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  <Article>
    <Journal>
      <PublisherName>revista-medicina-scolara</PublisherName>
      <JournalTitle>The Journal of School and University Medicine</JournalTitle>
      <PISSN/>
      <EISSN/>
      <Volume-Issue/>
      <PartNumber/>
      <IssueTopic>Multidisciplinary</IssueTopic>
      <IssueLanguage>English</IssueLanguage>
      <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>0</FirstPage>
      <LastPage>0</LastPage>
      <AuthorList>
        <Author>
          <FirstName>Jan</FirstName>
          <LastName>Kik</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>N</CorrespondingAuthor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DOI/>
      <Abstract>BACKGROUND:

Vision screening by measurement of visual acuity at age four or five was implemented in Cluj County in 2018 and 2019. We identified barriers and facilitators to implementation and formulate conditions for nationwide implementation of vision screening in Romania.



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.

Implementation was assessed with on-site observations, interviews, questionnaires and analysis of screening results, including ophthalmological examinations.



RESULTS:

In cities, screening by kindergarten nurses went well. In rural areas, family doctors’ nurses screened only small numbers of children. The travelling screening nurse, however, 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%, but it varied 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. Fidelity was high in both urban and rural areas. However, in rural communes screening was deemed less appropriate and feasible.



CONCLUSIONS:

Screening by urban kindergarten nurses went well. For nationwide vision screening in rural areas, family doctors and their nurses should be supported by a travelling screening nurse.

The variation in referral rates among screeners emphasizes the need for adequate supervision and monitoring.

Universal vision screening at age four or five in Romania will result in many children with amblyopia needing treatment with glasses and eye patches. Hence, reimbursement of these by health insurance and a training programme for orthoptists would 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=13477&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>
        <References/>
      </References>
    </Journal>
  </Article>
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