Elementary school comprehensive intervention and myopia development: the Wenzhou Epidemiology of Refraction Error Study

INTRODUCTION

Myopia is a global health problem and nearly 50% of the global population has been estimated to be affected by 2050

. The increasing prevalence and severity of myopia in school-age children during the last decades has become a major health problem in East Asia

. This increase is too rapid to be explained by genetic changes, and implies the involvement of environmental factors

. Thus, by modifying environmental exposure it is potentially possible to prevent or mitigate myopia onset and/or progression in children. Myopia is one of the six categories of disease prevention for schools stipulated by the 1992 Students’ Common Disease Control Programme of China

. This program includes establishing recommendations for schoolchildren myopia control such as an eye exercise system, increased outdoor activities, the use of standardized classroom desks and chairs, and specific lighting requirements.

Many randomized controlled trials (RCTs) and epidemiological studies have reported that myopia is significantly associated with environmental factors, such as time outdoors, inadequate lighting when reading or writing, and time spent on hand-held devices and near work

. Results for reading posture, Chinese eye exercises, and time spent using computers have been inconsistent

. Only a few countries such as the Singapore have practiced health care education and screening of ocular diseases in children, with improved control of myopia progression

.

In the Wenzhou Epidemiology of Refraction Error (WERE)study, school-based comprehensive intervention was offered to children, teachers, and parents with a 2.5y follow-up. The study aimed to evaluate the effects of comprehensive intervention on the prevention of myopia in elementary school children.

用于預防家禽球蟲病。用法與用量：混飲每升水，雞0.17～0.34 g。規格：100 g∶1 g，休藥期：肉雞5日。批準文號：獸藥字（2016）190466209，生產日期20180910，有效期至20200909。生產企業：佛山市正典生物技術有限公司。

SUBJECTS AND METHODS

Ethics Committee of the Eye Hospital of Wenzhou Medical University approved this study. The study obtained permission from the parents and teachers from school. The research clung to the tenets of the Declaration of Helsinki. The nature of the study and details regarding the eye examination and questionnaire were explained to the parents and children, and informed written consent was obtained from at least one parent.

The study was a prospective, interventional school-based research in which grades 1-3 children were selected from the WERE study and followed for 2.5y(September 2012 to March 2015; Figure 1).

There was a significant difference in the myopic shift in the two groups. The overall mean myopia progression during the 2.5y follow-up was-0.49±1.04 D in the intervention group and -0.65±1.08 D in the control group (

=0.004; Table 2).

IOL Master (Carl Zeiss Meditec AG, Jena, Germany) was used to measure AL. The measurements of AL were considered valid if individual measurements varied by no more than 0.02 mm. Because of difficulties in getting the IOL master on a regular basis and introducing it into the examination plan,measurement was only taken once per year. Children with bestcorrected visual acuity worse than 20/25 at baseline were excluded.

The number of students in the one campus was approximately equal to the sum of other two. The campus with the most students was served as intervention group, whereas the other two campuses served as control group. The interventions were provided every semester to the intervention group; none was provided to the control group.

Intervention methods included education intervention and behaviour intervention. First, students, their parents and teachers received ocular health-related knowledge education,which included a powerpoint presentation, 3-D model eyes,eyeglasses, and other displays. Different ways to prevent myopia, such as correct near work related behaviours, increase outdoor activities, use standardized classroom desks and chairs, and use specific lighting were taught or adopted. Theme class meetings about ocular health were provided to every class in the intervention school at the beginning of every semester(which was approximately every 6mo). The intervention started at the beginning of October 2012. Parents and teachers were also educated on ocular health at the first semester. In addition, a handbook of ocular health prepared by the research team was issued to the children and their parents. Second,children were cultivated to develop correct near-work related behaviours. Behavioural intervention was implemented during their classes. The researchers corrected their reading posture and near-work distance. Teachers also encouraged students to go outside during class breaks.

通過對直接粉碎、經減壓干燥法、液氮凍干法、凍干法處理的枸杞子顆粒，粉碎后測定特性量值。實驗結果表明，經3種預處理方法得到的枸杞子樣品，其水分測定結果均低于直接粉碎的枸杞子樣品；而其他檢測項目，3種處理方法得到的樣品與直接粉碎的枸杞子樣品基本相同，理化性質均符合《中國藥典》2015年版要求，可以作為對照藥材標準品使用。但基于成本考慮，減壓干燥法最經濟實惠，采用凍干法或液氮加凍干法的運行成本基本相似，均較高。因此，在實際工作中，推薦使用減壓干燥法最佳。

“秦晨蕊，你不要擔心沒有新鮮的瓜果蔬菜吃，你媽不能種了，我還能種給你們吃。”父親花白的頭發在陽光下格外顯眼。

The participants underwent eye examinations given by 4 trained ophthalmic nurses, two experienced senior optometrists and two ophthalmic graduate students a week after theme class meetings about ocular health every semester.Visual acuity and noncycloplegic refraction were assessed each semester (6 times total), axial length (AL) was assessed annually for 2y (3 times). The autorefractor measurements were performed without cycloplegia by skilled optometrists.Each eye was measured at least three times by an autorefractor(Topcon RM8900, Topcon Co., Tokyo, Japan). Three reliable measurements were then be averaged.

世界范圍內資本賬戶開放的浪潮大致經歷了80年代各國爭相放開，90年代發展中國家陸續發生貨幣危機從而產生質疑，再到目前注重時序性和漸進性政策三個階段。歷史經驗表明，資本項目開放的收益多體現在發達國家，而較少見諸發展中國家，而一些經濟、金融欠發達的中小發展中國家，往往因為缺少資本管制的屏障保護而成為國際投機資本攻擊的犧牲品。因此，如何充分享受資本項目開放的收益成為政策面臨的重大挑戰。前國際貨幣基金組織總裁Camdessus提出，亞洲金融危機的根源在于既定的宏觀經濟環境和制度背景下，資本項目開放措施與經濟金融等改革的銜接出現了問題[1]。……