Pediatricians' focus of sight at pain assessment during a neonatal heel puncture / Foco do olhar do pediatra na avaliação da dor neonatal durante uma punção de calcanhar

ABSTRACT Objective: To evaluate the focus of pediatricians' gaze during the heel prick of neonates. Methods: Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians' pain perception: absent/mild (score: 0-5) and moderate/intense (score: 6-10). Results: 24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5-8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain. Conclusions: At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.

RESUMO Objetivo: Avaliar o foco do olhar do pediatra durante a punção do calcanhar de neonatos. Métodos: Estudo prospectivo no qual pediatras, utilizando óculos de rastreamento visual, avaliaram a dor neonatal antes/depois de uma punção de calcanhar. Os pediatras pontuaram a dor de acordo com a sua percepção por meio de uma escala analógica verbal (0=sem dor; 10=dor máxima). Os desfechos analisados foram o número e o tempo das fixações visuais na face superior, face inferior e mãos, em dois períodos de 10 segundos, antes (PRÉ) e depois da punção (PÓS). Os resultados foram comparados entre os períodos e segundo a percepção da dor do pediatra: ausente/leve (escore: 0-5) e moderada/grave (escore: 6-10). Resultados: Vinte e quatro pediatras (31 anos, 92% sexo feminino) avaliaram 24 neonatos. A mediana do escore atribuído à dor do recém-nascido durante a punção do calcanhar foi 7,0 (intervalo interquartil: 5-8). Comparado ao período PRÉ, no período PÓS, o maior número de pediatras fixou o olhar na face inferior (63 vs. 92%; p=0,036) e o número de fixações visuais foi maior na face inferior (2,0 vs. 5,0; p=0,018). Não houve diferença no número e no tempo das fixações visuais de acordo com a intensidade da dor. Conclusões: À beira do leito, os pediatras mudam seu foco de atenção visual na face do recém-nascido após um procedimento doloroso, focando o olhar principalmente na parte inferior da face.

Research progress on the association between screen exposure and autism spectrum disorder in preschool children / 中国学校卫生

Abstract@#Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Early life social experience assessment before symptoms of ASD might be helpful for determining the causal link between social experiences and early childhood ASD. Younger children are exposed to excessive screen time in recent years. This paper summarizes the association between screen exposure with ASD in preschool children, and proposes future research directions and provides evidencebased guidance to optimize and support children s early media experiences.

Effect of screen time on sleep in preschool children in Haikou City / 中国学校卫生

Objective@#To understand the impact of screen time on duration and quality of sleep, so as to provide scientific basis for the development of interventions.@*Methods@#A total of 3 584 preschool children in Haikou City were selected by stratified sampling method from March to June in 2022, and the Children s Sleep Habits Questionnaire (CSHQ) and self designed questionnaire were used.@*Results@#The average sleep duration of preschool children was (10.41±0.98)h/d, the rate of sleep deprivation was 28.71 %, and the report rate of sleep problems was 50.47%. The average sleep duration in general as well as on weekdays and weekends decreased by age ( F=21.00, 29.53, 3.26, P ＜0.05), and insufficient sleep duration rate significantly varied by age groups ( χ 2=29.85, P ＜ 0.01 ). The average screen time was (1.15±0.37)h/d, and the screen exposure rate was 55.39%. The total sleep problems ( 52.14 %), poor bedtime habits (43.02%), daytime sleepiness (67.10%), irregular sleep duration (53.05%), and abnormal sleep latency ( 24.99 %) were all higher than those in the non exposed group (48.41%, 39.59%, 63.29%, 48.91%, 19.57 %) ( χ 2= 4.94 , 4.31, 5.69 , 6.08, 14.85, P <0.05). Multiple linear regression analysis showed that age and weekend average screen time were negatively associated with sleep duration ( β =-0.01, -0.06), weekday and weekend average outdoor activity duration were positively correlated with sleep duration ( β =0.08, 0.08) ( P <0.05).@*Conclusion@#Screen exposure to preschool children s sleep time,sleep quality was closely related. Parents should cultivate good sleep habits of preschool children, and limit children s screen time to maximize outdoor activities, so as to ensure healthy development of children.

