Portugal making a difference with children and families: the GADIF model

Portugal is a culture grounded in strong traditions and family. Yet, social changes like women returning to the workforce and a decreas ed national birth rate are impacting the traditional family structure and care giving environments of children. Female employment has been increasing steadily in P ortugal over the last three decades (Galego & Pereira, 2006) and the total fert ility rate decreasing from 4.1 to 2.8 (INE, 2006). Furthermore, extended family me mbers, like grandparents, no longer reside close by to their children and grandc hildren as in the past, because of a changing labor market. Many of the younger gen eration are leaving their rural communities to flock to urban areas because o f job opportunities, leaving behind older relatives who would have otherwise par ticipated in the daily care of children. Given these social and economic changes, children are spending more time in out-of-home care with non-familial caregive rs. Yet, government regulations and guidelines in early care and educat ion (ECCE) and early intervention (EI) are only just emerging; it contin ues to be a work in progress.

Fusional vergence measurements for eso versus exo deviations: is there a difference?

Purpose: The aims of this study were to compare angle of deviation, fusional vergence measurements and fusion reserve ratio between esophoria and exophoria. Methods: A cross-sectional study was performed in children with best-corrected visual acuity of 0.0 LogMAR in either eye, compensated heterophoria within 10 prism dioptres (PD), full ocular rotations, presence of fusional vergence and stereopsis (60 seconds of arc or better). Fusional amplitudes were compared between angle of deviation (2, 4, 6, 8 and 10 PD) in esophoria and exophoria. The fusion reserve ratio was calculated (to assess the effect of the underlying angle of deviation) as fusional convergence divided by prism alternating cover test measurements. Results: Two-hundred and eleven children (7.65±1.16 years) were recruited to this study. Exophoria was most common for near (n=181; 85.8%) and distance (n=20; 9.5%). Esophoria was present in 22 children for near (10.4%) and in 1 child for distance (0.5%). No significant differences were found between fusional amplitudes and angle of deviation for near (p>0.05). Children with exophoria of 10PD had a slight, but not, significant (p=0.264) increase in fusional convergence from 2PD (19.95±5.09) to 10PD (26.67±5.77). In esophoric children the variation of fusional convergence was smaller from 2P (25.00±0.00) to 10PD (22.50±3.54) and non significant (p=0.185). The fusion reserve ratio was significantly smaller in children with higher deviations (i.e. 10PD) for both esophoria (p=0.003) and exophoria (p>0.001). The fusion reserve ratio ranged between 12.50 (2PD) and 2.25±0.35 (10PD) for esophoria and between 9.98±2.55 (2PD) and 2.67±0.58 (10PD) for exophoria. Conclusions: Angle of deviation is not an efficient measure to predict fusional amplitudes. The fusion reserve ratio appears to be a better measurement to assess the effect of the underlying angle of deviation on fusional convergence. More studies are necessary to understand better the relationship between fusion amplitudes and angle of deviation.