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Renner G, Schroeder A, Irblich D. Factorial Validity of the German KABC-II at Ages 7 to 12 in a Clinical Sample: Four Factors Fit Better than Five. J Intell 2023; 11:148. [PMID: 37504791 PMCID: PMC10381406 DOI: 10.3390/jintelligence11070148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Multidimensional intelligence test batteries such as the KABC-II are widely used in clinical practice. Although validity evidence should be provided for all intended uses of a test, data on the factorial validity of the KABC-II mostly relies on the standardization samples and raises some concerns about the adequacy of the factor structure. Confirmatory factor analyses of the KABC-II core subtests were conducted in a sample of 627 children who had been assessed in German Centers for Social Pediatrics. The standard structure of the KABC-II was superior to unidimensional models but, as in previous research, evidenced cross-loadings and a high correlation between Planning/Gf and Simultaneous/Gv. Pattern Reasoning was more closely related to Simultaneous/Gv than to Planning/Gf. A four-factorial structure combining subtests from Planning/Gf and Simultaneous/Gv to form a common factor emerged as a better representation of the data. Story Completion showed a secondary loading on Knowledge/Gc. On average, most subtest variance was accounted for by the general factor. Models with bonus points for fast responses generally fitted worse than those without. Clinicians should be aware that Planning/Gf and Simultaneous/Gv measure both visual and fluid abilities. Scales of the KABC-II should not be interpreted as dimensions independent of the general factor.
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Affiliation(s)
- Gerolf Renner
- Faculty of Special Education, Ludwigsburg University of Education, 71634 Ludwigsburg, Germany
| | | | - Dieter Irblich
- Social Pediatric Center Kreuznacher Diakonie, 55469 Simmern, Germany
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Maternal HIV does not affect resiliency among uninfected/HIV exposed South African children from birth to 5 years of age. AIDS 2019; 33 Suppl 1:S5-S16. [PMID: 31397718 DOI: 10.1097/qad.0000000000002176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Examine resiliency among a South African population cohort of children of mothers living with HIV (MLH) and mothers without HIV (MWOH) in low-income townships over the first 5 years of life. DESIGN A cluster randomized controlled intervention trial evaluating child resiliency and the effects of home visiting in township neighborhoods from pregnancy through 5 years postbirth. METHODS The population of pregnant women in 24 matched neighborhoods were recruited and randomized by neighborhood to a standard care condition (n = 594) or a paraprofessional home visiting intervention condition (n = 644). Mothers and children were assessed at 2 weeks, 6, 18, 36, and 60 months postbirth (92-84% follow-up; 10.2% mortality). Resilient children were identified based on consistently meeting global standards for growth, cognitive functioning, and behavior. Maternal HIV status (n = 354 MLH; n = 723 mothers without HIV MWOH), intervention condition, maternal risks, caretaking, sociodemographic characteristics, and neighborhood were examined as predictors of child resiliency over time using analysis of variance, chi-square analyses, and Fisher's exact tests, where appropriate. RESULTS None of HIV-seropositive children (n = 17) were resilient; 19% of 345 HIV-exposed but uninfected children of MLH were resilient, a rate very similar to the 16% among MWOH. Resiliency was significantly associated with lower income, food security, not having a live-in partner, and the absence of maternal risk (i.e., not being depressed, using alcohol, or being a victim of intimate partner violence). Being randomized to a home visiting intervention, maternal breastfeeding for at least 3 months and attending a preschool crèche were also unrelated to resiliency. Although matched pairs of neighborhoods had similar rates of resilient children, resiliency varied significantly by neighborhood with rates ranging from 9.5 to 27%. CONCLUSION We set a new standard to define resiliency, as consistently recommended by theoreticians. Although seropositive children are not resilient, uninfected children of MLH are as resilient as their peers of MWOH. Typical protective factors (e.g., home visiting, breastfeeding, preschool) were unrelated to resiliency over the first 5 years of life. TRIAL REGISTRATION ClinicalTrials.gov registration #NCT00996528.
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Patel DV, Gopalan RT, Nimbalkar SM. Adaptation of Subtests of Kaufman Assessment Battery for Children, Second Edition for Gujarati Pre-school Children. Indian J Psychol Med 2018; 40:420-425. [PMID: 30275616 PMCID: PMC6149313 DOI: 10.4103/ijpsym.ijpsym_104_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
CONTEXT Cognition testing is frequently used in children to assess their intelligence for various needs. Abundant tests to assess cognition are available in the western world. The paucity of such tests for use in Gujarati population necessitates their adaptation for Gujarati culture. AIMS To adapt three subtests (Number Recall, Word Order, and Triangles) of Kaufman Assessment Battery for Children, Second Edition for Gujarati-speaking preschool age children using priori (judgemental) procedures of test adaptation process. SETTINGS AND DESIGN This was a prospective study of test adaptation process carried out in three kindergarten schools of Gujarat. SUBJECTS AND METHODS Three subtests were translated and adapted into Gujarati. A pilot study evaluating the applicability and appropriateness of the adapted version of the three tests was done, and the results of these raw scores were compared with English tests' scores. Of 68 children (age 3-6 years) who completed the pilot study, 15 boys and 15 girls 4-6 years of age were randomly selected to perform English tests for agreement between English and the adapted versions. STATISTICAL ANALYSIS USED Agreement between the adapted and English versions of the tests was measured. RESULTS During adaptation, modifications were required only in the items of the Word order subtest. All children were able to understand and perform the test. Triangles did not require adaptation or modifications in test items. The agreement between raw scores of the two versions was good for both "Number Recall" (mean difference = 0.8, 95% confidence limits: -2.6, 4.1) and "Word Order" (mean difference = 0.6, 95% confidence limits: -3.2, 4.4). CONCLUSION Adaptation of three subtests of KABC-II using a priori, that is, judgemental, procedure was suitable for Gujarati-speaking preschool children.