Relationship between physical fitness and energy balance related behaviors of primary school students in Shaanxi Province / 中国学校卫生

Objective@#To explore the relationship between physical fitness and energy balance related behaviors (EBRBs), and their influencing factors among primary school students, so as to provide a scientific basis for the improvement of physical fitness in primary school students.@*Methods@#By using a random sampling method, a total of 1 451 pupils aged 10-12 were selected from 8 regions of Shannxi Province (Fengxiang, Weibin, Danfeng, Shangzhou, Huazhou, Linwei, Gaoling, Weiyang). According to the total score of physical fitness test, pupils were divided into the excellent good physical fitness group and the pass failed group. The students EBRBs and their influencing factors were investigated cross sectionally, and the Mann-Whitney U test and stepwise linear regression analysis were used to explore the relationship between physical fitness and EBRBs.@*Results@#Breakfasts behavior( r = 0.061 ) and physical activity behavior( r =0.105) among primary school students were positively correlated with total physical scores, with the excellent good physical fitness group (757.56, 768.57)were higher than that of the pass failed group(710.93, 705.67) ( Z= -2.41, -2.69, P <0.05). The screen behavior ( r =-0.065) was negatively correlated with the total physical fitness scores, with the excellent good physical fitness group (681.96) was significantly lower than the pass failed group(747.04) ( Z=2.78, P < 0.05 ). There was no statistically significant correlation between the frequency of beverage behavior and the total score of physical fitness ( P >0.05). The excellent good physical fitness group scored(762.22, 761.19, 758.82, 756.00, 761.20, 755.57, 761.52, 759.48, 781.78) higher than the pass failed group(708.70, 709.19, 710.32, 711.67, 709.19, 711.88, 709.04, 710.01, 699.36) including health beliefs, parental norms and parental role models for breakfast behaviors, and preferences, self efficacy, and self regulation for physical activities, as well as self efficacy, parental role models, family rules for screen behavior ( Z=-2.40, -2.78, -2.35, -2.48, -2.52, -2.27, -2.35, -2.22, -3.65, P <0.05).@*Conclusion@#The physical fitness of primary school students is affected by EBRBs. Parents should model positive behaviors in the family, promote the health behavior of primary school students, improve the physical health of primary school students health.

Relationship between physical fitness and energy balance related behaviors of primary school students in Shaanxi Province / 中国学校卫生

Objective@#To explore the relationship between physical fitness and energy balance related behaviors (EBRBs), and their influencing factors among primary school students, so as to provide a scientific basis for the improvement of physical fitness in primary school students.@*Methods@#By using a random sampling method, a total of 1 451 pupils aged 10-12 were selected from 8 regions of Shannxi Province (Fengxiang, Weibin, Danfeng, Shangzhou, Huazhou, Linwei, Gaoling, Weiyang). According to the total score of physical fitness test, pupils were divided into the excellent good physical fitness group and the pass failed group. The students EBRBs and their influencing factors were investigated cross sectionally, and the Mann-Whitney U test and stepwise linear regression analysis were used to explore the relationship between physical fitness and EBRBs.@*Results@#Breakfasts behavior( r = 0.061 ) and physical activity behavior( r =0.105) among primary school students were positively correlated with total physical scores, with the excellent good physical fitness group (757.56, 768.57)were higher than that of the pass failed group(710.93, 705.67) ( Z= -2.41, -2.69, P <0.05). The screen behavior ( r =-0.065) was negatively correlated with the total physical fitness scores, with the excellent good physical fitness group (681.96) was significantly lower than the pass failed group(747.04) ( Z=2.78, P < 0.05 ). There was no statistically significant correlation between the frequency of beverage behavior and the total score of physical fitness ( P >0.05). The excellent good physical fitness group scored(762.22, 761.19, 758.82, 756.00, 761.20, 755.57, 761.52, 759.48, 781.78) higher than the pass failed group(708.70, 709.19, 710.32, 711.67, 709.19, 711.88, 709.04, 710.01, 699.36) including health beliefs, parental norms and parental role models for breakfast behaviors, and preferences, self efficacy, and self regulation for physical activities, as well as self efficacy, parental role models, family rules for screen behavior ( Z=-2.40, -2.78, -2.35, -2.48, -2.52, -2.27, -2.35, -2.22, -3.65, P <0.05).@*Conclusion@#The physical fitness of primary school students is affected by EBRBs. Parents should model positive behaviors in the family, promote the health behavior of primary school students, improve the physical health of primary school students health.

