss of consciousness (LOC) was higher (73%) followed by vomiting (44%). LOC and oral bleed was significant with outcome. Associated injuries was higher in extremities (22.5%) followed by chest (4.4%). About 15% of patients require intracranial surgery that was significant with discharge outcome. Conclusion. The present pilot study finding is similar to available literature data and adds knowledge to TBI data of a developing country like India.

In the style of radio programmes, we developed three episodes of audio HIV prevention education for illiterate women in Ethiopia. We used social-oriented presentation formats, such as discussion between women on HIV prevention, and expert-oriented presentation formats, such as an interview with a male doctor. The aim of this study was to assess the relation between evaluation of presentation formats and overall liking of episodes, which is important for persuasive effects. Thirty women from rural Amhara listened to the episodes and, after listening, female data collectors interviewed the women on evaluation of presentation formats, overall liking of episodes, identification with the characters and convincingness. Evaluation of social-oriented presentation formats was strongly related to overall liking of episodes, but evaluation of expert-oriented presentation formats was not. This relation was mediated through convincingness and not through identification. We conclude that social-oriented presentation formats make messages more convincing and, consequently, improve overall liking and persuasive impact.

Por mucho tiempo, pero particularmente durante el siglo pasado, el alfabetismo y la lectura han sido objeto de interés por parte de la comunidad académica y de organismos internacionales. Esta situación ha puesto al descubierto la existencia de diferentes enfoques relacionados con la definición del alfabetismo y la lectura, especialmente tras reconocerse su influencia en el desarrollo socioeconómico y su vinculación con los derechos fundamentales de las personas. Este trabajo analiza el significado de los términos alfabetismo, lectura y otros relacionados; así como la forma en que han variado a lo largo de la historia como producto del desarrollo de la civilización; y señala que éstos no sólo son importantes en sí mismos sino también en tanto que su medición varia en función del concepto que se elija.For some time now, but particularly during the last century, literacy and reading have been objects of interest for the academic community and international agencies. This situation has brought into the open the existence of different approaches to the definition of literacy and reading, especially once their influence on socioeconomic development and its link with basic human rights have been recognized. This paper analyses the meaning of such terms as literacy and reading, as well as how these have changed throughout history as products of the development of civilization. It shows that these terms are not only important in themselves but also inasmuch as their measurement varies according to the definition chosen.

Introduction: Hundreds of millions of children live in urban slums, many deprived to basic services. This all are resulted in the different kind of behavioural problems in children living in urban slum. Many of these problems are of transient nature and are often not even noticed or sometimes neglected. Various factors play role in causation of behaviour problems. Aim: The present cross-sectional study was planned in the adopted slum field area of Government Medical College, Miraj to find out prevalence and factors associated with behaviour problems amongst slum dwellers of 6 – 18 years age group. Material and Methods: Total 600 parents of children in the age group of 6-18 years were selected by simple random sampling method using random number table from the register of "Family survey register" of field workers of UHC. Results: The behavioural problems were identified in 189(55.1%) male children out of total 343 male children. The gender wise difference was statistically significant (p-Value < 0.005). There was statistically significant difference between behavioural problems according to family size (p-Value < 0.05). Children coming from large family were having more behavioural problems. The higher prevalence rate of behaviour problems was found amongst children having either or both of parents illiterate. It was highest among children having only illiterate mother. This was statistically significant (p-Value

Literacy program irrelevance to learners and societal real needs is a major problem confronting literacy and development efforts in Saudi Arabia. In an attempt to remedy this problem. this study investigates the appropriate-ness of an alternative functional literacy model that would complement the existing religious-alphabetical model. This study is based on the belief that an effective adult education program requires a thorough and systematic planning effort which logically begins with the identification o+ appropriate educational goals. The responses of 208 univesity professors. 337 literacy teachers, and 35t adult learners inVol.ved in this study were the basis for proposing necessary literacy policy changes. Moreover, in right of research findings and a thorough observation of current practices. numerous recom-mendations for implementing the proposed model and changes in delivery system were made. Illiteracy has been a major impediment confronting all phases of development in the Saudi Arabian Society. Although this problem reigns unrivaled in all regions and among all subcultural groups , e.g., urban, rural, nomads, , it is more evident among women, particularly old and middle-aged women in rural and nomadic areas , see Table 1, . Recognizing the inherent potential danger of this problem, the General Presidency of Girls' Education , GPGE, founded in 1960, estab-lished a separate division called the Female Literacy Division that was assigned the authority and responsibilities of planning, organizing, inspecting, and coor-dinating all female literacy programs. Paradoxically, despite the availability of