Reach and uptake of mass drug administration for worm infections through health facility-, school-, and community-based approaches in two districts of Zambia: a call for scale-up

Helminthiases cause significant health deficiencies among children. Mass administration of anthelminthic drugs has had significant results to counter these effects. We assessed the effects on and determinants of treatment coverage of community-directed treatment among children in Zambia, using cross-sectional survey data, and using chi-square test and multilevel mixed-effects model. Of 1,416 children, 51.5% were males and 48.5% were females, while 52.7%, were school-age, and 47.3% were preschool-age. Overall treatment coverage was 53.7% (95% confidence interval (CI) 51.1, 56.4). More preschool-age children were treated compared to school-age ones, 65.2% versus 43.4%, P < 0.001. Similarly, more children under community-directed intervention were treated compared to regular mass drug administration (65.2% versus 51.1 %, P < 0.001). Treatment among school-age participants was associated with being male (Adjusted Odds Ratio (AOR 1.83, 95%CI 1.23-2.72), receiving community-directed treatment (AOR 5.53; 95%CI 3.41-8.97), and shorter distance to health facility (AOR 2.20; 95%CI 1.36-3.56). Among preschool-aged participants, treatment was associated with being residents of Siavonga district (AOR 0.03; 95%CI 0.01-0.04) and shorter distance to health facility (AOR 0.35; 95%CI 0.21-0.59). Community-directed treatment can be used to increase treatment coverage, thereby contribute to 2030 vision of ending epidemics of neglected tropical diseases.

Academic Challenges in Developmental Coordination Disorder: A Systematic Review and Meta-Analysis

AIMS

Developmental Coordination Disorder (DCD) is a chronic condition affecting motor coordination in daily activities. While motor difficulties are well documented in this population, it is unclear how frequent and to what extent academic activities are affected. This systematic review aims to comprehensively summarize the knowledge regarding the prevalence and extent of academic difficulties in reading, writing and mathematics in school-aged children with DCD.

METHODS

Two independent reviewers analyzed original studies on academic difficulties in school-aged children with DCD. A binary random-effects model was used to calculate the pooled prevalence by academic difficulty. A random-effects model using standardized mean differences (g statistic) was calculated to estimate the extent of the academic difficulties.

RESULTS

Twenty-four studies were included. A pooled prevalence of 84% of handwriting difficulties and 89.5% of mathematical difficulties was reported. No pooled prevalence of difficulties could be calculated for the other academic outcomes. Children with DCD present with poorer performance in handwriting legibility (g = -1.312) and speed (g = -0.931), writing (g = -0.859), mathematics (g = -1.199) and reading (g = -1.193).

CONCLUSIONS

This review highlights the high frequency and severity of academic difficulties in children with DCD, specifically in mathematics, which stresses the importance of evaluating academic performance to target interventions to support optimal functioning in daily life.

Sugar-Sweetened Beverages and Symptom Complaints among School-Aged Children: A National Longitudinal Study

The association between sugar-sweetened beverages (SSBs) and symptom complaints among school-aged children remains unclear. Children aged 6−17 years (n = 29,028) were recruited on the basis of a national school-based study. Data collection included two waves: the exposure was the amount and frequency of SSB consumption, collected in the 2013 autumn semester, and outcomes were defined as having clinical symptom complaints after two weeks of observation, collected in the 2014 spring semester. Symptom complaints were defined as fever, cough, headache, loose bowels, vomiting, sore throat, rash, conjunctival congestion, and stomachache. The associations between the amount/frequency of SSBs and symptoms complaints were explored by a general linear model, with adjustments made for socio-demographic and other lifestyle information. Among the 12,454 children (10.32 ± 3.15 years, 48.7% male) in the final analysis, the odds ratio for having symptom complaints (1.46, 95% CI: 1.10−1.95) among children whose SSB consumption was >75 mL/day was significantly higher than that among children who had no SSB consumption. Among children with a daily SSB intake of more than 75 mL, there was a higher risk for symptom complaints. We recommend more support for decreasing SSB consumption among children to minimize negative health outcomes.