Relationship between physical fitness and energy balance related behaviors of primary school students in Shaanxi Province / 中国学校卫生

Objective@#To explore the relationship between physical fitness and energy balance related behaviors (EBRBs), and their influencing factors among primary school students, so as to provide a scientific basis for the improvement of physical fitness in primary school students.@*Methods@#By using a random sampling method, a total of 1 451 pupils aged 10-12 were selected from 8 regions of Shannxi Province (Fengxiang, Weibin, Danfeng, Shangzhou, Huazhou, Linwei, Gaoling, Weiyang). According to the total score of physical fitness test, pupils were divided into the excellent good physical fitness group and the pass failed group. The students EBRBs and their influencing factors were investigated cross sectionally, and the Mann-Whitney U test and stepwise linear regression analysis were used to explore the relationship between physical fitness and EBRBs.@*Results@#Breakfasts behavior( r = 0.061 ) and physical activity behavior( r =0.105) among primary school students were positively correlated with total physical scores, with the excellent good physical fitness group (757.56, 768.57)were higher than that of the pass failed group(710.93, 705.67) ( Z= -2.41, -2.69, P <0.05). The screen behavior ( r =-0.065) was negatively correlated with the total physical fitness scores, with the excellent good physical fitness group (681.96) was significantly lower than the pass failed group(747.04) ( Z=2.78, P < 0.05 ). There was no statistically significant correlation between the frequency of beverage behavior and the total score of physical fitness ( P >0.05). The excellent good physical fitness group scored(762.22, 761.19, 758.82, 756.00, 761.20, 755.57, 761.52, 759.48, 781.78) higher than the pass failed group(708.70, 709.19, 710.32, 711.67, 709.19, 711.88, 709.04, 710.01, 699.36) including health beliefs, parental norms and parental role models for breakfast behaviors, and preferences, self efficacy, and self regulation for physical activities, as well as self efficacy, parental role models, family rules for screen behavior ( Z=-2.40, -2.78, -2.35, -2.48, -2.52, -2.27, -2.35, -2.22, -3.65, P <0.05).@*Conclusion@#The physical fitness of primary school students is affected by EBRBs. Parents should model positive behaviors in the family, promote the health behavior of primary school students, improve the physical health of primary school students health.

Development of an Assessment Questionnaire for Screen based Behaviors among Primary and Secondary School Students / 中国学校卫生

Objective@#To develop an assessment questionnaire for screen based behaviors among primary and secondary school students, so as to provide a basis for comprehensive assessment among the population.@*Methods@#Nineteen experts were invited to take part in this study from August to September 2022. The initial framework and item pool of the assessment questionnaire were developed based on literature review and a series of guidelines and standards issued by the national education and health authorities, as well as relevant domestic and foreign guidelines, and were combined with existing assessment tools that were used to evaluate screen based behavior among these age groups. Experts in related fields were selected for two rounds of Delphi consultation to determine the dimensions, items and corresponding weights of the assessment questionnaire.@*Results@#The response rates from two rounds of consultation were 95.0% and 100.0% respectively, the opinion submission rates were 89.5% and 63.2% respectively, and the authority coefficient ( Cr ) was 0.87. An assessment questionnaire was finally designed, consisting in 44 items and four dimensions, namely screen use type and time, screen use related health behaviors, safety and civilization in screen use, and reasonable arrangement of screen and non screen activities. The coefficient of variation( CV ) of each item ranged from 0.00 to 0.19, and the Kendall s W increased from 0.22 to 0.34( P <0.01). Expert opinions were in agreement and credible.@*Conclusion@#The designed assessment questionnaire can be used to comprehensively evaluate screen based behavior among primary and middle school students, and provides a basis for subsequent intervention measures to improve screen based behavior among this population.

Review on screen time among children and adolescents and impact on mental health / 中国学校卫生

Abstract@#The popularization of the use of electronic has become a global trend, and children are exposed to devices at younger ages. A large proportion of children and adolescents spend on screen time more than 2 h which is recommended in most guidelines. The paper reviews possible effects of screen time on physical and mental health, as well as mental disorders in children and adolescents. It is found that excessive screen time showed negative impacts on mental health, including depression, anxiety, mood disorder, social adaptational problems, behavioral disorders, self injurious behaviors, and health risk behaviors. Much attention has been paid on the association between excessive screen time and mental health of children and adolescents, while possible mechanisms and influencing factors are lacking. Effective intervention studies are needed to provide a basis for child and adolescent health promotion.

