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PubMed1997

Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing.

OBJECTIVE: To test a hypothesis of no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood. DESIGN: Follow up of eight to nine year old children born to women who participated in a randomised controlled trial on ultrasound screening during pregnancy. SETTING: Nineteen antenatal care clinics run by three central hospitals in Sweden from 1985 to 1987. POPULATION AND METHODS: Of 4637 eligible singleton pregnancies, 3265 (71%) were followed up through a questionnaire sent to their mothers. Analyses were performed both according to randomised groups and to ultrasound exposure. MAIN OUTCOME MEASURES: Parents' report of vision and hearing tests as recorded on child's record card. Parents' report of their child's weight and height at 1, 4 and 7 years of age. RESULTS: Reduced hearing was reported by 3.4% in the screening group compared with 3.5% in the nonscreening group (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.67-1.41). The same prevalences were found when analysed according to ultrasound exposure (OR 1.0; 95% CI 0.67-1.42). Reduced vision was reported by 6.3% in the screening group compared with 7.8% in the nonscreening group (OR 0.8; 95% CI 0.60-1.03). Corresponding figures for ultrasound exposed and unexposed were 6.2% and 8.0%, respectively (OR 0.8; 95% CI 0.58-1.00). No statistically significant differences in body weight or height at 1, 4 or 7 years of age between screened and not screened children or between exposed and unexposed were found. CONCLUSION: This study found no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.

Adult↗
PubMedDate not supplied

When should children have their eyes checked?

Timely screening for the early detection of eye and vision problems in children is vital to avoid lifelong visual impairment. Early detection provides the best opportunity for effective treatment. Organizations devoted to the health and well-being of children have issued recommendations or policy statements regarding the timing of eye screenings and examinations. The American Academy of Pediatrics (AAP), American Association of Pediatric Ophthalmology and Strabismus (AAPOS), American Academy of Ophthalmology (AAO), American Association of Certified Orthoptists (AACO), and the American Academy of Family Physicians (AAFP) recommend screening at birth and all well-child visits. The American Optometric Association (AOA) recommends that vision examinations begin at 6 months of age. All children found to have an ocular abnormality or who fail vision assessment should be referred to an eye care specialist trained to treat pediatric patients.

Age Factors↗
PubMed2003

Eye examination in infants, children, and young adults by pediatricians.

Early detection and prompt treatment of ocular disorders in children is important to avoid lifelong visual impairment. Examination of the eyes should be performed beginning in the newborn period and at all well-child visits. Newborns should be examined for ocular structural abnormalities, such as cataract, corneal opacity, and ptosis, which are known to result in visual problems. Vision assessment beginning at birth has been endorsed by the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology. All children who are found to have an ocular abnormality or who fail vision assessment should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients.

Adolescent↗
PubMed2000

Use of psychoactive drugs and related falls among older people living in a community in Brazil.

INTRODUCTION: Population aging in Brazil has increased the prevalence of neurodegenerative diseases (Parkinson's and Alzheimer's disease) and affective disorders (anxiety, depression), all common in old age. A retrospective study was carried out with the purpose of ascertaining if there is an association between falls and psychoactive medication use among older residents of a community in Brazil. METHODS: All residents aged 65+ (n=161) of one neighborhood of Campo Belo, Brazil (population of 48,000) were evaluated regarding the use of psychoactive drugs and the occurrence of falls in the 12 months preceding the study. Vision and hearing screenings were also performed. RESULTS: From the study population, 9.3% were taking prolonged half-life benzodiazepines, 4.4% anticonvulsants (mostly barbiturates), 2.5% antidepressants (all cyclics) and 8.1% alpha-methyldopa. No subject reported use of hypnotics, neuroleptics or drugs to treat Alzheimer's or Parkinson's diseases (except biperiden). As a whole, drugs that increase the risk of falls were used by 1/5 of this population. In the 12-month period preceding the study, 27 residents (16.8%) experienced falls and, of those, 4 (14.8%) had fracture(s). There was an independent association between psychoactive drug use and falls when variables such as age, gender, vision and hearing were controlled (p=0.02). CONCLUSIONS: Although the population of this neighborhood must be considered young (only 4% are 65 years old or more), there are already problems related to the use of psychoactive drugs among people. Prescribed anxiolytics, anticonvulsants, antidepressants and antihypertensives are not appropriate for this age group and their use is associated with falls.

