Community Based Pre-School Screening to Detect Developmental, Behavioural, Hearing and Vision Problems in Survivors of Neonatal Cardiac Surgery.

Prolonged furosemide exposure and risk of abnormal newborn hearing screen in premature infants

PurposeTo examine whether changes in vision and hearing problems are associated with changes in psychosocial outcomes (in terms of depressive symptoms, loneliness, and perceived social isolation).MethodsWe used longitudinal data from the nationally representative German Ageing Survey, which covers individuals aged 43 years and over (wave 6 and wave 7, with 7108 observations and mean age of 67.5 years, SD 10.2 years). The 6-item De Jong Gierveld tool was used to quantify loneliness, the Bude and Lantermann tool was used to quantify perceived social isolation, and the Center for Epidemiologic Studies Depression Scale (15-item version) was used to quantify depressive symptoms. Self-rated problems reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used to quantify vision problems. In addition, self-rated hearing problems on the telephone and self-rated hearing problems in groups of more than four people were used to quantify hearing problems.ResultsAdjusting for various confounders, longitudinal regressions showed that the onset of major vision problems referring to difficulties recognizing people one knows on the street was associated with increases in loneliness (β = 0.17, p < .01) and depressive symptoms (β = 1.90, p < 0.05). Moreover, the onset of some vision problems referring to difficulties reading the newspaper was associated with increases in perceived social isolation (β = 0.06, p < 0.01). Additionally, the onset of some hearing problems in groups of more than four people was associated with increases in depressive symptoms (β = 0.43, p < 0.05).ConclusionOur longitudinal study showed that vision and hearing problems can contribute differently to psychosocial factors. Delaying sensory impairment may result in favorable psychosocial factors in later life.

To examine the diversity in paediatric vision and hearing screening programmes in Europe. Themes for comparison of screening programmes derived from literature were used to compile three questionnaires on vision, hearing, and public health screening. Tests used, professions involved, age, and frequency of testing seem to influence sensitivity, specificity, and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists, and audiologists involved in paediatric screening in all EU full-member, candidate, and associate states. Answers were cross-checked. Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% of these more than once. First measurement of VA varies from three to seven years of age, but is usually before age five. At age three and four, picture charts, including Lea Hyvarinen, are used most; in children over four, Tumbling-E and Snellen. As first hearing screening test, otoacoustic emission is used most in healthy neonates, and auditory brainstem response in premature newborns. The majority of hearing testing programmes are staged; children are referred after 1-4 abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists, or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4), and funding sources (8).

Comparing the effectiveness of vision screenings as part of the school entrance physical examination to comprehensive vision examinations in children ages 3 to 6: An exploratory study

Associational study of neonatal hearing screening results and common metabolic disorders.

Hearing and vision impairment are highly prevalent in ageing individuals and are significant public health concerns given their meaningful impacts on individuals and society. Yet, many cases of both visual and hearing impairment remain unidentified and thus, unaddressed. This article describes the rationale and process of monitoring for visual and hearing impairment in older adults, by summarising guidance and resources available from the World Health Organisation (WHO) that were developed based upon the best current available evidence. It is recommended that vision screening be offered at least annually to adults aged over 50years and hearing screening be offered every 5years to adults aged 50-64years, and every 1-3years to adults aged 65years or older. Both hearing and vision screening can be conducted in community, home or clinical settings by trained health workers with simple equipment. More specifically, vision screening can be conducted with a simple eye chart. Hearing screening can be conducted without specialised equipment by using pure tones set to a fixed level, an automated mobile- or web-based digits-in-noise test, or the whispered voice test. Hearing screening can also be conducted in audiology clinics using pure-tone air conduction threshold testing. There exists WHO guidance to support the monitoring of hearing and vision impairment, which, when warranted, can facilitate referral for comprehensive assessment and prompt appropriate, person-centred interventions to mitigate the negative consequences of hearing and vision impairment.

