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1.
Front Psychiatry ; 10: 859, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31824356

RESUMO

Background: Maternal depression affects a high proportion of women during the antenatal and postnatal period in low- and middle-income countries. While maternal depression is recognized as a significant risk for poor early child development that warrants interventions, the effects of chronic maternal depression on children's development are less understood. Objective: To determine the association of chronicity of maternal depressive symptoms and early child development in a rural population in southern Pakistan. Materials and Methods: This study employs data from the "Pakistan Early Child Development Scale-Up Trial," a randomized controlled study that evaluated the integration of responsive stimulation and nutrition interventions in a community health service. In the present analysis, linear regression was used to test the effects of chronicity of high maternal depressive symptoms on children's early development (n = 1205 mother-infant dyads). Children's development was assessed using the Bayley Scales of Infant and Toddler Development at 24 months of age. Maternal depressive symptoms were assessed at baseline and every 6 months using the Self-Reporting Questionnaire. Results: No significant associations were observed between chronic maternal depressive symptoms and child cognitive, language, or motor development after adjusting for parental characteristics, the caregiving environment and socioeconomic variables. A negative significant association between chronicity of high maternal depressive symptoms and child socio-emotional development (ß coefficient -2.57, 95% CI: -5.14; -0.04) was observed after adjusting for the selected variables. Conclusions: The results suggest that interventions designed to promote early child development should also integrate repeat screening for depression and longer-term psychosocial support for mothers.

2.
J Glob Health ; 9(3): 020703, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673352

RESUMO

Background: Approximately 250 million children under the age of five in low and middle-income countries (LMICs) will not achieve their developmental potential due to poverty and stunting alone. Investments in programming to improve early childhood development (ECD) have the potential to disrupt the cycle of poverty and therefore should be prioritised. Support for ECD has increased in recent years. Nevertheless, donors and policies continue to neglect ECD, in part from lack of evidence to guide policy makers and donors about where they should focus policies and programmes. Identification and investment in research is needed to overcome these constraints and in order to achieve high quality implementation of programmes to improve ECD. Methods: The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities for improving ECD. A group of 348 global and local experts in ECD-related research were identified and invited to generate research questions. This resulted in 406 research questions which were categorised and refined by study investigators into 54 research questions across six thematic goals which were evaluated using five criteria: answerability, effectiveness, feasibility, impact, and effect on equity. Research options were ranked by their final research priority score multiplied by 100. Results: The top three research priority options from the LMIC experts came from the third thematic goal of improving the impact of interventions, whereas the top three research priority options from high-income country experts came from different goals: improving the integration of interventions, increasing the understanding of health economics and social protection strategies, and improving the impact of interventions. Conclusion: The results of this process highlight that priorities for future research should focus on the need for services and support to parents to provide nurturing care, and the training of health workers and non-specialists in implementation of interventions to improve ECD. Three of the six thematic goals of the present priority setting centred on interventions (ie, improving impact, implementation of interventions and improving the integration of interventions). In order to achieve higher coverage through sustainable interventions to improve ECD with equitable reach, interventions should be integrated and not be sector driven.


Assuntos
Desenvolvimento Infantil , Saúde Global , Pesquisa , Pré-Escolar , Humanos , Lactente , Desenvolvimento Sustentável
3.
BMJ Open ; 9(10): e026449, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31585969

RESUMO

OBJECTIVE: To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs). DESIGN: Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data. DATA SOURCES: We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study. ANALYSES: Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses. RESULTS: We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs. CONCLUSIONS: Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

