Barriers to the Ponseti method in Peru: a two-year follow-up.

Idiopathic clubfoot affects approximately 100,000 children each year and is one of the leading causes of disability worldwide. The Ponseti method is an inexpensive, non-surgical treatment that, when executed correctly, is more than 95% effective; however, in Peru, a developing country where a low-cost alternative is greatly needed, physicians report up to 30% of patients do not complete treatment. This study involved semi-structured interviews with 25 physicians who practice the Ponseti Method in Peru to discuss obstacles for the method in their country. The most frequent obstacles to the Ponseti method in Peru reported by physicians included lack of physicians trained in the Ponseti method in the country, patient transportation and distance to treatment centers, and lack of parental knowledge of the Ponseti method. These data suggest the need to train more physicians in Peru, particularly in the provinces. Increasing access to trained physicians in provincial areas may reduce the financial and travel burden of parents to help increase compliance with treatment.

The plusoptiX S08 photoscreener as a vision screening tool for children with autism.

PURPOSE: Children with autism and related disorders reportedly have an increased prevalence (40%) of ocular disorders, and comprehensive eye examinations by a pediatric ophthalmologist are recommended. Examinations can be very time consuming, expensive, and stressful for the child. A photoscreener such as the plusoptiX S08 may be a cost-effective, time-saving, and less invasive method for testing patients with autism. The purpose of this study was to determine the efficacy of photoscreening with the plusoptiX S08 in detecting amblyopia risk factors in children with autism. METHODS: Photoscreening and complete ophthalmologic examinations were performed on 43 children with autism. Prevalence, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using ophthalmologic examination as the gold standard. RESULTS: The gold standard examination used American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee guidelines for the definition of amblyopia risk factors. The plusoptiX S08 referred 29 (67%) of 43 children. On examination, 16 patients (37%) had amblyopia risk factors. The plusoptiX S08 had a sensitivity of 94% (95% CI, 0.68-0.99). The specificity was 48% (95% CI, 0.29-0.68), the positive predictive value was 52% (95% CI, 0.33-0.70), and the negative predictive value was 93% (95% CI, 0.64-0.99). CONCLUSIONS: The plusoptiX S08 is sensitive but less specific at detecting treatable ocular conditions in children with autism. The majority of children with autism and amblyopia risk factors were detected on screening; however, about half of all referrals had no amblyopia risk factors. The plusoptiX S08 reduced the need for a full examination in one-third of the children screened.

Innovation in global collaborations: from student placement to mutually beneficial exchanges.

Five years ago, an academic department in the United States and the Ann Sullivan Center of Peru (CASP) initiated an international partnership to foster research collaborations and reciprocal consultation, and to create an advanced clinical placement for occupational therapy doctoral students. CASP is a globally recognized hub for community-based research, demonstration and training for people with disabilities (most of whom are from low-income families). CASP has provided occupational therapy students and faculty with a rich cultural environment in which to learn and collaborate as well as opportunities for developing research collaborations. The purpose of this manuscript is to discuss an innovative model of international collaboration highlighting specific areas of exchange and reciprocal learning. First, we will describe the collaboration and CASP's rich learning opportunities. Second, we will discuss a model of collaboration that includes three main phases: planning and preparation, developing and sustaining the partnership, and evaluating and celebrating outcomes and benefits. We illustrate the partnership with a case example and describe exchanges between CASP and a local community agency with whom faculty have collaborated for 20 years. Finally, we discuss implications of our innovative model towards developing and sustaining global partnerships. .