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  <Article>
    <Journal>
      <PublisherName>revista-medicina-scolara</PublisherName>
      <JournalTitle>The Journal of School and University Medicine</JournalTitle>
      <PISSN/>
      <EISSN/>
      <Volume-Issue>Volume 8 issue 4</Volume-Issue>
      <PartNumber/>
      <IssueTopic>Multidisciplinary</IssueTopic>
      <IssueLanguage>English</IssueLanguage>
      <Season>October-December 2021</Season>
      <SpecialIssue>N</SpecialIssue>
      <SupplementaryIssue>N</SupplementaryIssue>
      <IssueOA>Y</IssueOA>
      <PubDate>
        <Year>-0001</Year>
        <Month>11</Month>
        <Day>30</Day>
      </PubDate>
      <ArticleType>Medical</ArticleType>
      <ArticleTitle>VISION SCREENING OF FOUR-AND FIVE-YEAR-OLD CHILDREN IN CLUJ COUNTY: RECOMMENDATIONS FOR NATIONWIDE IMPLEMENTATION</ArticleTitle>
      <SubTitle/>
      <ArticleLanguage>English</ArticleLanguage>
      <ArticleOA>Y</ArticleOA>
      <FirstPage>5</FirstPage>
      <LastPage>23</LastPage>
      <AuthorList>
        <Author>
          <FirstName>Jan</FirstName>
          <LastName>Kik</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>N</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Mandy</FirstName>
          <LastName>Nordmann</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Daniela</FirstName>
          <LastName>Rajka</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Mihai</FirstName>
          <LastName>Mara</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Simona</FirstName>
          <LastName>Cainap</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Oana</FirstName>
          <LastName>Teodosescu</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Alin</FirstName>
          <LastName>Vladescu</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Aurel</FirstName>
          <LastName>Mocan</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Anna</FirstName>
          <LastName>Horwood</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Maria</FirstName>
          <LastName>Fronius</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Cristina</FirstName>
          <LastName>Vladutiu</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Huibert Jan</FirstName>
          <LastName>Simonsz</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DOI>10.51546/JSUM.2021.8401</DOI>
      <Abstract>BACKGROUND: Vision screening by measurement of visual acuity at age four or five was implemented in Cluj County in 2018 and 2019. Our aim was to identify barriers and facilitators to implementation and to formulate conditions for nationwide implementation of vision screening in Romania.&#13;
&#13;
METHODS: In cities, children were screened by resident kindergarten nurses. In rural areas, kindergartens are small and have no nurses. Children were screened by family doctors’ nurses instead, initially at the doctors’ offices and later also at kindergartens. Because rural coverage was low in the first year, a travelling screening nurse was employed to screen children in remote rural areas.&#13;
&#13;
Implementation was assessed with on-site observations, interviews, questionnaires and analysis of screening results, including ophthalmological examinations.&#13;
&#13;
RESULTS: In cities, 74.8% of eligible children were screened, in rural areas, 47.1%. The travelling screening nurse screened 805 children in seven months and rural communes where screening had taken place increased from 24 to 72 out of 75 during the second year. Referral rate was 15.8% initially, decreasing to 7.9%, varying between 0% and 57.1% among screeners. Of referred children, 27.8% were reported back by ophthalmologists, 15.3% were examined but not reported back, 21.4% were not examined and of 35.4% it was unclear whether they were examined. Referral and treatment were hampered by travel distance and lack of awareness. Of children reported back by ophthalmologists, 34.1% were prescribed glasses, 7.2% both glasses and occlusion and 0.7% occlusion. Vision screening was considered acceptable by respondents. However, in rural communes screening was deemed less appropriate and feasible. Fidelity was high in both urban and rural areas.&#13;
&#13;
CONCLUSIONS: In cities, screening by kindergarten nurses proved very effective. In rural areas, family doctors’ nurses screened only screen small numbers of children. The travelling screening nurse screened many children in underserved rural communes and screening had been offered in almost all rural communes at the end of the study. Universal vision screening at age four or five in Romania will result in many children with amblyopia needing treatment with glasses and eye patches, for which reimbursement by health insurance may be necessary. A training programme for orthoptists to assist ophthalmologists could be advisable.</Abstract>
      <AbstractLanguage>English</AbstractLanguage>
      <Keywords>vision screening, amblyopia, children, implementation study, disparity</Keywords>
      <URLs>
        <Abstract>https://www.revista-medicina-scolara.ro/ubijournal-v1copy/journals/abstract.php?article_id=13471&amp;title=VISION SCREENING OF FOUR-AND FIVE-YEAR-OLD CHILDREN IN CLUJ COUNTY: RECOMMENDATIONS FOR NATIONWIDE IMPLEMENTATION</Abstract>
      </URLs>
      <References>
        <ReferencesarticleTitle>References</ReferencesarticleTitle>
        <ReferencesfirstPage>16</ReferencesfirstPage>
        <ReferenceslastPage>19</ReferenceslastPage>
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    </Journal>
  </Article>
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