4.
Children (Basel) ; 6(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31618843

RESUMO

Parental stimulation and responsiveness are associated with improved early child development outcomes. However, the majority of studies have relied on maternal-reported measures of only mothers' parenting practices. The purpose of this study was to assess the agreement between fathers' and mothers' reports of their own and their partner's engagement in stimulation and assess the degree to which parents' reported stimulation correlated with their observed responsive caregiving behaviors. Data were collected from 33 couples (33 fathers and 32 mothers) who had a child under 5 years of age in rural Pakistan. Paternal and maternal stimulation were measured based on reports of their own and their partner's practices in play and learning activities with the child. Paternal and maternal responsiveness were observed in a subsample of 18 families. Moderate agreement was found between paternal and maternal reports of their own and their partner's practices. Moderate associations were also found between self-reported measures of stimulation and observed responsive caregiving for both fathers and mothers. The strengths of agreement and associations were greater among couples who had higher quality coparenting relationships. Findings highlight the feasibility, reliability, and promise of assessing fathers' parenting in a low-resource setting, using similar methods as for mothers' parenting, to triangulate measures between reported and observed parenting and gain a deeper understanding of fathers' and mothers' unique caregiving contributions.

5.
BMC Public Health ; 19(1): 641, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31132997

RESUMO

BACKGROUND: Child health, nutrition, and responsive stimulation interventions have been developed to improve child survival, growth and development outcomes in low- and middle-income countries. Nevertheless, research on integrated implementation approaches to deliver and promote uptake of these interventions is needed, particularly in sub-Saharan Africa. METHODS/DESIGN: We will conduct a cluster-randomized controlled trial of a supply-side community health worker (CHW) delivered child health, nutrition, and responsive stimulation intervention alone and in combination with a demand-side conditional cash transfer (CCT) intervention to promote antenatal care and child growth monitoring attendance in rural Morogoro region, Tanzania. Twelve village clusters will be randomly assigned to one of the three trial arms: (1) CHW, (2) CHW + CCT, or (3) Control. Mothers (or another primary caregiver) residing in study villages are eligible for trial enrollment if they are currently pregnant or have a child < 1 year of age at the time of enrollment. For the duration of the trial, CHWs will visit households once every 4-6 weeks to deliver the intervention package and CCTs will be provided for documented antenatal care and routine child health and growth monitoring clinic visits. Participants will be followed-up at 9 months (midline) and 18 months (endline) post-randomization. The primary outcomes of the trial are child development assessed by the Bayley Scales of Infant and Toddler Development (BSID-III) and child height-for-age z-score. Secondary outcomes include a range of maternal, child and household outcomes. DISCUSSION: This trial will provide evidence on the effect of CHWs and conditional cash transfers on child growth and development. The results of the trial may be generalizable to similar settings in sub-Saharan Africa. TRIAL REGISTRATION: ISRCTN10323949 , Retrospectively registered on October 3, 2017.


Assuntos
Desenvolvimento Infantil , Agentes Comunitários de Saúde , Promoção da Saúde/organização & administração , População Rural , Pré-Escolar , Feminino , Apoio Financeiro , Promoção da Saúde/métodos , Humanos , Lactente , Masculino , Estado Nutricional , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Tanzânia
7.
Child Abuse Negl ; 88: 51-57, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30447502

RESUMO

Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan. Healthcare professionals (HCP) are ideally placed to detect abuse, but, to inform interventions, an understanding of their experiences, training needs and cultural beliefs is needed. This study aimed to: (1) Explore the challenges that HCP face when managing cases of abuse; (2) Explore cultural beliefs and understand how these shape practice and (3) Identify training needs. A qualitative study using a phenomenological design was conducted. In-depth interviews were conducted with doctors, nurses and security staff in the emergency department of a large private hospital in Pakistan (n = 15). Interviews were undertaken in Urdu, translated into English and analysed using an inductive thematic approach. Multiple challenges were identified. The process of referral to legal services was poorly understood and further training and guidelines was suggested by participants. As the legal system in Pakistan does not allow HCP to keep potentially abused patients in their custody, they felt restricted in their ability to advocate and concerned about the safety of both the identified children and themselves. HCP have potential to detect abuse early; however, in Pakistan there are numerous challenges. HCP require support through training, as well as clear institutional frameworks and legal support to undertake this role.

