RESUMO
The issues arising from implementing an early intervention service, developed in the rural United States in the late 1960s in a range of different cultural contexts over a period of a quarter of a century, are explained. Services from India, Bangladesh, Jamaica and the United Kingdom are compared. As well as considering cross-cultural aspects of Portage, variability within one country, the United Kingdom, is considered by comparing one service in an inner-city area and one in a rural area.
PIP: In the late 1960s in rural Wisconsin, the Portage Guide to Early Intervention was developed to manage development delay in preschool children. A parent, usually the mother, teaches the child each day and keeps a record. A home visitor monitors progress weekly and teaches the parent by modelling the program with the child. It operates under basic assumptions, some of which many countries cannot meet. For example, services available in developed countries (e.g., health services) are not available in Bangladesh and India, because resources are limited and the population is so large. Further, there are considerable differences in culture between these countries and the West (e.g., extended family vs. nuclear family). Moreover, the major causes of developmental delay in these South Asian countries are different than in developed countries (birth asphyxia, malnutrition, and deficiency diseases vs. genetic causes). Professionals in India and Bangladesh have incorporated Portage into a variety of early intervention services, thereby modifying the model considerably. In Jamaica, however, professionals use the Portage model with only a few modifications. Fore example, they use it with all disabled children rather than just those with learning disabilities. A problem with using the model is the lack of manufactured toys and play materials listed in the curriculum. Jamaica has a training program for child development aides. Portage services exist throughout the UK. Urban programs serve many more immigrants from developing countries than do the rural programs. This requires modifying the Portage model. In all countries, costs pose a constraint. This overview of Portage services in various countries indicates that these services alone are relatively unimportant as direct agents of social change and may be an important element of broader social changes.
Assuntos
Comparação Transcultural , Atenção à Saúde/economia , Promoção da Saúde , Aculturação , Bangladesh , Criança , Desenvolvimento Infantil , Pré-Escolar , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Países em Desenvolvimento , Educação , Etnicidade , Família , Feminino , Humanos , Lactente , Jamaica , Masculino , Desnutrição Proteico-Calórica/prevenção & controle , Desnutrição Proteico-Calórica/terapia , Reino Unido , Estados UnidosRESUMO
PIP: The total fertility rate (TFR) estimated for the period of 1930-35 was 6.22 children per mother, which declined to 5.80 during 1940-45, increased slightly to 5.86 during 1950-55, and to 6.0 during 1960-65, to drop to 4.97 during 1970-75. The decline was 17.2% between 1963 and 1973, 14.3% between 1943-1973, and 20.1% between 1933 and 1973 (or an average decline by 1.26 children per woman in 40 years). The evolution of the national and regional levels of fertility was estimated by a unique methodology that utilized the average births per woman with data extracted from censuses and research samples. In particular, the technique of Brass was used with correction for P2/F2 as valid data 5 years prior to taking the information. In this manner the TFR was estimated at 3.5142 based on the 1984 national household survey and specific rates for age groups encompassed the period of 1979-84. In this case it was estimated that 3,311,000 births must have occurred on the average annually during this period. It was only in 1980 that the Civil Register recorded 3,860,000 births. During this same period the hypothesis of constancy, utilizing current fertility rates corrected for P2/F2, yielded 2,745,000 births in the course of 5 years. In recent times fertility in Brazil has been on a declining trend, starting in the 1960s. The intensity of this decline varied according to the sources of information: the Civil Register and the national survey of households. Prior to the 1960s the less developed regions of the north experienced pronounced increases, while the southeastern and southern regions showed declines. From the mid-1960s all regions experienced a forceful decline in fertiltiy levels. The results indicate the convincing nature of the proposed model for estimating the levels and patterns of fertility, and it is particularly useful for other levels of disaggregation.^ieng