Poor stereoacuity among children with poor literacy: prevalence and associated factors.

PURPOSE: Population-based studies on abnormal binocular vision and low literacy are rare. The aim is to determine the prevalence of poor stereoacuity among children with low literacy; to identify the characteristics associated with poor stereoacuity among children with low literacy; and to determine the agreement between poor stereoacuity as measured by graded stereocircles with a computerized assessment. METHODS: A total of 490 children attending primary school in the greater Hobart region, Tasmania, aged 7 to 14 years, with literacy results below the 10th percentile for Tasmanian students at grade 3 level of the NAPLAN (National Assessment Program in Literacy and Numeracy) testing completed a vision screen. Poor stereoacuity was defined as more than 100 seconds of arc as measured by Titmus stereocircles. RESULTS: The prevalence of poor stereoacuity was 16.8% (95% confidence interval [95% CI], 13.6 to 20.4%). Children with poor stereoacuity had a higher frequency of symptom report using the Convergence Insufficiency Symptom Survey. Factors associated with poor stereopsis were prematurity (adjusted odds ratio [AOR], 2.19; 95% CI, 1.09 to 4.42) and bottom shuffling (AOR, 2.39; 95% CI, 1.17 to 4.88). Features associated with poor stereopsis included squint (AOR, 6.05; 95% CI, 3.02 to 12.12), migraine (AOR, 2.25; 95% CI, 1.05 to 4.83), and attention deficit disorder (AOR, 1.92; 95% CI, 1.01 to 3.65). CONCLUSIONS: In this low-literacy sample, one-sixth had low stereoacuity. The associations reported require further investigation.

Children with low literacy and poor stereoacuity: an evaluation of complex interventions in a community-based randomized trial.

PURPOSE: To assess, among children with low literacy and poor stereoacuity, the efficacy of two intervention programs on child vision and education compared to a control program. METHODS: Eighty-eight children aged 8 to 13 years who had reading problems, and demonstrated poor stereoacuity as measured by the Titmus stereocircle test (> 100 seconds arc) or computerized assessment were randomized to one of two intervention programs: Lawson vision or Phono-Graphix, or a control group: Parental Literacy Support. Vision (Lang test, visual acuity, convergence insufficiency symptom survey) and education assessments (Woodcock Reading Mastery Tests-Revised) were conducted at baseline, intervention end (10 weeks), and 36 weeks. Analysis used intention to treat multi-level models. RESULTS: Compared to the parental literacy support group, convergence insufficiency symptoms were reduced 36 weeks post-randomization amongst those receiving the Lawson orthoptic intervention (mean difference -5.55; 95% confidence interval (CI): -11.1 to -0.05, P < 0.05). Stereoacuity, measured by the Lang test, improved for both the Lawson and Phono-Graphix interventions compared to the parental literacy support group (-1.01; 95% CI: -1.6 to -0.4, P = 0.001, and -0.77; 95% CI: -1.4 to -0.2, P = 0.01). At the 36 week follow-up assessment, word identification had also improved for the Lawson and Phono-Graphix groups but other educational outcomes did not improve. CONCLUSION: A formal randomized control trial was feasible in this setting. Intervention among children with poor stereoacuity and low literacy produced small improvements in stereopsis and convergence insufficiency symptom scores. Further randomized control trials should be conducted to clarify the role of orthoptic intervention on literacy in selected child populations.

Use of sedation to relieve refractory symptoms in dying patients.

OBJECTIVES: To document the use of sedation for refractory symptoms in patients admitted to an independent palliative care unit. METHOD: A prospective descriptive study. SETTING: The 7-bed inpatient unit at Sungardens Hospice, Pretoria. SUBJECTS: Patients who required sedation for refractory symptoms in addition to normal palliative care treatment between January and June 2002. FINDINGS: Twenty of 100 consecutive patients admitted required sedation. All had advanced cancer. Their mean age was 68 years. Thirty-six per cent were men and 64% women. INDICATIONS: Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation. Intractable pain was the main reason for sedation in only 1 patient. SURVIVAL: Mean survival following the start of sedation was 92 hours/3.8 days (range 6 - 369 hours/0.25 - 19.4 days). The combined mean survival recorded in 9 other studies was 57 hours/2.4 days (range 36 - 93.6 hours/1.5 - 3.9 days). MEDICATION: The main drugs used for sedation were midazolam and haloperidol. The mean dosage for midazolam was 18.5 mg/24 hours (range 7.5 - 40 mg) and for haloperidol 8 mg/24 hours (range 5 - 10 mg). For pain relief the mean daily dose of parenteral morphine was 76 mg (range 15 - 260 mg). CONCLUSION: Use of sedation for the relief of refractory symptoms at Sungardens Hospice is in line with several studies reported in the international literature.