Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

OBJECTIVE

To test the association of material deprivation and the utilization of vision care services for young children.

STUDY DESIGN

We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician.

RESULTS

Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas.

CONCLUSIONS

Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.

Pretend play ability in preschool-aged children with an acquired brain injury

INTRODUCTION

This study compares the self-initiated pretend play abilities of preschool-aged children with an acquired brain injury, with the self-initiated pretend play ability of their neurotypical peers.

METHOD

A non-experimental group comparison was conducted between 22 preschool-aged neurotypical children (M = 52.8 months, SD = 7.1 months) and 21 children with an acquired brain injury (ABI, M = 50.5 months, SD = 11.9 months), who had been discharged from inpatient rehabilitation and who were able to engage in a play session. The children were assessed individually using the Child-Initiated Pretend Play Assessment (ChIPPA).

RESULTS

The children with an ABI had significantly lower scores in pretend play ability than their neurotypical peers as measured by the percentage of elaborate play actions in both the conventional (P < .000) and symbolic (P < .000) sections of the ChIPPA, as well as the number of object substitutions (P < .000). The children with an ABI completed significantly less of the play time required compared with their neurotypical peers (P = .001); 66% could not play for the required time. There was no significant difference in the ChIPPA scores of the children with an ABI injured before and after the age of 18 months, nor between children with a severe or moderate injury.

CONCLUSION

The quality and the quantity of pretend play of preschool-aged children with an ABI are significantly below that of their neurotypical peers. Assessment of pretend play ability and direct intervention in ABI rehabilitation by occupational therapists is essential to enable children with an ABI to participate in pretend play and garner the developmental benefit this affords.

Expressive and receptive language skills in preschool children from a socially disadvantaged area

PURPOSE

Evidence suggests that children present with receptive language skills that are equivalent to or more advanced than expressive language skills. This profile holds true for typical and delayed language development. This study aimed to determine if such a profile existed for preschool children from an area of social deprivation and to investigate if particular language skills influence any differences found between expressive and receptive skills.

METHOD

Data from 187 CELF P2 UK assessments conducted on preschool children from two socially disadvantaged areas in a city in southern Ireland.

RESULT

A significant difference was found between Receptive Language Index (RLI) and Expressive Language Index (ELI) scores with Receptive scores found to be lower than Expressive scores. The majority (78.6%) of participants had a lower Receptive Language than Expressive score (RLI < ELI), 18.2% of participants had a higher Receptive score than score (RLI > ELI), with very few (3.2%) having the same Receptive and Expressive scores (RLI = ELI). Scores for the Concepts and Following Directions (receptive) sub-test were significantly lower than for the other receptive sub tests, while scores for the Expressive Vocabulary sub-test were significantly higher than for the other expressive sub tests.

CONCLUSION

The finding of more advanced expressive than receptive language skills in socially deprived preschool children is previously unreported and clinically relevant for speech-language pathologists in identifying the needs of this population.

Multidimensional treatment foster care for preschoolers: early findings of an implementation in the Netherlands

Multidimensional Treatment Foster Care (MTFC) has been shown to be an evidence based alternative to residential rearing and an effective method to improve behavior and attachment of foster children in the US. This preliminary study investigated an application of MTFC for preschoolers (MTFC-P) in the Netherlands focusing on behavioral outcomes in course of the intervention. To examine the following hypothesis: "the time in the MTFC-P intervention predicts a decline in problem behavior", as this is the desired outcome for children assigned to MTFC-P, we assessed the daily occurrence of 38 problem behaviors via telephone interviews. Repeated measures revealed significant reduced problem behavior in course of the program. MTFC-P promises to be a treatment model suitable for high-risk foster children, that is transferable across centres and countries.

TRIAL REGISTRATION

Netherlands Trial Register: 1747.