Association of screen time with psychological and behavioral development problems in children aged 3-6 years / 中国学校卫生

Objective@#To investigate the distribution of various types of screen time and examine the association of screen time with psychological and behavioral development problems in children aged 3-6 years, so as to provide scientific basis for children s screen use and mental health promotion.@*Methods@#A total of 3 875 mother child dyads who completed the follow up in Shanghai Maternal-Child Pairs Cohort were included. The daily usage time of children s tablet, mobile phone, TV, projectors, and other types of screens were obtained in questionnaire survey. Children s psychological and behavioral development problems were evaluated by Age-Stage Questionnaire, Third Edition (ASQ-3) and Strengths and Difficulties Questionnaire (Parent version) (SDQ). The Chi-square test, Mann Whitney U and Kruskal Wallis rank sum test were used to compare the detection rate of psychological and behavioral development problems and screen time in children with different characteristics. Multivariate binary Logistic regression was used to analyze the association of screen time with psychological and behavioral development problems.@*Results@#There were 49.91% of children having screen time more than 1 h/d. Children s TV, tablet and mobile phone screen time were 0.39(0.25, 0.96 ), 0.25(0,0.61) and 0.18(0,0.25) h/d. The detection rates of suspected developmental delay in fine motor, problem solving and personal-social domains and pro social behavior deficiency and externalizing behaviors in boys (8.54%, 6.77%, 5.46%, 30.07 %, 27.39%) were higher than that in girls (4.64%, 4.85%, 2.48%, 22.10%, 22.36%) ( χ 2=23.76, 6.49, 22.37, 31.81, 13.06, P <0.05). There were statistically significant differences in the detection rates of suspected developmental delay in communication, fine motor and problem solving, as well as internalizing behavior and externalizing behavior of children with different parents educational levels ( χ 2=14.37, 15.18, 21.10, 11.66, 9.27; 16.34, 26.75, 32.89, 16.97, 6.37, P <0.05). There were significant differences in the detection rates of suspected developmental delay in problem solving, prosocial behavior deficiency, internalizing behavior and externalizing behavior of children whose mothers had anxiety/depression symptoms during pregnancy ( χ 2= 5.61 , 9.05, 21.90, 7.17; 8.75, 6.06, 12.76 , 5.55, P <0.05). The average total screen time of boys was longer than that of girls (1.07, 1.00 h/d, Z=-2.08, P =0.04). Compared with children with other educational levels of their parents, the total screen time, mobile phone and TV screen time of children whose parents had college education or above were short (father: H =42.01, 44.49 , 21.24, mother: H =42.31, 39.21 , 26.47, P <0.01). Among all types of screen time, mobile phone screen time had the most impact on psychological and behavioral development. More mobile phone screen time increased the risk of suspected developmental delay and abnormal emotional behavior ( P < 0.05). Screen time of tablet, mobile phone and TV were positively correlated with externalizing behavior ( OR=1.36, 1.57, 1.27 , P <0.05).@*Conclusions@#Screen time is related to children s psychological and behavioral development problems and mobile phones affect the most. Parents should limit their children s screen time to avoid excessive screen time affecting their psychological and behavioral development.

Relationship between screen time and gross motor development among preschool children / 中国学校卫生

Objective@#To analyze the relationship between screen time and gross motor development and to provide scientific basis for health promotion among preschool children.@*Methods@#In March 2021, gross motor of 373 children from 5 kindergartens in Baotou was tested by Test of Gross Motor Development (TGMD). Screen time (ST) was collected by parental questionnaire. Paired t-test was used to compare the screen time between working days and weekends, and independent sample t-test was used to compare the differences of children s motor development between different sexes.@*Results@#ST of children was (52.10±31.67) min/d during the week and (65.79±10.36) min/d during the weekend. There were significant differences in the total scores of gross motor and mobile motor of children in different sexes( t=2.35, 2.65, P <0.05). The correlation between total screen time and gross motor, mobile motor and operant motor was statistically significant ( r =-0.22--0.20, P <0.01). Multiple linear regression showed that the time spent watching TV and the time spent using mobile phones during the week were the main factors affecting the gross motor development.@*Conclusion@#There is a significant negative correlation between children s screen time and gross motor development. It is important to reduce the time spent on TV and mobile phone to improve childhood gross motor development.