Accidental Falls↗
PubMed2005

Vision needs of people with intellectual disability in residential facilities and community-based homes for independent living.

PURPOSE: The purpose of this study is to assess the visual problems of people with intellectual disability in residential and community-based facilities. METHOD: A purposive sample of 146 male and female adults, aged 21 and older, living in residential facilities and community-based homes in the southern region of Israel was used to assess and compare vision problems. RESULTS: Among those screened, 77% were found to have a visual problem. Only astigmatism was found to differentiate the two groups. Those living in the community, particularly men, were more likely to have astigmatism. CONCLUSIONS: Addressing the eye care needs of people with intellectual disability is a difficult process. People with intellectual disability, however, need ophthalmological and optometric screening to determine whether they can benefit from such intervention, including cataract removal and eyeglasses, to improve their quality of life.

Adult↗
PubMed2006

Ophthalmology resident surgical competency: a national survey.

PURPOSE: To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. DESIGN: Fourteen-question written survey. PARTICIPANTS: Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. METHODS: Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. MAIN OUTCOME MEASURES: Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. RESULTS: One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. CONCLUSIONS: The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Career Choice↗
PubMed1981

Pediatric-based assessment: children with school problems.

Twenty-one children with school problems underwent pediatric assessment within a university hospital primary care clinic. Assessment included history-taking facilitated by parent and teacher questionnaires, physical examinations, vision and hearing screening and neurodevelopmental examination. For 11 of the children, psychoeducational assessment was also obtained. Parent and school personnel were interviewed 2 to 6 months following assessment to determine implementation rates for recommendations. Overall, 66% of parent recommendations were implemented, including 72% of medical, 58% of mental health and 64% of educational recommendations. Seventy-two percent of school recommendations were implemented. Interdisciplinary evaluation as compared to pediatric-based assessment alone resulted in a greater number of recommendations generated (p less than .05) and a higher percentage of school recommendations implemented (p less than .01). Implementation rates for school recommendations were greater for young children (p less than .01). This study supports the usefulness of pediatric-based assessments for school problems and documents the advantages of an interdisciplinary approach to such children.

Child↗
PubMed1999

The visual physiology of the wild type mouse determined with pattern VEPs.

Genetically manipulated mice are important tools for studies on plasticity and degeneration/regeneration in the visual system. However, a description of the basic properties of the visual performance of the wild type mouse is still lacking. To characterize the visual physiology of the wild type (C57BL/6J) mouse we recorded Visual Evoked Potentials (VEPs) from the primary visual cortex. As compared to behavioral methods, VEPs may have the advantage that different aspects of vision can be screened readily and simultaneously in the same animals, including those with poor visual behavior due to motor or learning deficits. Local VEP responses to patterned visual stimuli have been recorded from the binocular visual cortex of anesthetized mice. Spatial (visual acuity, contrast threshold) and temporal (temporal function, response latency, motion sensitivity) aspects of VEPs were evaluated. The mouse VEP acuity was 0.6 c/deg, which is comparable to the behavioral visual acuity. The VEP peak contrast threshold was 5% (no behavioral data are available). Cortical representation of visual coordinates and cortical magnification factor corresponded to those previously reported using single cell recordings. Laminar analysis of VEPs indicated a dipole source in the supragranular layers of the visual cortex as a major response generator. VEPs showed contribution from both eyes, although biased strongly towards the eye contralateral to the recorded cortex. Results provide a comprehensive framework for characterizing visual phenotypes of a variety of transgenic mice.

Animals↗
PubMed2005

Effects of age and auditory and visual dual tasks on closed-road driving performance.

