| Myopia is one of the main factors that endanger the health of students, especially in recent years, the prevalence of myopia in primary and middle school students continues to rise and has become a serious physical and mental health hazard.The pathogenesis of myopia has not yet been fully clarified so far, but the clinical observation rusults and epidemiology investigation showed that genetic factors and environmental factors played an important role in the formation of myopia. Under the condition of non-preventable of genetic factors, taking measures to change the environmental factors of myopia is the main way to prevent and control the students’ myopia.National Education and Health departments have always attached great importance to the student mypia prevention, and repeatedly issued regulations and plans to stress the serious of myopia which is one of the six common diseases need to focus on more attention in sudents. In May 2007, the regulation of opinions about encouraging youngsters to take part in more sports to improve their health" put forward:Helping teenagers to master scientific knowledge and methods of myopia prevention to decrease the rate of myopia, and make our students generally reach the basic requirement of the national physical health through 5 years. To make the student myopia prevention work better, the Shanghai municipal Education Commission developed the study of myopia prevention strategy and implementation in primary and middle school students in 2007, and this program was listed as a key project of Shanghai munipal education scientific research. In 2012, we investigated the students in original regions and schools of 2007 to compare the prevalence of myopia and the changes of associated risk factors in 5 years, to evaluate the effect of prevention measures during the 5 years in Shanghai and also to provide the basis of more targeted myopia prevention strategies for students.ObjectivesThrough two cross-sectional surveys in 2007 and 2012 to compare the prevalence of myopia and the changes of risk factors related to myopia in students and the changes of understanding of the related information on myopia in parents and primary school teachers in 5 years, to evaluate the effect of prevention measures during the 5 years in Shanghai and also to explore the more targeted interventions of myopia.1. To compare the prevalence of myopia in primary and middle school sudents between 2007 and 2012;2. To compare the changes of myopia related risk factors in primary and middle school sudents between 2007 and 2012;3. To compare the changes of myopia related knowledge in parents and teachers between 2007 and 2012;4. To evaluate the effect of prevention measures during the 5 years in Shanghai and also to explore the practical interventions of myopia through the above results.MethodsIn 2007 year:stratified sampling method was used to select sample area, so six areas in Shanghai(Xuhui district, Huangpu district, Zhabei district, Luwan district, Songjiang district and Qingpu district) were choosed on the base of considering factors such as education, economic level and geographic position; then choosing subjects randomly in the schools of sample areas. To the subjects of high school students, we used the method of system cluster sampling with the class as a unit among the fresh students of high schools in each sample area; while to the subjects of lower grade students in elementary schools, we randomly selected six schools in each sample area using the same method, totally 36 shcools, and all the students of grade 1 to 3 and their parents were included in this survey.In 2012 year:the same sample method and the same sample areas, same schools, and also same classes with the year of 2007. Because Luwan district has been belong to Huangpu district, so the sampling schools in Huangpu district in 2012 contained the schools in Luwan district in 2007. And if the sampling schools or classes investigated in 2007 did not exist in 2012, we would select the similar and nearby schools instead.Investigate the student, parents and teachers with self-designed questionnaires through quantitative research methods, and analyze the vision of students by the last visual acuity test results which provide by school. After being sorted and collected, data would be analyzed by statistical software SPSS 16.0.Results1. The prevalence of myopia of the students in senior middle schools in 2012 year (83.0%) was higher than that in 2007 year (77.6%), the ratio of mild and moderate myopia declined by 1.5% and 3.2% respectively; the ratio of severe myopia increased by 10.1%. girls always had a higher rate of myopia than boys in two years. Compared with 2007, students’reading and writing posture in 2012 had some improvement, but still need to be futhur educated; the learning load of student was increasing; and the time of each short-distance use of eyes and doing homework every night in 2012 were more than that in 2007; and the time of playing compute or video games were also more than that in 2007, but the time of outdoor activities and sleeping were less than that in 2007. The result of Multivariable Logistic regression analysis about the risk factors of myopia showed that girls, parents who had myopia and fatigue of eyes were the common risk factors of sudents myopia for the two years, but the three factors which were the risk factors of myopia in 2007 were not the risk factors in 2012, such as distance of eye and book when reading, the average duration for each reading