Screen use behavior before and after COVID-19 among primary and middle school students in Shanghai / 中国学校卫生

Objective@#The current situation and associated factors of primary and middle school students screen time and related eye hygiene in different periods before and after COVID-19 were investigated, so as to provide a scientific basis for taking targeted measures of preventing and controlling myopia among those students.@*Methods@#A total of 11 402 students were selected from 24 primary schools, 18 junior high schools and 16 high schools by multi stage stratified cluster sampling method. And a questionnaire survey was conducted among students and their parents to understand students screen time and screen hygiene behaviors and related factors in different periods before and after the outbreak of COVID-19.@*Results@#The rate of screen overuse was 7.26%, 9.12% and 35.30% during school days, weekends and home study, respectively. The overuse rate of mobile phones and tablets at home increases with the increase of school stage. Totally 16.30% of students use mobile phones for online learning. The screen overuse rate of those who have not been diagnosed with myopia was lower than that of those who have been diagnosed during home study( OR=0.77, P <0.05). The higher the parents educational level was, the lower the screen overuse rate of children during the weekends became( P <0.05). In any period, the high proportion of screens used in homework and poor home screen eye environment increased the risk of screen overuse and poor eye hygiene ( P <0.05). Parental good behavior was conducive to reducing the risk( OR= 0.65-0.97, P <0.05). When the family had regulation on the screen use time, the implementation of laxity would increase the risk of screen overuse ( OR=1.18-2.48, P <0.05).@*Conclusion@#The screen overuse rate of urban primary and middle school students during home study is high, and a certain proportion of students still use mobile phones for online learning. The proportion of screens used in homework, home screen eye environment and screen use management are related to screens overuse. More attention should be paid to those with myopia and low educational level of parents.

Association of physical activity and screen time with overweight and obesity in preschool children / 中国学校卫生

Objective@#To analyze the association between physical activity and screen time with overweight and obesity in preschool children, and to provide evidence for childhood obesity prevention and control.@*Methods@#Using a case control study design, 109 overweight or obese children (the case group) were recruited from four kindergartens from a community of Chaoyang District, Beijing, and 117 children with normal weight in the same kindergarten (the control group) were recruited as control. Gender and age were matched between the case and the control group. Univariate analysis was used to compare the demographics, physical activity time, screen time, sleep and diet characteristics between the two groups. Logistic regression was used to analyze the association of physical activity and screen time with overweight and obesity in preschool children with adjustment for covariates.@*Results@#After adjusting for age, gender, average daily sleep time, the total score of Children s Sleep Habits Questionnaire (CSHQ), Chinese diet balance index for preschool children (DBI-C), children with <3 h of daily physical activity had an increased risk of overweight and obesity compared with those with ≥3 h of physical activity ( OR=2.55,95%CI=1.16-5.64，P =0.02), and the risk of overweight and obesity increased with each additional quartile of daily screen time in children ( OR=2.44,95%CI=1.69-3.52, P <0.01).@*Conclusion@#Insufficient physical activity and excessive screen time are independent risk factors of overweight and obesity in preschool children. Comprehensive intervention measures should be taken to effectively increase physical activity and reduce screen time for overweight and obesity prevention and control in preschool children.

Relationship between screen time, sleep duration and depressive symptoms among middle school students / 中国学校卫生

Objective@#To explore the prevalence of depressive symptoms among middle school students in Nanjing and the relationship between screen time, sleep duration and depressive symptoms, and to provide a scientific reference for depression prevention in adolescents.@*Methods@#Using stratified cluster random sampling method, a total of 2 010 students from 5 middle schools in urban areas and 3 middle schools in suburban counties were selected. Screen time and sleep duration were evaluated through questionnaires, and depressive symptom was assessed by the Center for Epidemiological Studies Depression Scale (CES-D).@*Results@#The prevalence of depressive symptoms (CES-D≥16) was 27.71%(557). Logistic regression analysis showed that students with screen time >2 h/d( OR=1.90, 95%CI =1.53-2.37), sleep duration <7 h/d ( OR=2.54, 95%CI =1.88-3.42) were statistically associated with depressive symptoms. stratified analysis showed that, sleep duration of <7 h/d was associated with increased odds of depressive symptoms, the magnitude among students with screen time >2 h/d( OR=2.46, 95%CI =1.64-3.71) was higher than those with screen time ≤2 h/d( OR=2.35, 95%CI =1.51-3.65).@*Conclusion@#High prevalence of depressive symptoms was observed among middle school students in Nanjing. Prolonged screen time and insufficient sleep duration are associated with increased odds of depressive symptoms. Attention should be paid to the mental health of adolescents with the combined exposure of screen based activities and lack of sleep.