A systematic review of the academic achievement of primary and secondary school-aged students with developmental language disorder

BACKGROUND AND AIMS

The ability to communicate is a fundamental skill required to participate in school. Students with Developmental Language Disorder (DLD) have persistent and significant language difficulties that impact daily functioning. However, the impact of DLD on the academic achievement of primary and secondary school-aged students has received limited attention.

METHODS

A systematic review of the empirical research published between 2008 and 2020 was undertaken to identify studies that have examined the academic achievement of school-aged students with DLD within curriculum areas. A total of 44 studies were identified that met inclusion criteria for review.

RESULTS

Students with DLD demonstrated difficulties with academic achievement across all measured curriculum areas compared to their typically developing peers. Most studies focused on literacy skills, including reading, spelling, writing and narratives.

CONCLUSIONS AND IMPLICATIONS

The performance of students with DLD was heterogeneous with individual students demonstrating relative strengths in some areas of academic achievement. The implications of these results for educational practices and future research are discussed.

Cross-Sectional and Longitudinal Associations between 24-Hour Movement Behaviours, Recreational Screen Use and Psychosocial Health Outcomes in Children: A Compositional Data Analysis Approach

It remains unclear whether the time-use composition of 24-h movement behaviours (sleep, sedentary time (ST), physical activity (PA)) and recreational screen use are independently associated with psychosocial health. This study examined the cross-sectional and longitudinal associations between 24-h movement behaviour composition, recreational screen use and psychosocial health outcomes in children. Measures completed at baseline (n = 127; 11.7 years) and follow-up (n = 88; 12.8 years) included accelerometer-based 24-h movement behaviours, self-reported recreational screen use and psychosocial health (Strengths and Difficulties Questionnaire, Kessler’s Psychological Distress Scale). Linear mixed models were used to examine the cross-sectional and longitudinal associations between the 24-h movement behaviour composition and recreational screen use levels with psychosocial health outcomes. Overall, the movement behaviour composition (p < 0.05) and recreational screen use levels (p < 0.01) were both cross-sectionally but not longitudinally associated with psychosocial health outcomes. Relative to other behaviours, sleep was negatively associated, while light-intensity PA was positively associated with internalising problems and total difficulties scores. ST was positively associated with internalising problems. High levels of recreational screen use (>2 h/day) were associated with greater externalising problems, total difficulties scores and psychological distress. These findings reinforce the importance of achieving a balance between different types of movement behaviours over a 24-h period for psychosocial health.

Metabolic Syndrome: Prevalence and Risk Factors among Adolescent Female Intermediate and Secondary Students in Saudi Arabia

Background: Metabolic syndrome (MS) has become one of the major challenges to public health worldwide due to its significant association with increased risk of developing type 2 diabetes and cardiovascular disease (CVD) among children and adolescents. Therefore, this study aims to determine the prevalence and risk factors of MS in Saudi adolescents. Methods: This cross-sectional study was conducted in two female National Guard schools (Um Kalthoom Intermediate School and Zainab Bint Jahsh Secondary School) in Jeddah, Saudi Arabia, between January 2018 and March 2018. Of the 808 female students, 172 (age range of 12–19 years) participated voluntarily, with consent from their guardian(s), fasted for at least 8 h prior to the study, and represent the final study sample. Male students were not included due to cultural constraints in conducting the study. Demographic data, physical measurement (blood pressure, weight, height, body mass index (BMI) and waist circumference (WC)), and biochemical measurement (fasting plasma glucose and triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein) were obtained. The International Diabetes Federation (IDF) criteria was utilized in the diagnosis of MS. Results: Of the 172 female adolescents, 24 (13.75%) are overweight, 20 (11.63%) are obese, and 3 (1.74%) are underweight. High-fasting plasma glucose (n = 85, 49.41%) and high waist circumference (n = 74, 43.02%) were the most common risk factors of MS among female adolescents. The overall prevalence of MS was 7% (n = 12/172). MS is more common among those who are obese or among those with a BMI that falls at the ≥95th percentile (n = 6/20, 30.0%) (p < 0.05) as compared to those who are overweight with a BMI that falls within the 85th to <95th percentiles (n = 2/24, 8.33%). Interestingly, 3.20% of the sample (n = 4/125) with normal BMI were diagnosed with MS. Conclusions: Our study indicates that MS is common among obese and overweight female adolescents but is also present among those who are not obese or with normal BMI. Moreover, the prevalence of overweight, obese, and those with MS in this reference population are lower compared to the cities of Makkah and Riyadh; however, it varies widely around the world due to different criteria and cut-off values in the diagnosis of MS.

Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management

OBJECTIVE

To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes.

STUDY DESIGN

A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015. Electronic health record data were abstracted for a 20% random sample of 292 patients.

RESULTS

Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more frequently exhibiting deficits than their younger counterparts (67.9% vs 53.2%; P = .03). Almost all patients (95.9%) reported at least 1 somatic symptom (eg, headache, dizziness), and one-half to two-thirds reported problems with sleep (54.1%) and visiovestibular symptoms (66.1%). Only 11.6% of children were referred for rehabilitation therapies and less than one-half of concussed patients (43.8%) were provided with a letter recommending school accommodations.

CONCLUSIONS

Somatic symptoms, sleep problems, and visiovestibular deficits are common in elementary school-aged children with concussion, but specific visiovestibular clinical assessments are often not performed, particularly in the emergency department setting. Recommendations for school accommodations are often not provided at the time of concussion diagnosis. Incorporating a standardized visiovestibular assessment into practice could facilitate early targeted school accommodations and thereby improve return to learning for elementary school-aged children with concussion.

Associations of Heart Rate Measures during Physical Education with Academic Performance and Executive Function in Children: A Cross-Sectional Study

The current evidence for a relation between children’s heart rate measures and their academic performance and executive functioning is infancy. Despite several studies observing dose-response effects of physical activity on academic performance and executive function in children, further research using objective measures of the relative intensity of physical activity (e.g., heart rate) is warranted. The present study aimed to inspect associations between heart rate response and various academic performance indicators and executive function domains. A total of 130 schoolchildren between the ages of 9 and 13 years (M = 10.69, SD 0.96 years old; 56.9% boys) participated in a cross-sectional study. Children’s heart rate data were collected through participation in physical education classes using the polar Team^TM hardware and software. One week before heart rate measures, academic performance was obtained from the school records in maths, Spanish language, Catalan language, physical education, and Grade point average. Executive function was measured by two domains, cognitive flexibility with the Trail Making Test and inhibition with the Stroop test. Associations between children’s heart rate data and academic performance and executive function were analyzed using regression models. Academic performance was found to be positively related to four heart rate measures (β range, 0.191 to 0.275; all p < 0.040). Additionally, the hard heart rate intensity level was positively related to two academic indicators (β range, 0.183 to 0.192; all p < 0.044). Three heart rate measures were associated with two cognitive flexibility subdomains (β range, −0.248 to 0.195; all p < 0.043), and three heart rate measures were related to one inhibition subdomain (β range, 0.198 to 0.278; all p < 0.028). The results showed slight associations of heart rate responses during physical education lessons with academic performance but did not clearly indicate associations with executive function. Future experimental studies testing associations between different bouts of intensity levels are needed to disentangle the relationship with brain function during childhood.

Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain)

The sagittal spinal morphology presents 4 physiological curvatures that increase endurance to axial compression forces and allow adequate postural balance. These curves must remain within normal ranges to achieve a static and dynamic balance, a correct functioning of the muscles and an adequate distribution of the loads, and thus minimize the injury risk. The purpose of this study was to categorize the sagittal spinal alignment according to the different morphotypes obtained for each curve in standing, slump sitting, and trunk forward bending positions in schoolchildren. It was a cross-sectional study. Sagittal spinal curvatures were assessed in 731 students from 16 elementary schools. In the sagittal standing position assessment, 70.45% and 89.06% of schoolchildren presented a “normal” morphotype for both dorsal and lumbar curves, respectively. After the application of the “Sagittal Integral Morphotype” protocol according to the morphotypes obtained in the three positions assessment (standing, slump sitting, and trunk forward bending), it was observed how the frequency of normal morphotypes for the dorsal and lumbar curve decreased considerably (only 32% and 6.6% of children obtained a “normal sagittal integral morphotype” for the thoracic and lumbar curvatures, respectively). These results show how it is necessary to include the slump sitting and trunk forward bending assessment as part of the protocol to define the “integral” sagittal alignment of the spine and establish a correct diagnosis. The use of the diagnostic classification presented in this study will allow early detection of misalignment not identified with the assessment of standing position.