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Affiliation(s)
- Dipen V Patel
- Department of Pediatrics, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | | | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.,Central Research Services, H M Patel Center for Medical Care and Education, Karamsad, Anand, Gujarat, India
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Mitchell JM, Tomlinson M, Bland RM, Houle B, Stein A, Rochat TJ. Confirmatory factor analysis of the Kaufman assessment battery in a sample of primary school-aged children in rural South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317741822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Kaufman Assessment Battery for Children, Second Edition, measures cognitive processing, includes non-verbal sub-tests, and is increasingly used in low- and middle-income countries. While the Kaufman Assessment Battery for Children, Second Edition, has been validated in the United States, a psychometric evaluation has not been conducted in Southern Africa. This study aims to establish the reliability and validity of the Kaufman Assessment Battery for Children, Second Edition, among a sample of 376 primary school-aged children in rural South Africa (7–11 years). We examined Cronbach’s alpha and conducted a confirmatory factor analysis. The battery showed good reliability (mental processing index [α = .78]), and the originally validated structure of the Kaufman Assessment Battery for Children, Second Edition, was maintained (χ2 = 16.30, p = .432). Mean scores were low on the Planning sub-scale. On the Simultaneous sub-scale, the mean score was higher for the supplementary sub-test Block Counting versus the core sub-test Triangles. With translation and the inclusion of supplementary sub-tests, the Kaufman Assessment Battery for Children, Second Edition, is an appropriate assessment to use in this context (150/150).
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Affiliation(s)
- Joanie M Mitchell
- Africa Health Research Institute, Durban, South Africa
- Department of Psychology, Stellenbosch University, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, South Africa
| | - Ruth M Bland
- Africa Health Research Institute, Durban, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Royal Hospital for Sick Children and Institute of Health and Wellbeing, University of Glasgow, UK
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Demography, The Australian National University, Australia
- CU Population Center, Institute of Behavioral Science, University of Colorado Boulder, United States
| | - Alan Stein
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, UK
| | - Tamsen J Rochat
- Africa Health Research Institute, Durban, South Africa
- Department of Psychiatry, University of Oxford, UK
- Human and Social Development, Human Sciences Research Council, South Africa
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Semrud-Clikeman M, Romero RAA, Prado EL, Shapiro EG, Bangirana P, John CC. [Formula: see text]Selecting measures for the neurodevelopmental assessment of children in low- and middle-income countries. Child Neuropsychol 2017; 23:761-802. [PMID: 27609060 PMCID: PMC5690490 DOI: 10.1080/09297049.2016.1216536] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Diseases affecting millions of children in low- and middle-income countries (LMICs), such as malnutrition, micronutrient deficiency, malaria, and HIV, can lead to adverse neurodevelopmental outcomes. Thus, a key health outcome in children is neurodevelopmental status. In this paper, the neurodevelopmental screening and testing measures most commonly utilized in LMICs are reviewed, and a matrix is presented to help researchers and clinicians determine which measures may be most useful for various LMIC inquiries. The matrix is based on an Internet literature review of 114 publications for the period January 1998 to February 2016, reporting the psychometric properties of instruments tested in LMIC children. The measures are classified as screening tests or more detailed tests that include both comprehensive batteries of general development and tests of specific domains. For completeness, two experts have reviewed this paper, as well as the authors. An overview of the tests used to date is presented, including the benefits and drawbacks of each test, in order to provide researchers and developmental clinicians with a way to decide which tests may be best suited to their developmental assessment goals. Remarkable progress has been made in neurodevelopmental testing in children in LMICs over the past two decades but there remains a need for additional research in this area to develop new tests, better evaluate and adapt current tests, and assess test validity and reliability across cultures.