Association between outdoor activity, screen time and the performance of 20 meter shuttle run test among children and adolescents / 中国学校卫生

Objective@#To analyze the relationship between outdoor activity, screen time and 20 meter shuttle run test (20 m SRT) score among children and adolescents in Baoan District, Shenzhen, so as to provide scientific basis for the management and promotion of physical health of children and adolescents.@*Methods@#Stratified cluster sampling was used to select students from 14 schools in 6 communities in Baoan District of Shenzhen, from April to May 2019. A self designed questionnaire was used to investigate demographic characteristics, outdoor activity duration and screen time of primary and middle school students. A total of 3 192 primary and secondary school students in grade 1-12 were selected from each school. Weight, height and 20 m SRT were measured.@*Results@#About 985(30.9%) out of 3 192 primary and middle school students were estimated excellent on 20 m SRT test, with boys being higher than that of girls (34.7% vs 26.3%) ( χ 2=26.43, P <0.01). Logistic regression analysis showed that compared with the group with outdoor activity <2 h/d, the excellent and good performers on 20 m SRT with outdoor activity time ≥2 h/d was higher( OR=1.38, 95%CI =1.12-1.70). Compared with students with screen time ≥2 h/d, the excellent and good performers on 20 m SRT with screen time <2 h/d was higher( OR=1.42, 95%CI=1.17-1.71). Compared with students with outdoor activity time < 2 h/d and screen time ≥ 2 h/d, students with outdoor activity time ≥2 h/d and video time < 2 h/d had a higher proportion of excellent score on 20 m SRT( OR=1.97, 95%CI =1.46-2.67).@*Conclusion@#Increasing outdoor activity and reducing screen time are helpful to improve the performance score of 20 m SRT among primary and secondary school students.

Relationship between bullying victimization and perpetration, academic achievement and screen time among primary and secondary school students / 中国学校卫生

Objective@#The study aims to determine the latent class of roles in bullying victimization and perpetration among primary and secondary school students and to explore its relationship with academic achievement and screen use, to provide a reference for developing preventive measures and intervention plans.@*Methods@#A total of 29 099 students at grade 5,6,7,8,10, and 11 from Shenzhen were surveyed through convenient cluster sampling method by Olweus Bully/Victim Questionnaire. The latent class analysis was used for classifying bully/victim category.@*Results@#The latent class analysis revealed three classes, the noninvolvement group (low response rate at all items, 80.9%), the bullying victimization group (low response rate at bullying and high response rate at victimization items, 15.9%), and the bullying victimization and perpetration group (high response rate at all items,3.3%). Boys were more likely than girls to belong to the bullying victimization and perpetration at all study sections ( OR =0.83,0.74, 0.47 , P <0.05). Transfer students were at higher risk to be in the bullying victimization group in elementary and middle school ( OR = 1.21 ,1.21), while they were more likely to fall into the bullying victimization and perpetration group in high school ( OR =2.65)( P < 0.05). Students with poor academic performance were more likely to be in the bullying victimization group at all sections ( OR = 0.98 ,0.98,0.98) and in the bullying victimization and perpetration group at elementary and middle school ( OR =0.97, 0.98)( P < 0.05 ). Students spending longer time on screen had elevated risk in the bullying victimization group ( OR =1.06,1.04,1.08, P < 0.05 ).@*Conclusion@#Students with poor academic achievement and prolonged screen time are at higher risks to be involved in bullying victimization and perpetration. Collaboration between home and school are needed to preventing bullying victimization perpetration.

Relationship between physical activity screen time and sleep duration and overweight and obesity among children and adolescents in Beijing Tianjin Hebei region / 中国学校卫生

