Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental infl uences on children’s cognition at age 9–12 years in Indonesia: follow-up of the SUMMIT randomised trial

Background Brain and cognitive development during the fi rst 1000 days from conception are aff ected by multiple biomedical and socioenvironmental determinants including nutrition, health, nurturing, and stimulation. An improved understanding of the long-term infl uence of these factors is needed to prioritise public health investments to optimise human development. Methods We did a follow-up study of the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a double-blind, cluster-randomised trial of maternal supplementation with multiple micronutrients (MMN) or iron and folic acid (IFA) in Indonesia. Of 27 356 live infants from birth to 3 months of age in 2001–04, we re-enrolled 19 274 (70%) children at age 9–12 years, and randomly selected 2879 from the 18 230 who were attending school at a known location. Of these, 574 children were oversampled from mothers who were anaemic or malnourished at SUMMIT enrolment. We assessed the eff ects of MMN and associations of biomedical (ie, maternal and child anthropometry and haemoglobin and preterm birth) and socioenvironmental determinants (ie, parental education, socioeconomic status, home environment, and maternal depression) on general intellectual ability, declarative memory, procedural memory, executive function, academic achievement, fi ne motor dexterity, and socioemotional health. The SUMMIT trial was registered, number ISRCTN34151616. Findings Children of mothers given MMN had a mean score of 0·11 SD (95% CI 0·01–0·20, p=0·0319) higher in procedural memory than those given IFA, equivalent to the increase in scores with half a year of schooling. Children of anaemic mothers in the MMN group scored 0·18 SD (0·06–0·31, p=0·0047) higher in general intellectual ability, similar to the increase with 1 year of schooling. Overall, 18 of 21 tests showed a positive coeffi cient of MMN versus IFA (p=0·0431) with eff ect sizes from 0·00–0·18 SD. In multiple regression models, socioenvironmental determinants had coeffi cients of 0·00–0·43 SD and 22 of 35 tests were signifi cant at the 95% CI level, whereas biomedical coeffi cients were 0·00–0·10 SD and eight of 56 tests were signifi cant, indicating larger and more consistent impact of socioenvironmental factors (p<0·0001). Interpretation Maternal MMN had long-term benefi ts for child cognitive development at 9–12 years of age, thereby supporting its role in early childhood development, and policy change toward MMN. The stronger association of socioenvironmental determinants with improved cognition suggests present reproductive, maternal, neonatal, and child health programmes focused on biomedical determinants might not suffi ciently enhance child cognition, and that programmes addressing socioenvironmental determinants are essential to achieve thriving populations

Coordinate structures: A planar representation.

In this dissertation, I pursue the idea suggested in Chomsky (1982) that coordination should be treated as an object with three dimensions. I propose a planar model to account for the longstanding problems of coordination. The types of phenomena studied here are related to Phrasal Coordinations, Gapping, Verb Phrase Deletion, and Right-Node Raising. I claim that a coordinate sentence, unlike a simple one, is too expansive a domain for the Principles of Universal Grammar (UG) to hold. The relevant domain for the application of UG principles is each separate "component part" of the coordinate sentence. The "component parts", referred to here as planes, are elements of the coordinate sentence which have the same formal properties as simple sentences. Thus, under the planar model, a coordinate sentence has a number of "simple sentences" or planes. Intuitively, a plane, like a simple sentence, can be thought of as a complete functional complex in which all grammatical functions compatible with its head are realized. Given this, I argue that the well-formedness of a coordinate structure depends on whether or not each of its planes obeys the principles of UG. The planar model adopts the idea that conjuncts or disjuncts in coordination are based generated at D-Structure. It is claimed that no deletions or empty nodes exists in any type of coordinate structures. I show that the absence of some elements in coordination, e.g. a verb in Gapping, is a phonetic phenomenon, which occurs only as a result of the linearization process. At the other levels of representation, such as D-Structure, S-Structure, and Logical Form, all materials are present in each plane; thus, under the planar model, we do not need to invoke a deletion rule or the existence of some empty node in those levels of representation. Given this model, I show that the principles and parameters approach of GB can in fact give a unified treatment of coordination. I demonstrate that this can be done without recourse to construction-specific stipulation

Anatomi Sistem Sosial , Rekonstruksi Normalitas Relasi Intersubyektivitas dengan Pendekatan Sistem