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Affiliation(s)
| | | | | | - Elsa G Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Paul Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
- Department of Pediatrics, Indiana University, Indianapolis, IN
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Abstract
Neuropsychological assessment tools are the staple of our field. The development of standardized metrics sensitive to brain-behavior relationships has shaped the neuropsychological questions we can ask, our understanding of discrete brain functions, and has informed the detection and treatment of neurological disorders. We identify key turning points and innovations in neuropsychological assessment over the past 40-50 years that highlight how the tools used in common practice today came to be. Also selected for emphasis are several exciting lines of research and novel approaches that are underway to further probe and characterize brain functions to enhance diagnostic and treatment outcomes. We provide a brief historical review of different clinical neuropsychological assessment approaches (Lurian, Flexible and Fixed Batteries, Boston Process Approach) and critical developments that have influenced their interpretation (normative standards, cultural considerations, longitudinal change, common metric batteries, and translational assessment constructs). Lastly, we discuss growing trends in assessment including technological advances, efforts to integrate neuropsychology across disciplines (e.g., primary care), and changes in neuropsychological assessment infrastructure. Neuropsychological assessment has undergone massive growth in the past several decades. Nonetheless, there remain many unanswered questions and future challenges to better support measurement tools and translate assessment findings into meaningful recommendations and treatments. As technology and our understanding of brain function advance, efforts to support infrastructure for both traditional and novel assessment approaches and integration of complementary brain assessment tools from other disciplines will be integral to inform brain health treatments and promote the growth of our field. (JINS, 2017, 23, 778-790).
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Veena SR, Krishnaveni GV, Srinivasan K, Thajna KP, Hegde BG, Gale CR, Fall CH. Association between maternal vitamin D status during pregnancy and offspring cognitive function during childhood and adolescence. Asia Pac J Clin Nutr 2017; 26:438-449. [PMID: 28429909 DOI: 10.6133/apjcn.032016.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Animal studies have demonstrated poor cognitive outcomes in offspring in relation to maternal vitamin D deficiency before and/or during pregnancy. Human studies linking maternal vitamin D status during pregnancy with offspring cognitive function are limited. We aimed to test the hypothesis that lower maternal vitamin D status during pregnancy is associated with poor offspring cognitive ability in an Indian population. METHODS AND STUDY DESIGN Cognitive function was assessed in children from the Mysore Parthenon birth cohort during childhood (age 9-10 years; n=468) and adolescence (age 13-14 years; n=472) using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring learning, long-term retrieval/ storage, short-term memory, reasoning, verbal fluency, visuo-spatial ability, and attention and concentration. Maternal serum 25-hydroxyvitamin D concentration was measured at 30±2 weeks of gestation. RESULTS During pregnancy 320 (68%) women had 'vitamin D deficiency' (serum 25-hydroxyvitamin D concentration <50 nmol/L). Girls scored better than boys in tests of short-term memory, reasoning, verbal fluency, and attention (p<0.05 for all). Maternal vitamin D status (low as well as across the entire range) was unrelated to offspring cognitive function at both ages, either unadjusted or after adjustment for the child's current age, sex, maternal age, parity, season at the time of blood sampling, gestational age, the child's birth and current size, socio-economic status, parents' education, maternal intelligence and home environment. CONCLUSIONS In this population, despite a high prevalence of vitamin D deficiency during pregnancy, there was no evidence of an association between maternal vitamin D status and offspring cognitive function.
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Affiliation(s)
- Sargoor R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India.
| | - Ghattu V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
| | | | - Kotrangada P Thajna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
| | - Bhavya G Hegde
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
| | - Catharine R Gale
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Caroline Hd Fall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
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8
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Sanou AS, Diallo AH, Holding P, Nankabirwa V, Engebretsen IMS, Ndeezi G, Tumwine JK, Meda N, Tylleskar T, Kashala-Abotnes E. Maternal alcohol consumption during pregnancy and child's cognitive performance at 6-8 years of age in rural Burkina Faso: an observational study. PeerJ 2017; 5:e3507. [PMID: 28674660 PMCID: PMC5494175 DOI: 10.7717/peerj.3507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/06/2017] [Indexed: 01/06/2023] Open
Abstract
Background In Burkina Faso, it is not uncommon for mothers to drink alcohol, even during pregnancy. We aimed to study the association between maternal alcohol consumption during pregnancy and the child’s cognitive performance using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) and the Children’s Category Test Level 1 (CCT-1) in rural Burkina Faso. Methods We conducted a follow-up study of a community cluster-randomised Exclusive breastfeeding trial, and re-enrolled the children in rural Burkina Faso. A total of 518 children (268 boys and 250 girls) aged 6–8 years were assessed using the KABC-II and the CCT-1. We examined the effect size difference using Cohen’s d and conducted a linear regression analysis to examine the association. Results Self-reported alcohol consumption during pregnancy was 18.5% (96/518). Children whose mothers reported alcohol consumption during pregnancy performed significantly poorly for memory and spatial abilities tests from small effect size difference for ‘Atlantis’ (0.27) and ‘Triangle’ (0.29) to moderate effect size difference for ‘Number recall’ (0.72) compared to children whose mothers did not consume alcohol during pregnancy; the exposed children scored significantly higher errors with a small effect size (0.37) at problem solving (CCT-1) test compared to unexposed children. At unstandardized and standardized multivariable analysis, children whose mothers reported alcohol consumption during pregnancy performed significantly poorer for memory-‘Atlantis’ (p = 0.03) and ‘Number recall’ (p = 0.0001), and spatial ability tests-‘Triangle’ (p = 0.03); they scored significantly higher errors at problem solving CCT-1 test (p = 0.002); all the results were adjusted for age, sex, schooling, stunting, father’s education, mother’s employment and the promotion of exclusive breastfeeding. No statistical association was found for visual abilities-‘Conceptual Thinking’, ‘Face recognition’, ‘Story completion’, and reasoning tests-‘Rover’, ‘Block counting’, and ‘Pattern Reasoning’. Conclusion Maternal alcohol consumption during pregnancy is associated with poorer cognitive performance for memory, spatial ability, and problem solving tests in the offspring in rural Burkina Faso. Futures studies needs to assess in more detail the maternal alcohol consumption patterns in Burkina Faso and possible preventive strategies.