or writing and time for playing electric games from Monday to Friday; while the factor of time for watching TV from Monday to Friday was the new added risk factor in 2012.2. The low vision rate of low-grade pupils in Shanghai was 32.4% and 30.0% respectively in 2007 year and 2012 year, among which the mild, moderate and severe in 2007 was 10.7%,13.9% and 7.8% in turn, and in 2012 was 11.8%,13.1% and 5.3% in turn, there were statistics significance difference in degree of myopia for each year(P<0.05); that is to say, compared with 2007, the low vision rate of low-grade student in primary schools in Shanghai was decreasing, and the mild low vision rate increased by 1.1%, while the severe decreased by 2.5%. The low vision rate of student increased along with the grade, and the low vision rate of students in each grade for 2012 were lower than that in 2007, and the lower grade of students, the bigger amplification in rate of low vision rate, namely the effect of prevention to myopia was more obvious in the students of lower grade. The survey on the visual behaviors of pupils found that habits with eyes of reading and writing of students in 2012 were better than that in 2007, but learning load of student in 2012 was obvisous higher than that in 2007, and students who had more than 8 hours for sleeping were less than that in 2007. The ratio of watching TV more than 40 minutes each time in 2012 (65.4%) was less than that in 2007 (72.0%), while the ratio of play computer or computer games more than 40 minutes each time in 2012 (50.7%) was more than that in 2007 (39.7%). The results also showed that students with low vision had bad habits and behaviors with eyes in two years, and their short-distance use of eyes each time were longer. The result of Multivariable Logistic regression analysis about the risk factors of myopia showed that girls, grade, parents who had myopia and fatigue of eyes were the common risk factors of sudents myopia for the two years, but the factor-time of doing homework every night, which was the risk factor of myopia in 2007 was not the risk factors in 2012; while the factor of time in each reading or writing was more than 40 minutes was the new added risk factor in 2012.3. The survey suggested that the ratio of parents teaching children to do eye exercises in 2012 was less than that in 2007; although the ratio of parents teaching children right position to hold pen in 2012 was higher than that in 2007, the ratio of parents themselves not knowing the right eye exercises and position to hold pen was also higher than that in 2007; that suggested that parents in 2012 were lack of knowledge of myopia prevention and they were also lack of education and guidance to children for right use of eyes.4, The right answer rates of teachers about behavior with eyes in 2012 were less than that in 2007, the ratio of teachers teaching students right eye exercises and position to hold pen in 2012 was lower than that in 2007, and students who thought myopia could be prevented and myopia was harmful were also less than that in 2007, that is teachers in 2012 had less understanding of harmful of myopia and were lack of knowledge of myopia prevention and also had not enough attention.Conclusions1. The result showed that the prevalence of myopia of the students in senior middle schools in 2012 year was higher than that in 2007 year, among which the ratio of mild, moderate myopia decreased, while the severe myopia increased. The reason that prevention measures in Shanghai during five years were effective can not be ignored.2. Compared with the data in 2007, the low vision rate of low-grade pupils in Shanghai was decreasing, and the lower grade of students, the bigger amplification in rate of low vision rate, and the rate of myopia in low-grade pupils still decreased in the situation of more adverse factors, this shows more that a series of measures for pupils’vision in Shanghai during five years had achieved certaion success.3. The results showed that:more parents in 2012 were with high education and myopia. Students in 2012 had better behaviors and habits in reading and writing, but there were still more students had not. Students in 2012 need more time on learning and they had more learning burden; they had less time in watching TV, but little more time in palying compute and games, while most of which were less than one hour; students in 2012 had less time on outdoor activities and sleep.4. There were a variety of factors related to myopia. The results showed that sex, parents who had myopia, behaviors and habits on vision and fatigue of eyes were always the risk factors of sudents myopia, and another two factors also should be taken more attention, which were time of watching TV everyday and continuous time of each reading and writing.5. It is suggested that knowledge about myopia prevention for parents and teachers in 2012 were less than that in 2007, and they also had not enough attention in 2012. So the education on parents and teachers must be strengthened to improve their level of knowledge with the health of eyes and their attention to the myopia prevention, making parents and teachers to participate in myopia prevention actively to control and reduce the rising rate of low vision.6. Education departments and schools should fully implement the relevant prevention policies and measures of myopia, and play their roles in protectiong vision of teenagers to achieve the goals of myopia prevention. |
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