Health literacy is a complex issue affecting the health outcomes of women and their families. This study was conducted to determine the health literacy levels and related factors of women attending various courses in family centers of a municipality. This cross-sectional research was conducted on a sample of women enrolled in various courses at eight family centers in a city center. The sample consisted of 837 women who agreed to participate. The participation rate was 76%. Two different health literacy scales were used to collect data for analysis. Of the women, 50.4% were over 40 years old, 35.2% were high school graduates, 89.6% were not working, 53.2% self-reported their monthly income as equal to their monthly expenses, 88.8% had social security, 28.4% had chronic diseases, 29.2% used medication regularly, 35.2% had visual problems, 7.8% had hearing problems, and 77.9% used the internet. According to the results of the Turkish Health Literacy Scale, 45.9% of the participants were in the inadequate category, 30.6% were in the inadequate and limited category, 16.0% were in the adequate category, and 7.4% were in the excellent category. Women aged 40 years and over, those who were elementary school graduates, those who had visual and hearing problems, those who used eyewear, those whose monthly income was less than expenses, and those who were non-internet users respectively had mean health literary scores that were significantly below the mean score for all participants (p < .05). The largest number of participants was categorized has having a "low-insufficient" level of health literacy. Age, educational level, income, having visual and hearing problems, wearing glasses, and internet use were found to affect level of health literacy. For this reason, factors such as age, educational level, income, vision and hearing problems, use of eyeglasses, and internet use should be considered when planning initiatives to increase health literacy in women.

Very preterm (VPT) children (≤32 weeks) have school readiness difficulties across multiple domains, but routine follow-up is often limited. We assessed the performance of VPT children on the Before School Check (B4SC), a community-based screening programme of school readiness at 4 years of age. VPT children discharged from Wellington and Auckland Neonatal Intensive Care Units (2005-2009) were compared to a national control cohort born during the same period. Outcome measures included Parental Evaluation of Developmental Status (PEDS), parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ-P and SDQ-T) and vision and hearing screening, and were related to perinatal and demographic characteristics obtained from the Australia and New Zealand Neonatal Network database. Of 1105 VPT children, 920 were matched to the B4SC database, of whom 814 (88%) had one or more B4SC screening outcomes recorded. Compared with controls, VPT children were more likely to have abnormal PEDS (odds ratio (OR) = 1.79, 1.53-2.10), SDQ-P (OR = 1.82, 1.49-2.23), SDQ-T (OR = 1.51, 1.10-2.06), vision (OR = 2.00, 1.54-2.60) and hearing (OR = 1.95, 1.65-2.31) screen outcomes. While VPT children with an abnormal screen were more likely to be referred for further assessment, only 34%, 22%, 94% and 51% with abnormal PEDS, SDQ or vision and hearing screen, respectively, had evidence of appropriate referral. School readiness difficulties were significantly associated with birthweight z-score ≤ -1, vaginal delivery, significant cranial ultrasound abnormalities, younger maternal age, higher deprivation neighbourhood and ventilation ≥72 h. Community-based screening may be useful for identifying VPT children with school readiness difficulties, but low referral rates may limit the effectiveness of such programmes.

BackgroundSensory impairment in older adults is associated with cognitive decline, elevated depressive symptoms, and low levels of life satisfaction. However, these relationships are usually investigated separately and in pairs. This study examined these relationships comprehensively, for the first time.MethodsThe analysis included 5,658 community-dwelling older adults from the China Health and Retirement Longitudinal Study (aged 50 to 108 years, 52.1% male) who completed the Jorm Informant Questionnaire Cognitive Decline in the Elderly and the Center for Epidemiological Studies-Depression-short form. A questionnaire was used to collect information on hearing, visual status, and life satisfaction. Structural equation modelling was used to examine the direct and indirect relationships between these variables.ResultsSelf-reported hearing and vision problems are directly associated with cognitive decline and elevated depressive symptoms. In addition, hearing and vision problems are indirectly related to cognitive decline through elevated depressive symptoms. Although hearing and vision problems had no direct effect on life satisfaction, they were indirectly associated with life satisfaction through cognitive decline and depressive symptoms.ConclusionsThis study provides the first epidemiological evidence of the comprehensive relationships between hearing and vision problems, cognitive decline, depressive symptoms, and life satisfaction. When older adults report hearing and/or vision problems, clinicians and caregivers should be aware of the concurrence of declined cognition, elevated depressive symptoms, and compensated life satisfaction. Future studies should examine the causal relationships and potential mechanisms of these relationships.