PURPOSE: This study investigated how driving performance of young and old participants is affected by visual and auditory secondary tasks on a closed driving course. METHODS: Twenty-eight participants comprising two age groups (younger, mean age = 27.3 years; older, mean age = 69.2 years) drove around a 5.1-km closed-road circuit under both single and dual task conditions. Measures of driving performance included detection and identification of road signs, detection and avoidance of large low-contrast road hazards, gap judgment, lane keeping, and time to complete the course. The dual task required participants to verbally report the sums of pairs of single-digit numbers presented through either a computer speaker (auditorily) or a dashboard-mounted monitor (visually) while driving. Participants also completed a vision and cognitive screening battery, including LogMAR visual acuity, Pelli-Robson letter contrast sensitivity, the Trails test, and the Digit Symbol Substitution (DSS) test. RESULTS: Drivers reported significantly fewer signs, hit more road hazards, misjudged more gaps, and increased their time to complete the course under the dual task (visual and auditory) conditions compared with the single task condition. The older participants also reported significantly fewer road signs and drove significantly more slowly than the younger participants, and this was exacerbated for the visual dual task condition. The results of the regression analysis revealed that cognitive aging (measured by the DSS and Trails test) rather than chronologic age was a better predictor of the declines seen in driving performance under dual task conditions. An overall z score was calculated, which took into account both driving and the secondary task (summing) performance under the two dual task conditions. Performance was significantly worse for the auditory dual task compared with the visual dual task, and the older participants performed significantly worse than the young subjects. CONCLUSIONS: These findings demonstrate that multitasking had a significant detrimental impact on driving performance and that cognitive aging was the best predictor of the declines seen in driving performance under dual task conditions. These results have implications for use of mobile phones or in-vehicle navigational devices while driving, especially for older adults.

Adult↗
PubMed2000

Touch feel illusion in schizophrenic patients.

BACKGROUND: The rubber hand illusion is a tactile sensation referred to as an alien limb. The illusion has been explained by a spurious reconciliation of visual and tactile inputs reflecting functional connectivity in the brain and was used to explore alterations of functional connectivity in schizophrenia. METHODS: The rubber hand illusion was achieved when two paintbrushes simultaneously stroke the hand of the subject hidden from vision by a screen, as well as an artificial hand placed in view of the subject. The rubber hand illusion was assessed with a questionnaire affirming or denying the occurrence of the illusion. RESULTS: Schizophrenic subjects felt the illusion stronger and faster then did normal control subjects. Some rubber hand illusion effects correlated with positive symptoms of schizophrenia but not with negative symptoms. CONCLUSIONS: Altered functional integration of environmental inputs could constitute the basis for erroneous interpretations of reality, such as delusions and hallucinations.

Adult↗
PubMed1988

Disorders of attention and vigilance.

Attention deficit hyperactivity disorder has gone through multiple name and criterion changes over the last 10 years. It is still viewed as the most common neurobehavioral disorder in the pediatric age group. Diagnostic criteria, as outlined by the DSM III-R, have, as primary diagnostic features of ADHD, inattention, impulsivity, and hyperactivity. There are no diagnostic tests that will absolutely confirm this disorder. Many questionnaires have been devised to help organize and systematize the evaluation. Vision and hearing screening, physical examination, and the neurologic examination are important to exclude other causes for hyperactivity and impulsivity. There are no routine laboratory or specialized tests that are useful in the diagnosis of ADHD. When psychologic testing is deemed necessary, specific areas to study would include discrepancies in the performance and verbal IQ (possibly indicating further testing needed to rule out learning disabilities) and difficulties in the coding portion of the examination, which might point to attentional difficulties. Educational testing can further complete an evaluation when needed. Management of children with ADHD involves multimodal treatment, including educational, behavioral, and possibly pharmacologic intervention. Pharmacotherapy can be a useful adjunct in treating these children. The psycho-stimulants continue to be the first-line medication in treatment, although investigators have studied other drugs. Once the diagnosis has been made and a child has been placed on the multimodal treatment, he should be carefully followed. This disorder does not disappear at the time of puberty, as once was thought, but instead continues to cause problems through adolescence.

Attention Deficit Disorder with Hyperactivity↗
PubMed1986

Ill health and use of medical care. Community-based assessment of morbidity in children.