Community Characteristics, Victimization, and Psychological Adjustment Among School-Aged Adopted Children With Lesbian, Gay, and Heterosexual Parents

Little research has examined victimization among school-aged children raised in lesbian/gay (LG) parent households and almost no work has attended to the school and community contexts that may impact their victimization risk. This study examined predictors of parent-reported child victimization and child adjustment, and parent responses to victimization, in 43 two-mother, 37 two-father, and 56 mother–father families, with adopted children (median age = 8.6 years). Predictors included parent (sexual orientation), school (climate, public versus private) and community (urbanicity, percentage voted Democrat) factors, with parent and child demographics included as controls. A total of 47% of parents reported one or more child victimization experiences in the past year; there were no differences by family type. An exploratory interaction between family type and urbanicity indicated that in large urban areas, children with LG parents were predicted to experience less victimization than children with heterosexual parents; in more rural regions, children with LG parents were predicted to experience more victimization than children with heterosexual parents. School climate was related to victimization: Parents who reported more negative school climate reported more child victimization. Children with higher levels of parent-reported victimization had higher levels of parent-reported internalizing and externalizing symptoms. In large urban areas, children with LG parents were predicted to have fewer internalizing symptoms than children with heterosexual parents; in more rural areas, children with LG parents were predicted to have more internalizing symptoms than children with heterosexual parents. Regarding parents’ responses to victimization, LG parents were more likely to talk to school administrators, their children, and the bully, compared to heterosexual parents.

Validation of the Chinese Version of the Children's ChronoType Questionnaire (CCTQ) in school-aged children

The Children's ChronoType Questionnaire (CCTQ) is a valid and reliable measure for assessing prepubertal children aged 4-11 years. The CCTQ is a parent-reported, 27-item questionnaire consisting of sleep-wake parameters for scheduled and free days (16 items), a morningness/eveningness scale (M/E, 10 items), and a five-point, single-item, chronotype score. The CCTQ has been translated into different languages, but a Chinese version is not available. In the present study, we aimed to produce a Chinese version of the CCTQ and test its validity and reliability on school-aged children. A total of 555 children aged 7-11 years were recruited from five primary schools. The parents were told to complete the CCTQ and record their child's sleep pattern in a 7-day sleep diary. Sixty-six children and their parents were invited to participate in determining the test-retest reliability of the CCTQ over a 2-week interval, and their sleep patterns were assessed using a sleep diary. The internal consistency of the Chinese CCTQ M/E score as measured by Cronbach's alpha was acceptable (0.74). Regarding the test-retest reliability of the instrument, moderate to strong Spearman's correlation coefficients were found for most of the CCTQ - sleep-wake items (ρ = 0.52-0.86) and for the CCTQ-M/E total score (ρ = 0.78). For the concurrent validity, Spearman's correlations between the sleep-wake parameters of the CCTQ and the sleep diary were moderate to high on both the scheduled days (ρ = 0.54 to 0.87) and free days (ρ = 0.36 to 0.60). For the correlations measured with actigraphs, significant correlations were found in the CCTQ sleep-wake parameters, including bedtime, get-up time, sleep latency, sleep period, time in bed, and mid-sleep point on both the scheduled (ρ = 0.31 to 0.76) and free days (ρ = 0.27 to 0.52), but not in sleep latency and sleep period on free days. The results of the present study suggest that the Chinese version of the CCTQ is a reliable and valid tool for assessing chronotypes in Chinese school-aged children in Hong Kong.

Stepping It Up: Walking Behaviors in Children Transitioning from 5th to 7th Grade

The purpose of this study was to (1) describe children's walking behaviors in 5th to 7th grade and change over time and (2) examine associations between walking behaviors and Walk Score®. Participants consisted of n = 586 students from the Transitions and Activity Changes in Kids (TRACK) Study. Children reported any walking behavior (e.g., exercise and transportation) over the past five days. Walk Score was calculated based on children's home address. Descriptive statistics summarized walking behaviors by gender and time, and repeated measure mixed models examined the relationship between walking behaviors and Walk Score. Approximately 46.8% and 19.2% of 5th grade children reported walking for exercise and transportation, respectively, and these percentages declined through 7th grade. Girls reported higher levels of total walking behavior and walking for exercise than boys (p < 0.001). Girls with a higher Walk Score had 63% higher odds of reporting walking for transportation than girls with a lower Walk Score (OR = 1.63, 95% CI = 1.02, 2.62). Walking behaviors among children were infrequent with significant declines over time, and of the nine associations examined with Walk Score, only one was significant. Efforts should prioritize frequent walking behavior and community design to increase children's physical activity.