Objective@#To investigate the relationship among physical activity, sleep duration and screen time and overweight and obesity among children and adolescents in Beijing Tianjin Hebei region, and to provide reference for children and adolescents in Beijing Tianjin Hebei region to maintain healthy physique.@*Methods@#In November 2019, 4 262 primary and secondary school students in Beijing Tianjin Hebei region were surveyed on physical activity, sleep status and screen time according to the physical activity guidelines for children and adolescents, and the relationship between overweight and obesity was analyzed by Logistic regression.@*Results@#The prevalence of overweight and obesity among children and adolescents in Beijing Tianjin Hebei region was 22.03%. The positive rate of overweight was 12.01% and obesity was 10.02%. The prevalence of overweight and obesity in male students (26.09%) was higher than that in female students (17.88%), the difference was statistically significant ( χ 2=41.77, P < 0.01 ). The prevalence of overweight and obesity in urban children (24.09%) and Han children (22.74%) was significantly higher than that in rural areas (21.05%) and ethnic minorities (17.70%) ( χ 2=5.00, 7.63, P <0.05). The proportion of children who met physical activity, screen time and sleep duration guideline was 24.85%, 38.69% and 57.09%, respectively. A total of 21.68% of children and adolescents did not meet the guideline of physical activity, screen time and sleep duration, among which 42.80% and 28.77% met the guideline for one or two out of three behaviors, respectively. Only 6.76% of children and adolescents met the guideline of all three behaviors. Logistic regression analysis showed that the risk of overweight and obesity was negatively correlated with sleep duration ( OR=0.72, 95%CI =0.52-0.98). The risk of overweight and obesity was lower in patients with 2 criteria than in those with less sleep duration and less screen time ( OR=0.57, 95%CI =0.36-0.87).@*Conclusion@#Percentage of sufficient physical activity among children and adolescents in Beijing Tianjin Hebei region is low, and ensuring sufficient sleep duration is helpful for overweight and obesity prevention. The impact of sleep duration and screen time on overweight and obesity in children and adolescents should be considered in childhood obesity prevention and control.

Electric screen time of urban preschoolers during and before COVID-19 / 中国学校卫生

Objective@#To determine the influencing factors of electronic screen time of urban preschoolers before and after the COVID-19 outbreak, so as to provide a scientific basis for the control of digital screen use and early prevention of myopia among preschoolers.@*Methods@#Using multi stage cluster random sampling method, a cross sectional survey of 8 244 kindergarten students in a district of Shanghai was implemented, through parent questionnaire collecting the time child spent on various electronic screens before and after the COVID-19 outbreak, estimated the weighting screen time, and emphatically analyzed the relationship between family electronic screen supervision behavior and preschoolers weighting screen time.@*Results@#The proportion of daily over use time on average of mobile phones, computers and TV/projection screens among the surveyed preschool children during COVID-19 was 30.52%, 51.40% and 56.82%, respectively. On school days before the epidemic, the proportion was 21.94%, 41.80% and 47.51% respectively. After controlling for primary covariates, parents frequent control of children s electronic screen use, parents guidance for electronic screen use were significantly associated with lower weighted screen refractive time ( OR =0.60-0.77, P < 0.05 ). The use of electronic screen when parents accompanied their children, the use of electronic screen time by parents but not strictly implemented were significantly associated with higher weighted screen refractive time and increased screen refractive time ( OR =1.18-1.80, P <0.05).@*Conclusion@#Urban preschoolers electronic screen time was high during and before COVID-19. In the control measures of preschool children s electronic screen time, attention should be paid to the management of electronic screen use within the family and parents role model.

Online learning related screen use and associated factors in school aged children in Shanghai during the COVID-19 epidemic / 中国学校卫生

Objective@#To understand the online learning related screen use duration and screen types in school aged children in Shanghai during the COVID-19 epidemic.@*Methods@#Random clustering sampling was used to select 5 591 parents of students from 8 primary and junior schools that are in the sampling pool of the national myopia survey in districts of Jiading, Pudong and Baoshan in Shanghai in April 2020. Electronic questionnaire was administered to parents regarding their child s online learning related screen use.@*Results@#On average, the median weekly duration of online learning related screen use was 13.33 hours, the curricular and extracurricular parts of which were 10(8.75，16.67) and 0(0，3.33) hours, respectively. About 29.44% of investigated school aged children only used small size screen for online learning. Children in higher grades, being myopic and parents neither being myopic were associated with reporting higher weekly duration( P <0.05); children in higher grades of primary school and parents neither being myopic were associated with a higher likelihood of using small size screen for online learning( P <0.05).@*Conclusion@#At the early stage of the COVID-19 epidemic, the burden associated with online learning related screen use was high in school aged children in Shanghai. Health education regarding online learning related screen use should be addressed in parents to guide their children to use screen appropriately.

