Near Work Related Behaviors Associated with Myopic Shifts among Primary School Students in the Jiading District of Shanghai: A School-Based One-Year Cohort Study.
Near Work Related Behaviors Associated with Myopic Shifts among Primary School Students in the Jiading District of Shanghai: A School-Based One-Year Cohort Study.
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上海市嘉定区小学生近视行为与近视转变相关：基于学校的一年队列研究
DOI：
10.1371/journal.pone.0154671
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Zou H
中科院分区：
文献类型：
--
作者：
You X;Wang L;Tan H;He X;Qu X;Shi H;Zhu J;Zou H
目的研究小学生近距离作业行为的特点及其与近视眼相关眼生物特征的关系。方法2013年采用整群随机抽样方法，抽取北京市某小学一至四年级6-10岁学生4,814名。在基线时，学生和他们的父母一起填写了一份自填式问卷，内容包括近距离工作相关行为的9个方面以及近视的一些重要协变量。在基线和一年后进行了一系列全面的眼部检查，包括眼轴长度（AL）和睫状肌麻痹验光。结果随着年级的升高，学生在寻找各种方式进行眼动休息方面的表现越来越好，但他们越来越倾向于长时间连续做近距离工作而不进行眼动休息。在阅读、写作或看电视时保持合理的眼距和正确的手姿势，在2年级之前第一次变得更糟，但在3年级时变得更好。相比之下，选择适当的照明环境或情况，并保持均衡的饮食变得更好的第一次之前，2年级，但随后变得更糟，在3年级。随访1年，平均AL增加0.32 ± 0.35 mm，AL/CR增加0.032 ± 0.054，近视等效球镜增加-0.51 ± 0.51D，近视发生率为16.0%（237/1,477）。在控制了父母近视、学生年龄、性别、身高、每天近距离工作时间、每天户外活动时间和所有其他近距离工作相关行为的混杂效应后，阅读、书写和看电视时保持合理距离与AL延长相关[标准系数β =-0.062，P = 0.004]，SE [beta =-0.072，P = 0.020]和近视发生率[校正比值比（aOR）= 0.90，95%置信区间（CI）：0.84-0.96]的变化。选择光线充足的环境以获得视觉舒适的读写与AL的延长[beta =-0.039，P = 0.034]和AL/CR比的增加[beta =-0.030，P = 0.048]相关。此外，不连续近距离工作超过30-40分钟而不休息与AL/CR比值增加[beta =-0.028，P = 0.044]和SE变化[beta =-0.064，P = 0.023]相关。结论小学生近距离工作行为存在年级差异。独立于遗传因素，日常近距离工作负荷和户外活动，近距离工作相关的行为，如保持不适当的眼睛距离近距离工作，选择不适当的照明环境，并继续做近距离工作没有眼睛休息的近视转变的危险因素。
Purpose To investigate the characteristics of various near work related behaviors among primary students and their associations with changes in myopia related ocular biometric parameters during one-year of follow up. Methods A school-based sample of 4,814 primary 1st to 4th grade students aged 6–10 years old were selected by cluster randomization based on probability proportion to size in 2013. At baseline, students together with their parents filled in a self-administered questionnaire on 9 aspects of near work related behaviors and some important covariants of myopia. A comprehensive set of eye examinations including axial length (AL) and cycloplegic refraction was conducted both at baseline and one year later. Results With the grade level increase, students did increasingly better at finding various ways to have an eye break, but they were increasingly likely to continuously do long-time near work without an eye break. Keeping a reasonable eye distance and correct hand posture for reading, writing, or watching TV became worse for the first time before grade 2, but then became better at grade 3. In contrast, selecting appropriate lighting environments or situations and keeping a balanced diet became better for the first time before grade 2, but then became worse at grade 3. At one-year follow up, the mean AL increased by 0.32 ± 0.35 mm, the ratio of AL divided by the mean corneal radius of curvature (AL/CR ratio) increased by 0.032 ± 0.054, the myopic spherical equivalent (SE) increased by -0.51 ± 0.51 diopters and the incidence of myopia was 16.0% (237/1,477). After controlling for the confounding effects of parental myopia, student’s age, gender, height, daily near work time, daily outdoor activity time and all of the other near work related behaviors, keeping a reasonable distance when reading, writing and watching TV was associated with elongation of the AL [standard coefficient beta = -0.062, P = 0.004], a change in SE [beta = -0.072, P = 0.020] and incident myopia [adjusted odds ratio (aOR) = 0.90, 95% confidence interval (CI): 0.84–0.96]. Selecting an environment with adequate light for visual comfort to read and write was related to elongation of the AL [beta = -0.039, P = 0.034] and increase of AL/CR ratio [beta = -0.030, P = 0.048]. Also, not continuing to do near work for more than 30–40 minutes without an eye break was related to increase of the AL/CR ratio [beta = -0.028, P = 0.044] and a change in SE [beta = -0.064, P = 0.023]. Conclusion Various near work related behaviors changed according to grade level in primary school students. Independent of hereditary factors, daily near work load and outdoor activity, near work related behaviors such as keeping an inappropriate eye distance for near work, selecting inadequate lighting environments, and continuing to do near work without an eye break were risk factors for myopic shifts.