Disinvestment and implementation of vision screening tests based on their effectiveness
Bibliographic record
Abstract
OBJECTIVE To examine the diversity in paediatric vision and hearing screening programmes in Europe.METHODS Themes for comparison of screening programmes derived from literature were used to compile three questionnaires on vision, hearing and public health screening.Tests used, professions involved, age, and frequency of testing seem to influence sensitivity, specificity, and costs most.Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU full-member, candidate, and associate states.Answers were cross-checked.RESULTS Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme.Visual acuity is measured in 35 countries, in 71% of these more than once.First measurement of visual acuity varies from three to seven years of age, but is usually before the age of five.At age three and four, picture charts, including Lea Hyvarinen, are used most; in children over four, Tumbling-E and Snellen.As first hearing screening test, otoacoustic emission is used most in healthy neonates, and auditory brainstem response in premature newborns.The majority of hearing testing programmes are staged; children are referred after 1-4 abnormal tests.Vision screening is performed mostly by paediatricians, ophthalmologists or nurses.Funding is mostly by health insurance or state.Coverage was reported as >95% in half of countries, but reporting was often not first-hand.CONCLUSIONS Largest differences were found in visual acuity charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4), and funding sources (8).In the Netherlands and Sweden a combination of national and regional programmes exists.Almost all countries have a programme for all children, except Albania, where screening is selective.Screening is not free in Albania, Bulgaria, and Czech Republic, and is compulsory in Bulgaria, Flanders, Greece, Hungary, and Turkey. TestsWeight, height and head circumference are measured in all countries, cardiac function in all but Albania, lung function in all but Albania and Flanders, vision in all but Albania and Turkey, hearing in all but Albania and Malta, motor skills in all but Czech Republic and the UK, speech and language development in all but Albania, Bulgaria, Czech Republic, and the UK, cognitive development in all but Albania, Czech Republic, Flanders, and the UK.Psychosocial development is assessed in all countries but Albania, Bulgaria, Czech Republic, Flanders, Germany, Israel, Sweden, and the UK. Referral, funding and coverageReferral is most often to a specialist.Funding is provided mostly by the government or health insurance.Coverage is above 80% in all countries, except Albania.Further data is presented in table 4 and Appendix Map 3. Questionnaire answer checkChanges were made based on the first round of questionnaire answers.In hearing screening data: for Belgium (Flanders) the ASSR was added as test for neonates at risk; for Finland "testing one ear" was changed to "testing one ear or both ears"; for France "testing one ear and testing both ears" was changed to "always testing both ears"; for Italy coverage of "> 95%" was changed to "70%"; Malta selective screening, not population-wide screening, was confirmed; for Poland "non-staged screening" was changed to "staged screening"; for Israel, Italy, Lithuania, and Switzerland "only aABR testing" for neonates at risk was corrected to "OAE and/or aABR".Vision screening data was revised: for Austria funding was changed from "health insurance" to "health insurance and state"; for Belgium (Flanders) personnel was changed from "nurse" to "nurse and youth health care physician", testing of stereopsis and colour vision was added and VA chart was changed from "Landolt C" to "Pictures and HOTV"; for Croatia VA chart was changed from "only Tumbling E" to "Pictures, Lea and Tubling E"; for Czech Republic Pictures and Lea chart were added; for Denmark the "Snellen chart" was changed to "Pictures" and coverage was changed from ">80%" to ">95%"; for Iceland Snellen chart was added; for Israel coverage
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.004 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".