Abstract Background Schools play an organizational role in managing myopia-related behavioral habits among students. We evaluated the effects of school myopia management measures on myopia onset and progression in a school-based prospective 1-year observational study. Methods In total, 8319 children from 26 elementary schools were included. Online questionnaire completed by a parent, in which school myopia management experience including outdoor activities in recess or physical education class, teachers’ supervision, and teaching facilities. Variables were defined as implemented well or poorly, according to the Comprehensive Plan to Prevent Myopia among Children and Teenagers. Children underwent ophthalmic examinations, and the incidence and progression of myopia from 2019 to 2020 were estimated. Multilevel logistic regression models were constructed to analyze the association between school management measures and myopia development in 8,9 years and 10,11 years students. Results From 2019 to 2020, the incidence of myopia among primary school students was 36.49%; the mean difference of spherical equivalent in myopic children was − 0.29 ± 1.22 diopters. The risk of incident myopia was reduced by 20% in 8,9 years participants with well-implemented class recess compared with those with poorly implemented class recess (adjusted odds ratio [aOR]: 0.80, p = 0.032). PE outdoor time was significantly associated with myopia incidence in 10,11 years students (aOR: 0.76, p = 0.043). Compared with poorly implemented reading and writing posture, desk and chair height, 10,11 participants with well-implemented desk and chair height were less likely to have rapid myopic progression (p = 0.029, p = 0.022). Conclusion In Shanghai, children’s myopia is associated with better implementation of school myopia management measures. The present findings suggest that outdoor activities during class recess or PE class, providing suitable desks and chairs, and adequate instruction in reading and writing postures might protect against pathological eye growth. An age-specific myopia prevention and control programs in school is of primary importance.

目的 研制针对中小学生电子屏幕使用行为的评价问卷,为综合评价中小学生屏幕使用行为提供依据.方法 于2022年8-9月邀请19名专家,在查阅文献的基础上,以国家教育和卫生主管部门颁布的一系列指南和标准以及国内外相关指南为依据,结合现有的有关儿童青少年屏幕使用行为的评价工具,形成中小学生电子屏幕使用行为评价问卷的初始框架和条目池,通过德尔菲专家咨询后确定评价问卷的维度、评价条目及权重.结果 两轮专家咨询的问卷回收率分别为95.0％和100.0％,问卷意见提出率分别为89.5％和63.2％,专家权威系数(Cr)为0.87.最终形成包含屏幕使用类型和时间控制、屏幕使用相关卫生行为、屏幕使用中的安全与文明、合理安排屏幕与非屏幕使用活动4个维度,共44个具体条目的评价问卷.各条目变异系数(CV)范围为0.00～0.19,肯德尔协调系数(W)由0.22上升至0.34(P值均＜0.01),专家意见一致可信.结论 编制的中小学生电子屏幕使用行为评价问卷,可用于综合评价中小学生电子屏幕使用行为,为后续采取干预措施改善中小学生电子屏幕使用相关行为提供依据.

目的 编制适用于当代城市中学生、具有良好信效度的压力源评价量表,为研究中学生心理压力及相关因素提供工具.方法 根据量表编制理论和流程,结合已有的青少年生活事件或压力源量表,形成城市中学生压力源条目池,在上海市2个区的393名中学生中实施预调查,进行项目分析和评价维度确定.再经分层整群抽样选取上海市11个区的2 949名学生进行量表的验证性因子分析.结果 最终形成28个条目的"城市中学生压力源评价量表",学业压力、自我身心压力、人际压力和家庭压力4个分维度分别包含8,7,7,6个条目,量表总体的Cronbach α系数为0.94,Guttman分半信度为0.88,重测信度0.68.验证性因子分析显示,近似误差均方根(RMSEA)和标准化残差均方根(SRMR)均＜0.08,拟合度指标在0.8以上.结论 编制的"城市中学生压力源评价量表"信效度良好,模型拟合优度理想,适用于城市中学生.

目的 研制面向幼儿园、中小学教师的学生视力保护相关健康素养评价问卷,为量化评估学校教师近视防控能力提供依据.方法 依照教育部和国家卫生健康委等部门颁布的近视防控相关要求和文件、参考世界卫生组织提出的健康素养整合定义,形成学生视力保护相关学校教师健康素养评价体系和问题条目库,选择24名相关领域专家进行两轮德尔菲专家咨询后确定适用幼儿园和中小学校的评价指标条目、评价问题和权重.结果 两轮德尔菲专家咨询,专家回复率分别为83.3％和79.2％,专家权威系数为0.91.最终形成含近视核心知识掌握、日常教学行为、学生用眼行为指导、户外活动促进、教学用光环境营造5个维度,分别包含30和23个条目的 中小学教师和幼儿园教师评价问卷,各维度及各问题条目评分的变异系数范围分别为0.07～0.15,0.08～0.29,专家意见一致可信.结论 研究形成了学生视力保护相关的幼儿园教师和中小学校教师健康素养评价问卷,可作为基于学校的近视综合防控项目的 干预切入点和效果评估依据.