8.
Dev Sci ; 22(5): e12795, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30585683

RESUMO

This study extends the methodological and theoretical understanding of executive functions (EFs) in preschoolers from low- and middle-income countries (LMIC). First, the authors describe a rigorous process of adapting and evaluating six EF tasks to produce a culturally and developmentally appropriate measure of emerging EFs in a large sample of at-risk children in rural Pakistan. Next, the authors identify critical developmental and family factors that relate to preschoolers' EFs over the first 4 years of life. Direct assessment of children's general cognitive skills at age two showed developmental continuity with EFs at age four, and these early cognitive skills mediated the effect of an antecedent parenting intervention on EFs as well as associations of targeted individual and family factors with EFs. Furthermore, directly assessed maternal cognitive capacities and observed maternal scaffolding uniquely predicted EFs in preschoolers. This study is also the first to demonstrate a significant overlap between direct assessments of IQ and EFs in young children from LMIC. Children's general intelligence mediated the associations of EFs with antecedent physical growth and cognitive skills as well as concurrent family factors (maternal verbal intelligence, maternal scaffolding, and home stimulation). After controlling for shared variance between preschoolers' general intelligence and EFs, three factors emerged as unique predictors of EFs: exposure to an early parenting intervention, physical growth status at age two, and number of older siblings. The findings have important implications for the design of interventions that aim to improve EFs in young children in LMIC. A video abstract of this article can be viewed at https://vimeo.com/316329544/5abde94cd7.


Assuntos
Desenvolvimento Infantil/fisiologia , Função Executiva/fisiologia , Fatores de Proteção , Pré-Escolar , Feminino , Humanos , Inteligência/fisiologia , Masculino , Paquistão , Relações Pais-Filho , Poder Familiar , População Rural
9.
PLoS One ; 13(12): e0208335, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30566498

RESUMO

BACKGROUND: The United Nation's Sustainable Development Goals encompass lifelong learning from birth to youth to adulthood (Goal 4) and economic opportunities for young people (Goal 8). The targets include improving access to quality early childhood care and education (ECCE) as well as learning and training opportunities for adolescents and youth. Cross-generational models for young children and youth may offer opportunities to address the interconnections between goals and targets for the next generation. We investigated whether an ECCE programme for young children (3.5-6.5 years) delivered by female youth (18-24 years) in rural Pakistan would be effective on children's school readiness. METHODS: In partnership with the National Commission for Human Development in Pakistan, we implemented the 'Youth Leaders for Early Childhood Assuring Children are Prepared for School' (LEAPS) programme to train female youth to deliver ECCE. The effectiveness of the LEAPS programme on children's school readiness was evaluated in a cluster-randomised controlled trial. We randomly allocated five clusters (villages) to receive the intervention (n = 170 children) and five clusters to control (n = 170 children). Children's school readiness was assessed after nine months of intervention exposure using the International Development and Early Learning Assessment tool. Analyses was by intention-to-treat. The trial is registered with ClinicalTrials.gov, number NCT02645162. FINDINGS: At endline, the intervention group had significantly higher school readiness scores (n = 166, mean percentage score 59.4, 95% CI 52.7 to 66.2) compared with the control group (n = 168, mean percentage score 45.5, 95% CI 38.8 to 52.3). The effect size (Cohen's d) was 0.3. CONCLUSION: Trained female youth delivered an ECCE programme that was effective in benefitting young children's school readiness. The cross-generational model is a promising approach to support early child development; however, further evaluation of the model is needed to assess the specific benefits to youth including their skills and economic development.


Assuntos
Desenvolvimento Infantil , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Paquistão , População Rural/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Adulto Jovem
10.
BMC Public Health ; 18(1): 1350, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522475

RESUMO

After publication of the original article [1], the authors wanted to make an amendment in the Acknowledgments section as Muneera Rasheed requested to be removed. This correction article shows the original and revised version of the "Acknowledgments". The original article was not updated.

11.
BMC Public Health ; 18(1): 1274, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30453979

RESUMO

BACKGROUND: Parents are the primary providers of nurturing care for young children's healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers' parenting roles with regards to their young children's early health and development in rural Pakistan. METHODS: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis. RESULTS: Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers' coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community. CONCLUSIONS: Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers' direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.