Vision is crucial for childhood development, and ensuring good vision in children is one of the United Nation’s sustainability goals. Most countries have a childhood vision screening programme, and in Norway screening in children aged 4–5 years is performed in community health centres (CHC). Specialist health services such as ophthalmology and/or orthoptics are the referral bodies. However, access to these may be limited and they may be a long distance away from the child’s home, while optometrists are often more available and accessible. This study aims to investigate if vision screening reliably detects vision problems and to explore if using paediatric optometry as a referral body can relieve the specialist health services. The study also aims to report frequency of refractive errors and management of vision problems in this age group. Of 274 children who attended vision screening by school nurses at the CHC in Kongsberg, Norway, parents of 213 (77.7%) consented to a separate eye and vision examination by a paediatric optometrist. Agreements in screening results between school nurses and the paediatric optometrists were evaluated. Separately, an ophthalmologist and an orthoptist assessed records from the eye examinations through a digital communication tool (Eyecheck System AS). Agreements in diagnoses and management decisions between optometrists and the specialist health services were evaluated. Amblyopia or ocular pathology was found in 1.9% of the children, which were all identified by the vision screening. The vision screening had a sensitivity and specificity of 62.3% and 58.6%, respectively, for detecting other vision problems in need of treatment or follow-up. Hypermetropia was present in 82.7% of the children (58.0% low, 18.5% moderate, 6.5% high hypermetropia), 16.4% had emmetropia and 1.0% had myopia. Glasses were prescribed to 8.5% of the children and 16.4% were scheduled for follow-ups. There was a high level of agreement in management between optometrists and specialists (ophthalmologist 80.3%, orthoptist 81.7%). The vision screening reliably detected amblyopia and ocular pathology, and most refractive errors were detected. The high degree of agreement between the three eye care professions suggests that paediatric optometrists can be used as the referral body for this age group. Availability of a digital communication tool provides support for the paediatric optometrists in their decision making and can help relieve the specialist health services by providing children with an eye examination and vision correction earlier and more easily.

SIGNIFICANCE:Despite significant evidence supporting the utility of vision screening for identifying children who need further evaluation by an eye care professional, there is considerable variability in screening guidelines along with a lack of consensus for monitoring and reporting outcomes. This article provides updated vision screening recommendations for pre-school-age children (aged 3 to <6 years) in the United States.PURPOSE:The goal of vision screening programs is to identify, refer, and help ensure eye examinations for children who may have vision disorders, such as significant uncorrected refractive errors, amblyopia, strabismus, reduced visual acuity, and other vision and eye health problems. This article provides an update to the 2015 recommendations for vision screening in pre-school-age children in the United States, which were developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness.METHODS:Recommendations for vision screening for pre-school-age children were developed by the NCCVEH and published in 2015. The updated recommendations in this article were developed through a targeted literature review (PubMed and Science Direct) and expert opinion from the committee, which approved the final recommendations.RESULTS:The committee recommends that vision screening programs have follow-up systems to ensure that referred children receive comprehensive eye examinations. In addition, screening programs should consist of observation, threshold or critical line (age-specific minimal acuity line to pass) distance visual acuity, binocular critical line near visual acuity, and stereopsis, all of which should be performed annually. Instrument-based screening may be used in place of distance visual acuity and stereopsis, though additional research is needed to guide the recommendation for specific devices.CONCLUSIONS:The NCCVEH recommends that children aged 3 to <6 years have their vision screened annually to identify potential eye health and vision disorders. These updated vision screening recommendations provide lay screeners with a standardized approach for detecting vision problems and ensuring timely intervention and treatment. The NCCVEH will continue to provide vision screening updates at http://nationalcenter.preventblindness.org.