目的 了解新冠肺炎疫情前及期间城市学龄前儿童各类电子屏幕使用时间及影响因素,为控制学龄前儿童电子屏幕使用和预防近视提供科学依据.方法 运用多阶段整群随机抽样法,于2020年6-7月,横断面调查上海市闵行区幼儿园8 244名儿童,通过家长问卷收集学龄前儿童在新冠肺炎疫情暴发前后各类电子屏幕的使用时长,估算加权屏幕屈光时间,分析家庭电子屏幕督导行为与学龄前儿童加权屏幕屈光时间的关联.结果 被调查学龄前儿童新冠肺炎疫情期间每日手机、电脑/平板、电视/投影视屏时长过度检出率分别为30.52％,51.40％,56.82％,而疫情前上学日三者检出率分别为21.94％,41.80％,47.51％.控制重要混杂因素后,家长控制孩子使用电子屏幕的频率高、家长对孩子使用电子屏幕时间有规定并严格实施与疫情前加权屏幕屈光时间负向关联(调整OR=0.60～0.77,P值均＜0.05);家长陪伴孩子时使用电子屏幕的频率高、家长对孩子使用电子屏幕时间有规定但实施不严格与加权屏幕屈光时间和疫情期间加权屏幕屈光时间增加正向关联(调整OR=1.18～1.80,P值均＜0.05).结论 城市学前儿童疫情前后电子屏幕用眼时长均过长.学龄前儿童视屏行为的控制措施中,应注重家庭内部的电子屏幕使用管理和父母自身的榜样作用.

Objective::To explore the refractive status along with relevant factors during the fetal and infancy period in 9-month-old infants, and to provide evidence for early prevention and intervention of refractive errors.Methods::This study analyzed refractive screening data accumulated by the Minhang District Maternal and Child Health Care Institution, Shanghai, from 2012 to 2019. In all, 16 746 infants aged 9 months were included in the description of refractive status. Relevant factors before 9 months of age were collected by child health examination records and questionnaire survey data. Chi-square tests and multivariate regression models were used to analyze the association of factors during the fetal and infancy periods in 9-month-old infants with suspicious refractive errors.Results::The P5- P95 of the refractive sphere for infants aged 9 months was +0.50 D-+3.00 D, and the P5 of the refractive cylinder for infants aged 9 months was -2.50 D. Detection rates of suspected myopia, hyperopia, astigmatism, and anisometropia were 13.46%, 11.13%, 25.58%, 8.29%, respectively. Birth during the winter and frequent contact with electronic devices increased the risk of suspected myopia (adjusted OR were 1.35, 1.55 respectively). Birth during the summer or autumn, prematurity and a physique greater than the P80 quantile at 9 months of age increased the risk of suspected hyperopia (adjusted OR were 1.67, 1.62, 1.80, 1.22 respectively). Birth during the summer, a physique greater than the P80 quantile and artificial feeding at 9 months of age increased the risk of suspected astigmatism (adjusted OR were 1.92, 1.42, 1.19, respectively). Outdoor activities of more than 0.5 h per day decreased the risk of suspected refractive errors (adjusted OR=0.711-0.803). Conclusion::Detection rates of suspected refractive errors in infants aged 9 months are between 8% and 25%, among which astigmatism is most significant. Infants with high-risk factors such as prematurity, parents with refractive errors and large physique should be the focus of refractive screening and follow-up.

目的 评估上海市《闵行区儿童青少年近视防控三年行动计划(2019-2021年)》实施1年后家长对学生用眼卫生健康服务的态度,为优化干预措施提供科学依据和决策参考.方法 采用多阶段分层整群抽样的方法进行样本选择,最终完成20 176份有效学生家长问卷,进行对学生眼卫生健康服务态度评估.结果 家长对学生用眼卫生健康服务满意率前3位分别是定点医疗机构提供的服务6 849名(84.65％)、提供视力筛查结果反馈方式16 915名(83.84％)、定点医疗机构检查流程6 704名(82.91％).认为需要改善的环节前3位分别是用眼行为和用眼环境干预8 476名(42.01％)、家长告知7 850名(38.91％)、定期随访管理7 222名(33.67％).不同学段、既往眼部疾病诊断史对学生用眼卫生服务的满意率和改善环节需求有影响,差异均有统计学意义(P值均＜0.05).结论 干预实施1年后,家长对学生用眼卫生健康服务整体较满意,不同特征学生家长对卫生健康服务需求有所侧重,建议进一步提供精细化、个性化的用眼卫生健康服务.