Assuntos
Pai/psicologia , Poder Familiar/psicologia , Papel (figurativo) , Adolescente , Adulto , Pré-Escolar , Pai/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Mães/estatística & dados numéricos , Paquistão , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Adulto Jovem
12.
PLoS One ; 13(11): e0207807, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30481197

RESUMO

The Strengths and Difficulties Questionnaire (SDQ) is widely-used to measure symptoms of common childhood behavioral problems that may lead to mental health difficulties. In a sample of 1,302 highly-disadvantaged mothers and their preschoolers, we evaluated the factor structure and reliability of the parent-report version of the SDQ in rural Pakistan. Confirmatory factor analyses suggested that the original structure of the SDQ was not appropriate for our data. We created conceptually- and empirically-coherent measures of children's externalizing behavior problems and prosocial skills. Child and family correlates of social-emotional behaviors were similar to those found in other countries, supporting the validity of our new composites. Girls and children with more siblings had fewer externalizing behavior problems and more prosocial behaviors at four years. Further, maternal depressive symptoms and food insecurity were uniquely linked to more externalizing behavior problems at four years. In contrast, maternal education, home environment quality, and social-emotional skills at two years were associated with more prosocial behaviors at four years.


Assuntos
Emoções , População Rural/estatística & dados numéricos , Comportamento Social , Inquéritos e Questionários , Pré-Escolar , Feminino , Humanos , Masculino , Saúde Mental , Paquistão , Psicometria , Habilidades Sociais
14.
Ann N Y Acad Sci ; 1419(1): 264-271, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29791728

RESUMO

We summarize the state of the field of implementation research and practice for early child development and propose recommendations. First, conclusions are drawn regarding what is generally known about the implementation of early childhood development programs, based on papers and discussions leading to a published series on the topic. Second, recommendations for short-term activities emphasize the use of newly published guidelines for reporting data collection methods and results for implementation processes; knowledge of the guidelines and a menu of measures allows for planning ahead. Additional recommendations include careful documentation of early-stage implementation, such as adapting a program to a different context and assessing feasibility, as well as the process of sustaining and scaling up a program. Using existing implementation information by building on and improving past programs and translating them into policy are recommended. Longer term goals are to identify implementation characteristics of effective programs and determinants of these characteristics.


Assuntos
Desenvolvimento Infantil , Criança , Pré-Escolar , Guias como Assunto , Humanos , Técnicas de Planejamento , Desenvolvimento de Programas
15.
Ann N Y Acad Sci ; 1419(1): 160-178, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29791730

RESUMO

Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at-scale, how, and at what cost? To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed-methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale-up.


Assuntos
Desenvolvimento Infantil/fisiologia , Serviços de Saúde Comunitária/organização & administração , Dietética , Promoção da Saúde/organização & administração , Poder Familiar , Criança , Pré-Escolar , Países em Desenvolvimento , Humanos , Paquistão , Avaliação de Programas e Projetos de Saúde
16.
Ann N Y Acad Sci ; 1419(1): 26-37, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29791737

RESUMO

Meta-analyses of interventions such as parenting, stimulation, and early childhood education have reported consistent medium-to-high effect sizes on early childhood development (ECD) and early learning outcomes. However, few effective interventions promoting ECD have achieved scale. In order to increase the access to effective or high-quality services, greater focus on implementation research of interventions promoting ECD is necessary. In this paper, we describe the development of reporting guidelines for implementation research of nurturing care interventions designed to promote ECD following an expert consensus-building process. The goal of these guidelines is to support a transparent and standard reporting of implementation evidence on nurturing care interventions designed to promote early childhood development.