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Affiliation(s)
- Anselme Simeon Sanou
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Hama Diallo
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Victoria Nankabirwa
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.,Centre for Intervention Science in Maternal and Child Health (CISMAC), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Marie S Engebretsen
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Nicolas Meda
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Thorkild Tylleskar
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Esperance Kashala-Abotnes
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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van Wyhe KS, van de Water T, Boivin MJ, Cotton MF, Thomas KGF. Cross-cultural assessment of HIV-associated cognitive impairment using the Kaufman assessment battery for children: a systematic review. J Int AIDS Soc 2017; 20:21412. [PMID: 28664684 PMCID: PMC5515037 DOI: 10.7448/ias.20.1.21412] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 04/25/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Despite improved efficacy of, and access to, combination antiretroviral therapy (cART), HIV-associated cognitive impairments remain prevalent in both children and adults. Neuropsychological tests that detect such impairment can help clinicians formulate effective treatment plans. The Kaufman Assessment Battery for Children (KABC), although developed and standardized in the United States, is used frequently in many different countries and cultural contexts to assess paediatric performance across various cognitive domains. This systematic review investigated the cross-cultural utility of the original KABC, and its 2nd edition (KABC-II), in detecting HIV-associated cognitive impairment in children and adolescents. METHODS We entered relevant keywords and MeSH terms into the PubMed, PsycInfo, EBSCOHost, ProQuest, and Scopus databases, with search limits set from 1983-2017. Two independent reviewers evaluated the retrieved abstracts and manuscripts. Studies eligible for inclusion in the review were those that (a) used the KABC/KABC-II to assess cognitive function in children/adolescents aged 2-18 years, (b) featured a definition of cognitive impairment (e.g. >2 SD below the mean) or compared the performance of HIV-infected and uninfected control groups, and (c) used a sample excluded from population on which the instruments were normed. RESULTS AND DISCUSSION We identified nine studies (eight conducted in African countries, and one in the United Kingdom) to comprise the review's sample. All studies detected cognitive impairment in HIV-infected children, including those who were cART-naïve or who were cART treated and clinically stable. KABC/KABC-II subtests assessing simultaneous processing appeared most sensitive. Evaluation of the methodological quality of the selected studies by two independent reviews suggested that shortcomings included reporting and selection biases. CONCLUSIONS This systematic review provides evidence for the cross-cultural utility of the KABC/KABC-II, particularly the simultaneous processing subtests, in detecting cognitive impairment in HIV-infected children (including those who are clinically stable). Although the current results suggest there is justification for using the KABC/KABC-II primarily in East Africa, further investigation is required to explore the instrument's utility in other HIV-prevalent regions of the globe.
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Affiliation(s)
- Kaylee S van Wyhe
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
- Children with Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
| | - Tanya van de Water
- Children with Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Michael J Boivin
- Department of Psychiatry and Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark F Cotton
- Children with Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
| | - Kevin GF Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
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Teresi JA, Jones RN. Methodological Issues in Examining Measurement Equivalence in Patient Reported Outcomes Measures: Methods Overview to the Two-Part Series, "Measurement Equivalence of the Patient Reported Outcomes Measurement Information System ® (PROMIS ®) Short Forms". PSYCHOLOGICAL TEST AND ASSESSMENT MODELING 2016; 58:37-78. [PMID: 28983448 PMCID: PMC5625814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this article is to introduce the methods used and challenges confronted by the authors of this two-part series of articles describing the results of analyses of measurement equivalence of the short form scales from the Patient Reported Outcomes Measurement Information System® (PROMIS®). Qualitative and quantitative approaches used to examine differential item functioning (DIF) are reviewed briefly. Qualitative methods focused on generation of DIF hypotheses. The basic quantitative approaches used all rely on a latent variable model, and examine parameters either derived directly from item response theory (IRT) or from structural equation models (SEM). A key methods focus of these articles is to describe state-of-the art approaches to examination of measurement equivalence in eight domains: physical health, pain, fatigue, sleep, depression, anxiety, cognition, and social function. These articles represent the first time that DIF has been examined systematically in the PROMIS short form measures, particularly among ethnically diverse groups. This is also the first set of analyses to examine the performance of PROMIS short forms in patients with cancer. Latent variable model state-of-the-art methods for examining measurement equivalence are introduced briefly in this paper to orient readers to the approaches adopted in this set of papers. Several methodological challenges underlying (DIF-free) anchor item selection and model assumption violations are presented as a backdrop for the articles in this two-part series on measurement equivalence of PROMIS measures.