The purpose of this study was to assess the relationship between morbidity and ambulatory care utilization in a randomly selected sample of children with stable patterns of use of services in a prepaid multispecialty group practice. The unique features of the approach were a focus on long-term relationships (over 8 years) and on assessment of health status by a combination of parent reports, child reports, teacher reports, and physical examination. Domains of health status that were assessed included types and frequencies of health conditions and disability associated with them, functional status (physical health, mental health, social health, general well-being), school absence, vision and hearing screening, and physical abnormalities. Children with persistently high levels of use of services in a 6-year period (1974-79) were more likely to have health problems of all types, both concurrent and in a subsequent 2-year period (1980-81) than children with lower levels of use. As these findings were in agreement with those obtained in a study where morbidity was determined by diagnoses recorded in medical records, it is likely that the measures could be more generally useful to assess child health status in the community. Moreover, they distinguish groups of children who differ in their pattern of use of services and hence may be useful in the planning and budgeting of services for child populations.

Ambulatory Care↗
PubMed1988

Physiological variables affecting intraocular pressure in a population study.

Intraocular pressure (IOP) and several other parameters were measured on 560 subjects as part of a vision and health screening program. The sample included a large proportion of American Indians with diabetes (15.2%) and obesity. Multiple regression analysis showed that the percentage of ideal body weight index and average blood pressure both had independent effects on IOP, whereas age, blood sugar, sex, degree of Indian blood, and diabetes did not, although the latter three variables narrowly missed having a statistically significant effect in at least one eye. The analysis of variance showed that diabetes was associated with elevated IOP. This association was independent of random blood sugar, blood pressure, obesity index, and age.

Adolescent↗
PubMedDate not supplied

Community health nursing assessment of neurodevelopment in high-risk infants.

All infants discharged from designated perinatal center neonatal intensive care units in Illinois are referred for follow-up home visits by community health nurses. These visits provide parental support, teaching, and anticipatory guidance plus physical and developmental assessment of the infant. The maternal and child nursing consultants who coordinate this follow-up program are frequently called upon to assist the community health nurses in physical/developmental assessment techniques. The neurodevelopmental component of the assessment, including areas of alertness, tone, head circumference, vision and hearing screening, plus primitive reflexes, is described.

Attention↗
PubMed2002

Parent knowledge and opinions of school health services in an urban public school system.

Health services, provided through schools for more than 100 years, increasingly have expanded to meet preventive as well as acute health care needs of children. This article reports on a survey of parents of third-grade children in an urban public school system. The authors examined what parents know about school health services, what value they place on the services, and what barriers exist to health care access. Results indicated parents place a high value on health services offered in schools, but they know little about service availability and use. Parents often were unaware their children received many of the services listed, such as review of school health records, vision and hearing screening, and health education by school nurses.

Attitude to Health↗
PubMed1996

Barriers to preventive health services for minority households in the rural south.

Health values, behaviors, and status are shaped by place of residence, region, race, and socio-economic status, among other social factors. Consequently, this article examines barriers to preventive health services for lower-income blacks in five rural counties in Georgia. Qualitative and quantitative data were collected through 281 household, 51 community leader, and six focus group interviews. Female respondents who had been pregnant were most likely to have received pregnancy-related services and all respondents least likely to have received vision and dental screenings. Six of the seven types of services inquired about were most likely to have been received in a private practice setting. Primary barriers to preventive service utilization included ability to pay, perception of need, service availability, accessibility of services, and the perception of racism. The relationship between structural and nonstructural barriers, their impact on preventive service utilization, and research recommendations also were developed and presented.

Adaptation, Psychological↗
PubMed1984

Testing of colour vision for vocational purposes.

All red-green defects of colour vision can be effectively screened with a combination of two pseudo- isochromatic tests. Severe (major) colour vision defects regarded as a serious handicap in all occupations needing colour naming ability can be quickly detected with the Panel D-15 dichotomous test. Only a trained ophthalmologist can make the detailed estimation of the type and degree of the colour vision defect with the aid of the anomaloscope and the Farnsworth-Munsell 100-hue test. In the diagnosis of a congenital colour vision defect the exclusion of an eye disease with a consecutive acquired colour vision defect is important.

Color Perception Tests↗