Assuntos
Desenvolvimento Infantil , Guias como Assunto , Avaliação de Programas e Projetos de Saúde/métodos , Criança , Pré-Escolar , Consenso , Técnica Delfos , Humanos , Serviços de Informação , Desenvolvimento de Programas , Projetos de Pesquisa
17.
Ann N Y Acad Sci ; 1419(1): 5-16, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29791739

RESUMO

Research in early childhood development (ECD) has established the need for scaling-up multisectoral interventions for nurturing care to promote ECD, for improved socioeconomic outcomes for sustainable societies. However, key elements and processes for implementation and scale-up of such interventions are not well understood. This special series on implementation research and practice for ECD brings together evidence to inform effectiveness, quality, and scale in nurturing care programs; identifies knowledge gaps; and proposes further directions for research and practice. This paper frames the dimensions and components fundamental to the understanding of implementation processes for nurturing care interventions, factors for improving implementation of interventions, and strategies to scale by embedding interventions in delivery systems. We discuss emerging issues in implementation research for ECD, including (1) the role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) the importance of feasibility studies to inform scale-up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems. Effective implementation of nurturing care interventions is at the heart of achieving positive developmental outcomes for young children. It is pivotal to adapt and implement these interventions based on evidence for high impact, especially in low-resource settings.


Assuntos
Desenvolvimento Infantil , Prática Clínica Baseada em Evidências , Fortalecimento Institucional/organização & administração , Criança , Pré-Escolar , Difusão de Inovações , Família , Humanos , Lactente , Desenvolvimento de Programas
18.
Pediatrics ; 141(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29500293

RESUMO

CONTEXT: Early childhood stimulation interventions positively impact early child development (ECD) outcomes in low- and middle-income countries. However, trials have less comprehensively evaluated the effects of such parenting programs on caregivers' skills and capacities. OBJECTIVE: We conducted a systematic review and meta-analysis to assess the effectiveness of stimulation interventions on improving parenting outcomes. DATA SOURCES: Six electronic bibliographic databases. STUDY SELECTION: Inclusion criteria included randomized controlled trials of stimulation interventions designed to improve ECD outcomes during the first 2 years of life that measured any maternal or parenting-related outcome after the start of the intervention. DATA EXTRACTION: Two independent reviewers extracted data by using a structured form. RESULTS: Fifteen studies representing 13 unique randomized controlled trials met the inclusion criteria. Pooled standardized mean differences (SMDs) based on random-effects models revealed medium-to-large benefits of stimulation interventions for improving the home caregiving environment (n = 10; SMD = 0.57; 95% confidence interval [CI], 0.37 to 0.77), mother-child interactions (n = 3; SMD = 0.44; 95% CI, 0.14 to 0.74), and maternal knowledge of ECD (n = 6; SMD = 0.91; 95% CI, 0.51 to 1.31). No significant difference was seen for maternal depressive symptoms (n = 9; SMD = -0.10; 95% CI, -0.23 to -0.03). LIMITATIONS: Limitations include heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies. CONCLUSIONS: Early childhood stimulation interventions improve several distinct aspects of maternal parenting. Improvements in parenting capacities may serve as key mechanisms by which these programs benefit ECD outcomes.


Assuntos
Desenvolvimento Infantil , Renda/tendências , Poder Familiar/tendências , Pobreza/economia , Pobreza/tendências , Criança , Desenvolvimento Infantil/fisiologia , Feminino , Humanos , Masculino , Relações Mãe-Filho/psicologia , Poder Familiar/psicologia
20.
Dev Cogn Neurosci ; 26: 1-8, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28436831

RESUMO

Children in low- and middle-income countries are at high risk of cognitive deficits due to environmental deprivation that compromises brain development. Despite the high prevalence of unrealized cognitive potential, very little is known about neural correlates of cognition in this population. We assessed resting EEG power and cognitive ability in 105 highly disadvantaged 48-month-old children in rural Pakistan. An increase in EEG power in gamma frequency bands (21-30Hz and 31-45Hz) was associated with better executive function. For girls, EEG gamma power also related to higher verbal IQ. This study identifies EEG gamma power as a neural marker of cognitive function in disadvantaged children in low- and middle-income countries. Elevated gamma power may be a particularly important protective factor for girls, who may experience greater deprivation due to gender inequality.


Assuntos
Raios gama , Aprendizagem Verbal/fisiologia , Criança , Cognição , Função Executiva , Feminino , Humanos , Masculino , Paquistão
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