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Affiliation(s)
- Jeanne A. Teresi
- Weill Cornell Medical College, Division of Geriatrics and Palliative Medicine
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University
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Linn K, Fay A, Meddles K, Isbell S, Lin PN, Thair C, Heaps J, Paul R, Mar SS. HIV-Related Cognitive Impairment of Orphans in Myanmar With Vertically Transmitted HIV Taking Antiretroviral Therapy. Pediatr Neurol 2015; 53:485-490.e1. [PMID: 26386698 DOI: 10.1016/j.pediatrneurol.2015.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/02/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We determined the effect of perinatally acquired HIV on neurocognition in Myanmar children treated with antiretroviral therapy by comparison to demographically matched seronegative children. BACKGROUND Myanmar has one of the highest HIV-1 prevalence rates in Southeast Asia. Studies from other resource-poor countries have shown that HIV-infected children differ in socioeconomic, nutritional and caregiver status compared to normal controls. Some vertically infected orphans in Myanmar reside separately from HIV-uninfected children in separate orphanages, thus the demographic variables of interest are naturally controlled. This study provides a unique evaluation of the neurocognitive effects of HIV in children, with control over key demographic variables. We hypothesized that HIV-infected orphans would perform significantly worse on cognitive indices compared with HIV-negative orphans. DESIGN/METHODS A battery of cognitive tests sensitive to HIV-associated impairments in children was administered to 28 perinatally acquired HIV-positive children and 31 HIV-negative children from two orphanages in Myanmar; 21 children from each cohort underwent testing at baseline and again after 12 months. RESULTS Baseline comparison of the two groups indicated that the HIV-infected children performed poorly across all tests, with significant group differences in executive function, visuospatial reasoning, fine motor dexterity, and visual motor integration. On subsequent testing, both cohorts of children showed improvements across multiple domains, with no significant effect of age at treatment initiation. CONCLUSIONS Our results demonstrate a strong effect of HIV infection on specific neurocognitive deficits in vertically infected children. Understanding viral and host determinants and timing and choice of antiretroviral therapy on cognition will be critical to preventing cognitive impairment of children with HIV.
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Affiliation(s)
- Kyaw Linn
- Pediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar
| | - Alexander Fay
- Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
| | - Katherine Meddles
- Department of Pediatric Neurology, Washington University, St. Louis, Missouri
| | - Sara Isbell
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Phyo Nay Lin
- Pediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar
| | - Cho Thair
- Pediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar
| | - Jodi Heaps
- Department of Psychology and Behavioral Neuroscience, University of Missouri, St. Louis, Missouri
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri
| | - Soe Soe Mar
- Department of Pediatric Neurology, Washington University, St. Louis, Missouri
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The effect of maternal and child early life factors on grade repetition among HIV exposed and unexposed children in rural KwaZulu-Natal, South Africa. J Dev Orig Health Dis 2015; 7:185-96. [PMID: 26449271 DOI: 10.1017/s2040174415007230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Receiving an education is essential for children living in poverty to fulfil their potential. Success in the early years of schooling is important as children who repeat grade one are particularly at risk for future dropout. We examined early life factors associated with grade repetition through logistic regression and explored reasons for repeating a grade through parent report. In 2012-2014 we re-enrolled children aged 7-11 years in rural KwaZulu-Natal who had been part of an early life intervention. Of the 894 children included, 43.1% had repeated a grade, of which 62.9% were boys. Higher maternal education (aOR 0.44; 95% CI 0.2-0.9) and being further along in the birth order (aOR 0.46; 95% CI 0.3-0.9) reduced the odds of grade repetition. In addition, maternal HIV status had the strongest effect on grade repetition for girls (aOR 2.17; 95% CI 1.3-3.8), whereas for boys, it was a fridge in the household (aOR 0.59; 95% CI 0.4-1.0). Issues with school readiness was the most common reason for repeating a grade according to parental report (126/385, 32.7%), while school disruptions was an important reason among HIV-exposed boys. Further research is needed to elucidate the pathways through which HIV affects girls' educational outcomes and potentially impacts on disrupted schooling for boys. Our results also highlight the importance of preparation for schooling in the early years of life; future research could focus on gaining a better understanding of mechanisms by which to improve early school success, including increased quality of reception year and investigating the protective effect of older siblings.
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Abubakar A, Kariuki SM, Tumaini JD, Gona J, Katana K, Owen JAP, Newton CR. Community perceptions of developmental and behavioral problems experienced by children living with epilepsy on the Kenyan coast: A qualitative study. Epilepsy Behav 2015; 45:74-8. [PMID: 25868003 PMCID: PMC5257264 DOI: 10.1016/j.yebeh.2015.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 11/26/2022]
Abstract
Childhood epilepsy is common in Africa. However, there are little data on the developmental and behavioral problems experienced by children living with epilepsy, especially qualitative data that capture community perceptions of the challenges faced by these children. Identifying these perceptions using qualitative approaches is important not only to help design appropriate interventions but also to help adapt behavioral tools that are culturally appropriate. We documented the description of these problems as perceived by parents and teachers of children with or without epilepsy. The study involved 70 participants. Data were collected using in-depth interviews and focus group discussions and were analyzed using NVIVO to identify major themes. Our analysis identified four major areas that are perceived to be adversely affected among children with epilepsy. These included internalizing and externalizing problems such as aggression, temper tantrums, and excessive crying. Additionally, developmental delay, especially cognitive deficits and academic underachievement, was also identified as a major problematic area. There is a need to supplement these findings with quantitative estimates and to develop psychosocial and educational interventions to rehabilitate children with epilepsy who have these difficulties.