Neurocognitive Function of School-aged HIV-infected Children in Enugu, Nigeria

BACKGROUND

Evidence has shown neurocognitive problems often exist among human immunodeficiency virus (HIV)-infected children. There are limited data for children in Nigeria.

METHODS

This was a cross-sectional study of 100 school-aged perinatally HIV-infected children seen in the paediatric HIV clinic and age/sex-matched controls from the general paediatric clinic. Neuro-cognitive functioning was assessed using the Raven's progressive matrices (RPM) that has been adapted for the Nigerian population.

RESULTS

The mean RPM score of subjects was 22.97 ± 11.35 compared with 32.93 ± 15.71 among controls (p < 0.001). Twenty-two percent of subjects in the HIV-infected group vs. 56% of controls were in the above-average intelligence group on the RPM. Thirty-four percent had average scores, while 22% were in the below-average scoring range. Neuro-cognitive functioning of the subjects was significantly affected by immunologic staging and socio-economic status.

CONCLUSIONS

Neurocognitive functioning of the HIV-infected children was significantly lower than those of their un-infected counterparts. Neurodevelopmental evaluation should be part of standard care in HIV-infected children in Nigerian setting.

Enhancement of Pulmonary Tuberculosis Prevention Behavior With Role Play Among Elementary School Students

Tuberculosis as an infectious disease is increasing in both the number of cases and severity of impact, and the number of cases among school-aged children is also increasing. Health promotion campaigns in schools have not been intensive, and there is poor behavior in tuberculosis prevention. Role play-playing roles actively with provided materials-is one health education method that can empower school-aged children to understand tuberculosis prevention. The purpose of this research is to identify the influence of role playing on tuberculosis transmission prevention in school-aged children. Study participants were 100 school-aged children. The study used quasi-experimental types of pre-test and post-test, with a control group. The t test results showed that improvement of tuberculosis prevention behaviors in the intervention group was higher than the control group (p value = .000). The role play method is recommended for health education for at least 6 sessions in school-aged children.

Sleep Well!: A Pilot Study of an Education Campaign to Improve Sleep of Socioeconomically Disadvantaged Children

STUDY OBJECTIVES

Socioeconomically disadvantaged children are at risk for poor sleep hygiene and increased sleep problems. This pilot study examined the efficacy of Sleep Well!, a parent-based sleep education endeavor, which supplemented an outreach program that provides beds to socioeconomically disadvantaged children.

METHODS

In addition to receiving a bed, 152 children (mean age = 5.95 years, 57.2% boys) were randomly assigned to sleep education (3 messages: bedtime before 21:00; no caffeine; keep electronics out of the bedroom) or control (dental hygiene education) conditions. All education was provided at both the time of scheduling and delivery of a bed to each child. Parent-reported sleep data were collected at baseline and at 4-week follow-up.

RESULTS

Provision of a bed was associated with reduced bedroom electronics and increased parent-reported nighttime sleep duration for all children. However, relative to control children, intervention children showed even greater reductions in electronics (baseline mean = 1.91 items, follow-up mean = 0.85 items) and improvements in sleep duration (baseline mean = 9.75 hours, follow-up mean = 10.19 hours). There was no intervention effect for caffeine consumption or bedtime from baseline to follow-up.

CONCLUSIONS

Providing beds to socioeconomically disadvantaged children resulted in increased sleep duration and decreased use of electronics at bedtime, while the combination of a bed and brief parent sleep education conferred additional sleep benefits. Further study of brief child sleep interventions is warranted, particularly among socioeconomically disadvantaged children who are at risk for sleep problems.

Perinatal Risk Factors Associated with the Obstructive Sleep Apnea Syndrome in School-Aged Children Born Preterm

STUDY OBJECTIVES

The obstructive sleep apnea syndrome (OSAS) is more prevalent in ex-preterm children compared to the general pediatric population. However, it is unknown whether OSAS in ex-preterm children is associated with specific perinatal risk factors. This multicenter cohort study aimed to determine perinatal factors associated with OSAS at school age.