Dalam berbagai macam saluran informasi, kita setiap saat disuguhkan oleh kenyataan bergambar pertikaian, perselisihan, dan permusuhan. Mulai dari kalangan bawah, hingga para elit negeri ini yang berteriak-teriak rebut jabatan. Fenomena semacam ini, tak ayal menyebabkan mayoritas aspek kehidupan sosial terganggu. Terutama agenda perwujudan masyarakat sejahtera ansih menjadi angan semata.Di sisi lain, narasi globalisasi dan modernisasi makin berdampak pada perubahan sosial budaya di Indonesia. Bangsa yang dikenal komunal dan suka bergotong royong ini, kini kian egoistis dan individualis. Narasi tersebut telah mengakibatkan pengelompokan berdasarkan kepentingan. Segala interaksi sosial terjadi hanya dalam rangkan transaksional semata. Lalu, kemana perginya nilai luhur cerminan identitas bangsa? Apakah ia lenyap oleh pesona materi yang lekas tak berbekas ?Pada mulanya adalah kerisauan. Husni Muadz dalam bukunya Anatomi Sistem Sosial ini memandang fenomena sosial tersebut dengan penuh kerisauan. Sebab kehidupan sosial kini mulai bergeser ke arah abnormal. Keabnormalan ini kemudian, mengisyarakan akan adanya krisis identitas pada diri bangsa. Padahal, identitas ialah keutuhan yang dibangun melalui organisasi relasi dari komponen-komponen. Dengan demikian, ketika bangsa didapuk mengalami krisis identitas, sesungguhnya keutuhan bangsa pun tengah meradang.Berangkat dari sana, Husni Muadz hendak menawarkan konsep “normalisasi†terhadap interakasi dan relasi sosial yang sejauh ini berkembang. Linguist jebolan Universitas Arizona ini pun mengkaji ke-abnormal-an fenomena sosial tersebut dengan kaca mata sistem, “Buku ini mencoba memahami fenomena institusi sosial manusia dengan menggunakan teori sistem. Dengan pendekatan tersebut, gejala sosial yang terjadi dapat dikaji secara menyeluruh.â€Buku Anatomi Sistem Sosial ini terdiri atas dua bagian. Bagian pertama, berisi pemaparan tawaran mengenai konsep the ideal state of social order (keadaan ideal dalam tatanan sosial). Tawaran ini menjadi pancingan bagi pembaca sebagai awal dalam memahami pemikiran ke arah “normalisasi†tadi. Sedangkan bagian kedua berkaitan dengan tawaran apa yang harus dilakukan berdasarkan arahan dari konsep-konsep sebelumnya.Husni Muadz menulis, “berdasarkan pengalaman hidup sehari-hari, banyak dari pola relasi (intersubyektivitas) yang telah mengalami penyimpangan dari pola-pola relasi yang normal.†Maka, dalam mewujudkan konsep “normalisasi†terhadap pola relasi sosial yang abnormal itu, digunakanlah pembelajaran intersubyektivitas.Pembelajaran intersubyektivitas merupakan bagian dari sistem sosial. Dimana inti pembelajrannya adalah mewujudkan keutuhan sosial dengan memandang orang lain sebagai subyek yang bernilai sama. Permasalahan sosial yang kerap muncul disebabkan oleh belum mampunya kita untuk hidup saling berterima dengan sesama. Relasi kita masih bersyarat. Senyum kita pada sesama masih bersyarat. Di sinilah letak urgensi pembelajaran intersubyektivitas tersebut.Pembelajaran ini adalah pembelajaran tentang berjumpa dan berkomunikasi dengan orang lain. Dalam rangka membangun relasi murni tanpa ada intrik-intrik kepentingan. Husni Muadz mengatakan, “kita berjumpa tujuannya untuk berjumpa, tidak ada yang lain.†Singkatnya, ketika kelindan erat antar subyek telah terjalin apik, maka perlahan-lahan “normalisasi†yang dimaksud akan tercapai.Secara keseluruhan buku ini menyajikan gagasan-gagasan baru dan orisinal. Sangat pas didiskusikan lebih lanjut untuk mematangkan dan memperjelas apa yang menjadi pemikiran. Hanya saja gaya bahasa serta peristilahan yang tak umum, sedikit menyulitkan ketika membacanya. Selebihnya, akal kita akan dimanjakan oleh buku bergizi tinggi ini. Selamat membaca

Anatomi sistem sosial : rekonstruksi normalitas relasi intersubyektivitas dengan pendekatan sistem/ Muadz

xx, 444 hal.; 24 cm

Anatomi sistem sosial : rekonstruksi normalitas relasi intersubyektivitas dengan pendekatan sistem/ Muadz

xx, 444 hal.; 24 cm

Maternal Multiple Micronutrient Supplements and Child Cognition:A Randomized Trial in Indonesia

OBJECTIVES: We investigated the relative benefit of maternal multiple micronutrient (MMN) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age (42 months). METHODS: We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial, a cluster-randomized trial in Indonesia, on tests adapted and validated in the local context measuring motor, language, visual attention/spatial, executive, and socioemotional abilities. Analysis was according to intention to treat. RESULTS: In children of undernourished mothers (mid-upper arm circumferenc

The effect of maternal multiple micronutrient supplementation on cognition and mood during pregnancy and postpartum in Indonesia: a randomized trial.

Maternal caregiving capacity, which is affected in part by cognition and mood, is crucial for the health of mothers and infants. Few interventions aim to improve maternal and infant health through improving such capacity. Multiple micronutrient (MMN) supplementation may improve maternal cognition and mood, since micronutrients are essential for brain function. We assessed mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a double-blind cluster-randomized trial in Indonesia comparing MMN supplementation to iron and folic acid (IFA) during pregnancy and until three months postpartum. We adapted a set of well-studied tests of cognition, motor dexterity, and mood to the local context and administered them to a random sample of 640 SUMMIT participants after an average of 25 weeks (SD = 9) of supplementation. Analysis was by intention to treat. Controlling for maternal age, education, and socio-economic status, MMN resulted in a benefit of 0.12 SD on overall cognition, compared to IFA (95%CI 0.03-0.22, p = .010), and a benefit of 0.18 SD on reading efficiency (95%CI 0.02-0.35, p = .031). Both effects were found particularly in anemic (hemoglobin&lt;110 g/L; overall cognition: B = 0.20, 0.00-0.41, p = .055; reading: B = 0.40, 0.02-0.77, p = .039) and undernourished (mid-upper arm circumference&lt;23.5 cm; overall cognition: B = 0.33, 0.07-0.59, p = .020; reading: B = 0.65, 0.19-1.12, p = .007) mothers. The benefit of MMN on overall cognition was equivalent to the benefit of one year of education for all mothers, to two years of education for anemic mothers, and to three years of education for undernourished mothers. No effects were found on maternal motor dexterity or mood. This is the first study demonstrating an improvement in maternal cognition with MMN supplementation. This improvement may increase the quality of care mothers provide for their infants, potentially partly mediating effects of maternal MMN supplementation on infant health and survival. The study is registered as an International Standard Randomized Controlled Trial, number ISRCTN34151616. http://www.controlled-trials.com/ISRCTN34151616