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Affiliation(s)
- Amina Abubakar
- KEMRI-Wellcome Trust Research Programme- Centre for Geographic Medicine Research (Coast), Kenya; Department of Culture Studies, Tilburg University, Netherlands; Department of Psychology, Lancaster University, UK.
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme- Centre for Geographic Medicine Research (Coast), Kenya; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Judith Dzombo Tumaini
- KEMRI-Wellcome Trust Research Programme- Centre for Geographic Medicine Research (Coast), Kenya
| | - Joseph Gona
- KEMRI-Wellcome Trust Research Programme- Centre for Geographic Medicine Research (Coast), Kenya
| | - Khamis Katana
- KEMRI-Wellcome Trust Research Programme- Centre for Geographic Medicine Research (Coast), Kenya
| | | | - Charles R Newton
- KEMRI-Wellcome Trust Research Programme- Centre for Geographic Medicine Research (Coast), Kenya; Department of Psychiatry, University of Oxford, UK
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Kuriyan R, Thankachan P, Selvam S, Pauline M, Srinivasan K, Kamath-Jha S, Vinoy S, Misra S, Finnegan Y, Kurpad AV. The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance. Clin Nutr 2015; 35:190-198. [PMID: 25746819 DOI: 10.1016/j.clnu.2015.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/22/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022]
Abstract
Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies. This study aimed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status, cognition, physical performance and nutritional deficiencies of 7-10 years old south Indian children. A randomized, double blind placebo controlled study design was used with normal healthy children from low to middle income families, aged 7-10 years randomly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink. The drinks were provided 6 days/week for 5 months. Assessments included anthropometry, blood biochemistry, physical performance and cognition at baseline and endline. The baseline characteristics of the study groups were similar. The changes in body weight and height were similar between the groups at the end of the study. Levels of vitamin B12, red cell folate and vitamin B2 significantly improved in the intervention group, while vitamin D, selenium and body iron showed no difference. The Hemoglobin (Hb) and serum ferritin levels of the control group decreased at endline, while those in the intervention group maintained their levels. The serum transferrin receptor levels increased in both the groups. The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline. Overall improvement in cognitive and physical performance was seen in both the groups at endline, with no significant differences between the groups. The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2, Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink. It also reduced anemia and the risk of deficiencies of iron, and B12, in apparently healthy children. ClinicalTrials.gov IdentifierNCT01415557. Clinical Trial RegistryIndia - REF/2012/12/004332.
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Affiliation(s)
- Rebecca Kuriyan
- Division of Nutrition, St. John's Research Institute, India.
| | | | | | - Maria Pauline
- Division of Nutrition, St. John's Research Institute, India
| | - K Srinivasan
- Division of Nutrition, St. John's Research Institute, India
| | | | - Sophie Vinoy
- Mondelez International R&D, Nutrition Research, Saclay, France
| | - Situn Misra
- Mondelez International R&D, Product Development Beverages, Thane, Maharashtra, India
| | | | - Anura V Kurpad
- Division of Nutrition, St. John's Research Institute, India
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Khilari M, Narayan SK. The national institute of health toolbox. Ann Indian Acad Neurol 2014; 17:247-52. [PMID: 25221390 PMCID: PMC4162007 DOI: 10.4103/0972-2327.138464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/03/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Madhuri Khilari
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sunil K Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Harder VS, Mutiso VN, Khasakhala LI, Burke HM, Rettew DC, Ivanova MY, Ndetei DM. Emotional and Behavioral Problems among Impoverished Kenyan Youth: Factor Structure and Sex-Differences. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014; 36:580-590. [PMID: 25419046 DOI: 10.1007/s10862-014-9419-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Data on youth emotional and behavioral problems from societies in Sub-Saharan Africa are lacking. This may be due to the fact that few youth mental health assessments have been tested for construct validity of syndrome structure across multicultural societies that include developing countries, and almost none have been tested in Sub-Saharan Africa. The Youth Self-Report (YSR), for example, has shown great consistency of its syndrome structure across many cultures, yet data from only one developing country in Sub-Saharan Africa have been included. In this study, we test the factor structure of YSR syndromes among Kenyan youth ages 11-18 years from an informal settlement in Nairobi, Kenya and examine sex-differences in levels of emotional and behavioral problems. We find the eight syndrome structure of the YSR to fit these data well (Root Mean Square Error of Approximation=.049). While Kenyan girls have significantly higher internalizing (Anxious/Depressed, Withdrawn/Depressed, Somatic) problem scores than boys, these differences are of similar magnitude to published multicultural findings. The results support the generalizability of the YSR syndrome structure to Kenyan youth and are in line with multicultural findings supporting the YSR as an assessment of emotional and behavioral problems in diverse societies.