METHODS

197 ex-preterm (500-1,250 g) children aged 5-12 y who participated as neonates in a double-blind, randomized clinical trial of caffeine versus placebo (Caffeine for Apnea of Prematurity) underwent comprehensive ambulatory polysomnography. A negative binomial regression model was used to identify perinatal risk factors associated with OSAS.

RESULTS

19 children had OSAS (9.6%). Chorioamnionitis and multiple gestation were positively associated with OSAS with P values of 0.014 and 0.03, respectively. Maternal white race (P = 0.047) and maternal age (P = 0.002) were negatively associated with OSAS. Other risk factors, such as birth weight, Apgar score at 5 min, antenatal corticosteroids, delivery route, and sex were not significant.

CONCLUSIONS

OSAS is very frequent, and is associated with chorioamnionitis and multiple gestation in ex-preterm children. Those born to older white mothers appear to be protected. We speculate that the former may be due to systemic inflammation and the latter to a higher socio-economic status.

COMMENTARY

A commentary on this article appears in this issue on page 721.

Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial

OBJECTIVE

This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism.

METHOD

A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample.

RESULTS

Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes.

CONCLUSION

Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545.

Population-based survey of refractive error among school-aged children in rural northern China: the Heilongjiang eye study

BACKGROUND

The prevalence of refractive error in the north of China is unknown. The study aimed to estimate the prevalence and associated factors of refractive error in school-aged children in a rural area of northern China.

DESIGN

Cross-sectional study.

PARTICIPANTS OR SAMPLES

The cluster random sampling method was used to select the sample.

METHODS

A total of 1700 subjects of 5 to 18 years of age were examined. All participants underwent ophthalmic evaluation. Refraction was performed under cycloplegia. Association of refractive errors with age, sex, and education was analysed.

MAIN OUTCOME MEASURES

The main outcome measure was prevalence rates of refractive error among school-aged children.

RESULTS

Of the 1700 responders, 1675 were eligible. The prevalence of uncorrected, presenting, and best-corrected visual acuity of 20/40 or worse in the better eye was 6.3%, 3.0% and 1.2%, respectively. The prevalence of myopia was 5.0% (84/1675, 95% CI, 4.8%-5.4%) and of hyperopia was 1.6% (27/1675, 95% CI, 1.0%-2.2%). Astigmatism was evident in 2.0% of the subjects. Myopia increased with increasing age, whereas hyperopia and astigmatism were associated with younger age. Myopia, hyperopia and astigmatism were more common in females. We also found that prevalence of refractive error were associated with education. Myopia and astigmatism were more common in those with higher degrees of education.

CONCLUSION

This report has provided details of the refractive status in a rural school-aged population. Although the prevalence of refractive errors is lower in the population, the unmet need for spectacle correction remains a significant challenge for refractive eye-care services.

[Practical strategies to improve communications with school-aged children in the PICU]

BACKGROUND & PROBLEMS

Children in the PICU who are treated for illnesses using intubation are often unable to express their needs effectively. This project first used a self-designed survey to record the researcher's observations and interview data. Results indicated that even with clinical staffs trying their best to understand PICU patient needs, 50% of the patients had unmet demands due to inadequate communication. This unmet demand was a source of negative patient behavior.

PURPOSE

This project developed an appropriate communication system to improve communication efficacy between children and clinical staffs in order to meet patient demands and improve PICU patient outcomes.

RESOLUTION

Various types of auxiliary school-aged-children-appropriate communication tools such as picture cards, hand-held communication boards, and magnetic spelling board were used. Using these communication tools together with education and training greatly improved communication efficacy and patient needs provision.

RESULTS

Percentage of patient needs met increased from 50% to 98% and the average time clinical staffs needed to spend to understand a patient's needs decreased from 15 to 4 minutes per instance.

CONCLUSIONS

This project improved relationships and interactions between clinical nurses and school-aged children. The developed auxiliary communication tools may be introduced in the PICU based on the results of this project as an effective approach to improving patient-staff communication and reducing patient-perceived hospitalization stress.