Amblyopia affects up to 5% of all children and is the leading cause of monocular blindness in nonelderly adults.1 Because the effectiveness of treatment improves with early detection,2 preschool vision screening is widely endorsed.3,4 Unfortunately, the rate of vision screening is low in the primary care practice setting5,6 because of the difficulty of screening young children, lack of experience with the screening tests, and the high number of false positives associated with vision screening. Some communities have programs that offer vision screening to preschool children either by advocacy groups such as Prevent Blindness America and Lions clubs or local public health departments. Little is known about either the scope or effectiveness of community screening efforts for amblyopia. Because of the importance of early treatment for amblyopia and concerns about the low rate and questionable quality of preschool vision screening, the American Optometric Association recommends that all children have a complete eye examination at 6 months and then again at 3 years of age.7In this month’s Pediatrics, König and Barry8 present a cost-utility analysis of vision screening based on data collected in Germany. Their findings suggest that screening young children by orthoptists, trained specialists in the diagnosis and treatment of common types of visual impairment, has a reasonable cost per additional quality-adjusted life year compared with “usual care.”König and Barry’s results are based on statistical models that assume a certain loss of utility due to amblyopia. Amblyopia may adversely affect any activity that requires depth perception and may impact long-term educational attainment. However, there are no high-quality data to quantitatively assess the loss of utility.9 Instead, König and Barry based utility assessment on findings from adults with unilateral visual impairment. This may overstate the harm of amblyopia, because it does not consider compensatory mechanisms that individuals with amblyopia may develop; conversely, it may underestimate the harm caused by a lifetime of impairment leading to subtle declines in educational attainment. Assessing utilities is critical to ensuring robust cost-effectiveness models, but it is unclear how this could be done. Currently, there are no reliable means to assess utilities from young children; adults with amblyopia have never had normal vision and may not properly ascribe the harm of amblyopia, whereas adults with later onset of monocular vision loss have different experiences than those with amblyopia. There is a pressing need to develop a better understanding of the harm of amblyopia to ensure that screening efforts reflect the true potential benefit of early intervention.Finally, 2 factors must be considered before applying these results to the United States. First, the supply of orthoptists in the United States is insufficient to implement the program outlined in the study; other vision care providers would need to be included in screening efforts. Second, German children begin kindergarten at age 3, which eases the cost and logistic burden of early mass-screening outreach efforts. Despite these limitations, this study provides a useful and important framework for developing vision-screening policy.“Confusion caused by relative risks can be avoided by using absolute risks (such as one in 1000) or the number needed to treat or to be screened to save one life (the NNT, which is the reciprocal of the absolute risk reduction and is thus essentially the same representation as the absolute risk). However, health agencies typically inform the public in the form of relative risks. Health authorities tend not to encourage transparent representations and have themselves sometimes shown innumeracy, for example when funding proposals that report benefits in relative rather than absolute risks because the numbers look larger. For authorities that make decisions on allocation of resources the population impact number (the number of people in the population among whom one event will be prevented by an intervention) is a better means of putting risk into perspective.”Gigerenzer G, Edwards A. Simple tools for understanding risks. Br Med J. 2003;327:741–744Submitted by Student

1. Luis H. Ospina, MD* 1. *Assistant Professor, Pediatric Ophthalmology and Neuro-ophthalmology, Ste-Justine Hospital, University de Montreal, Montreal, Quebec, Canada After completing this article, readers should be able to: 1. Recognize cortical visual impairment (CVI) as an important cause of pediatric visual loss. 2. Identify the most frequent causes of pediatric CVI and, more specifically, understand the role of hypoxia as a cause of central visual damage. 3. Describe the different patterns and implications for future vision of hypoxic central visual damage occurring in preterm compared with term babies. 4. Know the clinical signs suggestive of CVI in children. 5. Discuss the involvement of visual functions other than visual acuity (ie, cognitive visual aspects) in CVI and correlate them with the likely affected neuroanatomic substrates. 6. Explain the value of using a multidisciplinary approach in rehabilitating children who have CVI early in their development. Vision loss caused by central nervous system damage often is referred to as CVI but also may be referred to as cerebral visual impairment or neurologic visual impairment. These terms refer to the fact that the primary defect may not necessarily be limited to the striate (primary visual) cortex and may affect other areas subserving vision, such as the visual associative cortex, optic radiations, and visual attention pathways. Although it is not yet certain which of these three terms best describes the visual deficit, it is clear that use of the label cortical blindness must be abandoned. That term not only evokes negative connotations for the child and the family but is inaccurate because in almost every instance, some degree of residual vision remains, and visual improvement can occur. CVI has become the greatest cause of pediatric visual impairment in developed countries (1)(2)(3)(4)(5) and is becoming increasingly prevalent in developing nations. CVI is a problem of increasing frequency for two primary reasons. First, the progress in neonatal care has resulted in improved survival of …

Seeing and Hearing: The Impacts of New York Cityys Universal Prekindergarten Program on the Health of Low-Income Children

Risk factors for failure in the newborn hearing screen test in very preterm twins