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Affiliation(s)
- Valerie S Harder
- University of Vermont, Department of Psychiatry, 1 S. Prospect Street, Burlington, Vermont, USA ; Africa Mental Health Foundation, Nairobi, KENYA
| | | | - Lincoln I Khasakhala
- Africa Mental Health Foundation, Nairobi, KENYA ; University of Nairobi, Department of Psychiatry, Nairobi, KENYA
| | - Heather M Burke
- Centers for Disease Control and Prevention, Global Disease Detection, Nairobi, KENYA
| | - David C Rettew
- University of Vermont, Department of Psychiatry, 1 S. Prospect Street, Burlington, Vermont, USA
| | - Masha Y Ivanova
- University of Vermont, Department of Psychiatry, 1 S. Prospect Street, Burlington, Vermont, USA
| | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, KENYA ; University of Nairobi, Department of Psychiatry, Nairobi, KENYA
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Veena SR, Hegde BG, Ramachandraiah S, Krishnaveni GV, Fall CHD, Srinivasan K. Relationship between adiposity and cognitive performance in 9-10-year-old children in South India. Arch Dis Child 2014; 99:126-34. [PMID: 24146284 PMCID: PMC3982043 DOI: 10.1136/archdischild-2013-304478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies in high-income countries have shown inverse associations between adiposity and cognitive performance in children. We aimed to examine the relationship between adiposity and cognitive function in Indian children. METHODS At a mean age of 9.7 years, height, weight, triceps and subscapular skinfold thicknesses and waist circumference were recorded for 540 children born in Mysore, India. Body fat percentage was estimated using bioimpedance. Cognitive function was assessed using three core tests from the Kaufman Assessment Battery for children-II edition and additional tests measuring learning, short-term memory, reasoning, verbal and visuo-spatial abilities, attention and concentration. Data on the parents' socioeconomic status, education, occupation and income were collected. RESULTS According to WHO definitions, 3.5% of the children were overweight/obese (Body Mass Index (BMI)>+1SD) and 27% underweight (BMI<-2SD). Compared to normal children, overweight/obese children scored higher in tests of learning/long-term retrieval, reasoning and verbal ability (unadjusted p<0.05 for all). All the Cognitive Test scores increased with increase in BMI and skinfold thickness, (unadjusted β=0.10-0.20 SD; p<0.05 for all). The effects, though attenuated, remained mainly significant after adjustment for age, sex and socioeconomic factors. Similar associations were found for waist circumference and percentage body fat. CONCLUSIONS In this Indian population, in which obesity was uncommon, greater adiposity predicted higher cognitive ability. These associations were only partly explained by socioeconomic factors. Our findings suggest that better nutrition is associated with better cognitive function, and that inverse associations between adiposity and cognitive function in high-income countries reflect confounding by socioeconomic factors.
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Affiliation(s)
- Sargoor R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, , Mysore, Karnataka, India
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18
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Catch-up growth does not associate with cognitive development in Indian school-age children. Eur J Clin Nutr 2013; 68:14-8. [DOI: 10.1038/ejcn.2013.208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/20/2013] [Accepted: 05/02/2013] [Indexed: 11/08/2022]
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Muthayya S, Thankachan P, Hirve S, Amalrajan V, Thomas T, Lubree H, Agarwal D, Srinivasan K, Hurrell RF, Yajnik CS, Kurpad AV. Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. J Nutr 2012; 142:1997-2003. [PMID: 23014487 DOI: 10.3945/jn.111.155135] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Wheat is the primary staple food for nearly one-third of the world's population. NaFeEDTA is the only iron (Fe) compound suitable for fortifying high extraction flours. We tested the hypothesis that NaFeEDTA-fortified, whole wheat flour reduces Fe deficiency (ID) and improves body Fe stores (BIS) and cognitive performance in Indian children. In a randomized, double-blind, controlled, school feeding trial, 6- to 15-y-old, Fe-depleted children (n = 401) were randomly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal. Hemoglobin (Hb) and Fe status were measured at baseline, 3.5 mo, and 7 mo. Cognitive performance was evaluated at baseline and 7 mo in children (n = 170) at one of the study sites. After 7 mo, the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21% and 18 to 9%, respectively. There was a time x treatment interaction for Hb, serum ferritin, transferrin receptor, zinc protoporphyrin, and BIS (all P < 0.0001). Changes in BIS differed between the groups; it increased in the treatment group (0.04 ± 0.04 mmol/kg body weight) and decreased in the control group (-0.02 ± 0.04 mmol/kg body weight) (P < 0.0001). In sensory tests, NaFeEDTA-fortified flour could not be differentiated from unfortified flour. There were no significant differences in cognitive performance tests between the groups. NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID in Fe-depleted children. It may be recommended for wider use in national school feeding programs.
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Affiliation(s)
- Sumithra Muthayya
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India.
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Kitsao-Wekulo PK, Holding PA, Taylor HG, Abubakar A, Connolly K. Neuropsychological testing in a rural African school-age population: evaluating contributions to variability in test performance. Assessment 2012; 20:776-84. [PMID: 22936783 DOI: 10.1177/1073191112457408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study investigated the psychometric properties of a number of neuropsychological tests adapted for use in sub-Saharan Africa. A total of 308 school-age children in a predominantly rural community completed the tests. These tests were developed to assess skills similar to those measured by assessments of cognitive development published for use in Western contexts. Culturally appropriate adaptations were made to enhance within-population variability. Internal consistency ranged from .70 to .84. Scores on individual tests were related to various background factors at the level of the child, household, and neighborhood. School experience was the most consistent predictor of outcome, accounting for up to 22.9% of the variance observed. Significant associations were identified to determine salient background characteristics that should be taken into account when measuring the discrete effects of disease exposure in similar sociocultural and economic settings.
