Multilevel Model Analysis On The Influencing Factors Of Pupil Myopia In Xuhui District Of Shanghai And Cross-sectional Investigation Of Myopia Prevention And Control

Myopia has become an important public health problem in many countries of Asia. In China, the detection rate of poor eyesight in students is also very high of which the myopia account for over 98% and there is a trend that the age of pupil myopia is becoming younger. Myopia not only brings inconvenience for pupil's study, daily life and future work, but also greatly increased the risk of becoming high myopia and intraocular complications. The etiology of myopia is very complicated. Generally speaking, environmental factors play an important role in the occurrence and development of simple myopia. While for genetic factor, it may be only related with minority of high myopia. Because the incidence of myopia in pupils is increasing each year, it is very necessary and urgent to study the impact factors of myopia and its effective prevention measures. In this study, multilevel model was first adopted to analyze the data with group effects from two levels of individual-based pupil level and school-based level for exploring the environmental risk factors of myopia. Then cross-sectional investigations on the school leaders and teachers were conducted for further information and cross-evidence about possible problems duing the process of myopia prevention and control. Finally the intervention emphasis for the above mentioned two levels were proposed accordingly based on the model-based quantitative analysis and cross-sectional qualitative/quantitative investigations.Partâ… Multilevel model analysis on the influencing factors of pupil myopia in Xuhui districtObjective To analyze the influencing factors of pupil myopia from the individual-and school-based levels using multilevel model and to propose the intervention emphasis of myopia at different levels. Methods Five primary schools in Xuhui district of Shanghai were selected with clustered sampling method, and all the pupils in grade 3-5 were included. The students'behavioral and environmental factors related to myopia were investigated by the questionnaire survey. Multilevel model was used to explore the influential factors of myopia. Results The significant influencing factors of myopia among pupils were grade, parent's eyesight, and eye relaxation at the individual-based level; gender, hours per week of outdoor activity, hours per day of reading and writing, hours per day of near-work entertainment outside school, and reading and writing posture were meaningful at the school-based level. Conclusion The intervention measures for myopia among pupils should be taken on the basis of the actual situation in different schools and students to protect the eyesight of pupils more effectively. The emphasis should be laid on instructing and supervising students' reading and writing posture at school and to enhance children'eye relaxation by parents.Partâ…¡Qualitative study on the work of myopia prevention and control in schoolsObjective To understand the actual situations, problems and weakness of myopia prevention in schools, and provide evidence for effective interventions. Methods Individual interview were conducted for the teachers of hygiene in selected five schools, including school system, the supervisory status of teachers on the reading and writing's postures and eye exercises, et al. Framework-based analysis was used to summarize and analyze the collected data. Results Schools have no systematic management and little attention for myopia prevention, devote insufficient manpower, material and financial resources to it, and some teachers have wrong ideas and deficient knowledge on myopia and its preventions, et al. This directly leads students to have not enough knowledge on the harms of myopia, lack serious attitude, ineffective eye exercises and others. Besides, additional assignments parents bring to students through extra interest classes have indirectly cancelled out or exceed the workload that schools have reduced. Conclusion Schools should establish a comprehensive and effective system for myopia prevention with active links among schools, students and parents for efficiently improving the work of myopia prevention, e.g. schools carry out extensive education and instruction of myopia, student's parents cooperate closely with schools, and students take part in it positively and actively.Partâ…¢Quantitative investigation on the work of myopia prevention for teachers in charge of the classObjective To find out the current situation, weakness and possible problems for teachers in charge of class to participate in the work of myopia prevention, and provide supports for effective intervention strategy. Methods Questionnaires were used to investigate the teachers in charge of class in selected five schools for the work of myopia prevention. Then descriptive analysis and chi-square analysis were performed to summarize and analyze the data. Results The teachers in charge of class do not have enough knowledge on myopia and lack good understanding about effect of correct reading and writing postures and eye exercising on myopia prevention. The weakness are the supervisions of high-grade pupils'reading and writing posture and outdoor activity. In the management process of students who are mild myopia or show the tendency of vision decreasing, they do not have efficient supervisions and communications with these students' parents and lack enthusiasm for the work of myopia prevention. Conclusion Propaganda and education on the knowledge of myopia and its prevention measures should be strengthened for the teachers in charge of class and the right methods should be adopted to impel them to join in the work of myopia prevention positively and actively by correcting their attitude, changing wrong opinions and improving the weakness such as supervisions of high-grade pupils'reading and writing posture and outdoor activity, carrying out effective communications with student's parents on myopia-related work.