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Affiliation(s)
- Patricia K. Kitsao-Wekulo
- International Centre for Behavioural Studies, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Penny A. Holding
- International Centre for Behavioural Studies, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Amina Abubakar
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Tilburg University, Tilburg, The Netherlands
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Pierson EE, Kilmer LM, Rothlisberg BA, McIntosh DE. Use of Brief Intelligence Tests in the Identification of Giftedness. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2011. [DOI: 10.1177/0734282911428193] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schools often administer brief intelligence tests as the first step in the identification of students who are cognitively gifted. However, brief measures are often used without consideration of underlying constructs or the psychometric properties of the measures and without regard to the links between screening decisions and educational programming. This article provides an overview of these issues and offers recommendations for using brief intelligence measures particularly when screening children who are cognitively gifted.
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Veena SR, Krishnaveni GV, Srinivasan K, Wills AK, Muthayya S, Kurpad AV, Yajnik CS, Fall CHD. Higher maternal plasma folate but not vitamin B-12 concentrations during pregnancy are associated with better cognitive function scores in 9- to 10- year-old children in South India. J Nutr 2010; 140:1014-22. [PMID: 20335637 PMCID: PMC3672847 DOI: 10.3945/jn.109.118075] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Folate and vitamin B-12 are essential for normal brain development. Few studies have examined the relationship of maternal folate and vitamin B-12 status during pregnancy and offspring cognitive function. To test the hypothesis that lower maternal plasma folate and vitamin B-12 concentrations and higher plasma homocysteine concentrations during pregnancy are associated with poorer neurodevelopment, 536 children (aged 9-10 y) from the Mysore Parthenon birth cohort underwent cognitive function assessment during 2007-2008 using 3 core tests from the Kaufman Assessment Battery, and additional tests measuring learning, long-term storage/retrieval, attention and concentration, and visuo-spatial and verbal abilities. Maternal folate, vitamin B-12, and homocysteine concentrations were measured at 30 +/- 2 wk gestation. During pregnancy, 4% of mothers had low folate concentrations (<7 nmol/L), 42.5% had low vitamin B-12 concentrations (<150 pmol/L), and 3% had hyperhomocysteinemia (>10 micromol/L). The children's cognitive test scores increased by 0.1-0.2 SD per SD increase across the entire range of maternal folate concentrations (P < 0.001 for all), with no apparent associations at the deficiency level. The associations with learning, long-term storage/retrieval, visuo-spatial ability, attention, and concentration were independent of the parents' education, socioeconomic status, religion, and the child's sex, age, current size, and folate and vitamin B-12 concentrations. There were no consistent associations of maternal vitamin B-12 and homocysteine concentrations with childhood cognitive performance. In this Indian population, higher maternal folate, but not vitamin B-12, concentrations during pregnancy predicted better childhood cognitive ability. It also suggests that, in terms of neurodevelopment, the concentration used to define folate deficiency may be set too low.
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Affiliation(s)
- Sargoor R Veena
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mysore 570 021, South India.
| | | | | | - Andrew K Wills
- MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK
| | - Sumithra Muthayya
- St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Anura V Kurpad
- St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | | | - Caroline HD Fall
- MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK
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Veena SR, Krishnaveni GV, Wills AK, Kurpad AV, Muthayya S, Hill JC, Karat SC, Nagarajaiah KK, Fall CHD, Srinivasan K. Association of birthweight and head circumference at birth to cognitive performance in 9- to 10-year-old children in South India: prospective birth cohort study. Pediatr Res 2010; 67:424-9. [PMID: 20032815 PMCID: PMC3073480 DOI: 10.1203/pdr.0b013e3181d00b45] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To examine whether birthweight and head circumference at birth are associated with childhood cognitive ability in South India, cognitive function was assessed using three core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, and visuospatial and verbal abilities among 505 full-term born children (mean age 9.7 y). In multiple linear regression adjusted for age, sex, gestation, socioeconomic status, parent's education, maternal age, parity, body mass index, height, rural/urban residence, and time of testing, Atlantis score (learning ability/long-term storage and retrieval) rose by 0.1 SD per SD increase in newborn weight and head circumference, respectively (p < 0.05 for all), and Kohs' block design score (visuospatial ability) increased by 0.1 SD per SD increase in birthweight (p < 0.05). The associations were reduced after further adjustment for current head circumference. There were no associations of birthweight and/or head circumference with measures of short-term memory, fluid reasoning, verbal abilities, and attention and concentration. In conclusion, higher birthweight and larger head circumference at birth are associated with better childhood cognitive ability. The effect may be specific to learning, long-term storage and retrieval, and visuospatial abilities, but this requires confirmation by further research.
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Affiliation(s)
- Sargoor R Veena
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mysore, Karnataka, India.
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