Relationship between screen time and myopia in children aged 11-14 years in China / 中国学校卫生

Objective@#To explore relationship between screen time and myopia in children aged 11-14 years in China.@*Methods@#The data were extracted from "National Nutrition and Health Systematic Survey and Application for 0-18 Years Old Children". A total of 12 397 children aged 11-14 years old from 14 provinces and 28 districts/counties in seven regions of China were surveyed by using multi stage stratified random sampling method. Daily screen time and visual acuity information were collected through a questionnaire.@*Results@#The myopia rate of 11-14 years old children in China was 45.0%, among which the rate of girls was higher than that of boys, and the rate of urban was higher than that of rural, and it increased with age ( χ 2=178.82,79.25, 495.96 , P <0.01). The daily screen time median of 12 397 children was 40.0 minutes, with boys(40.0 min) longer than girls( 35.0 min ) and urban children(40 min) longer than rural children(33.0 min) ( χ 2=20.86，102.68， P <0.01). The myopia rate of boys ( 42.5 %) with daily screen time greater than or equal to 60 minutes was higher than that of boys (36.4%) with daily screen time less than 60 minutes, and the myopia rate of girls (55.6%) with daily screen time greater than or equal to 60 minutes was higher than that of girls (48.0%)( χ 2=23.62，34.15， P <0.01). After adjusting for age, gender, region, time of medium and high intensity physical activity, intake of sugary food and sugary beverages, daily sleep time, multivariable Logistic regression model showed that girls with daily screen time greater than or equal to 60 minutes ( OR=1.14, 95%CI =1.03-1.27) had a higher risk of myopia than those with less than 60 minutes. After adjusting for confounding factors, there was no correlation between daily screen time and the degree of myopia in boys or girls( P >0.05).@*Conclusion@#Daily screen time greater than or equal to 60 minutes may be a risk factor for myopia in girls aged 11 to 14 years old. Given the complexity of the factors that affect vision, researches are needed to examine the relationship between screen time and myopia.

Microperimetry differences in macular sensitivity threshold between first and second tested eyes / Diferenças no limiar de sensibilidade macular na microperimetria entre o primeiro e o segundo olhos testados

ABSTRACT Purpose: To comparatively assess the macular sensitivity threshold of microperimetry and the fixation stability between the first (right) and second (left) tested eye of normal participants. Methods: Thirty healthy patients were randomly assigned to two groups. The participants underwent microperimetry in the fast mode and expert mode in groups I and II, respectively. Each participant underwent a single test and the right eye was tested first. Results: The mean macular sensitivity threshold (± standard deviation [SD]) was 24.5 ± 2.3 dB and 25.7 ± 1.1 dB in the first (right) and second (left) eyes of group I, respectively (p=0.0415) and 26.7 ± 4.5 dB and 27.3 ± 4.0 dB in the first (right) and second (left) eyes of group II, respectively (p=0.58). There was no statistically significant difference between eyes in either group (p=0.1512). Regarding fixation stability (evaluated in the microperimetry expert mode group), the mean ± SD percentage of fixation points within the 1-degree central macula (P1) was 87.9 ± 11.5% in the right eye and 93.8 ± 6.6% in the left eye. The paired t-test did not show a statistically significant difference between eyes (p=0.140). Mean ± SD P2 value was 95.5 ± 4.9% in the right eye and 98.5 ± 2.1% in the left eye. The analysis demonstrated an increase in the percentage of fixation points in the second tested eye compared with the first one (paired t-test= 2.364; p=0.034). There was a negative correlation between the macular sensitivity threshold of the right eye and the duration of the examination for both groups (microperimetry expert mode: r=-0.717; p=0.0026; microperimetry in the fast mode: r=-0.843; p<0.0001). Conclusion: Mean macular sensitivity threshold was higher in the second tested eye in the microperimetry in the fast mode group and was similar in both eyes in the expert mode. Our data suggest that comprehension of the examination by the individual may impact the results of the microperimetry test.(AU)

RESUMO Objetivo: Avaliar comparativamente o limiar de sensibilidade macular da microperimetria e a estabilidade de fixação entre o primeiro (direito) e o segundo (esquerdo) olhos testados de indivíduos normais. Métodos: Trinta pacientes saudáveis foram divididos aleatoriamente em 2 grupos. Os participantes foram submetidos à microperimetria no "fast mode" e no "expert mode" no grupo I e II, respectivamente. Cada participante foi submetido a um único teste e o olho direito foi testado primeiro. Resultados: No grupo I, o limiar médio de sensibilidade macular (± DP) foi de 24,5 ± 2,3 dB e 25,7 ± 1,1 dB nos olhos direito e esquerdo, respectivamente (p=0,0415). No grupo II foi de 26,7 ± 4,5 dB e 27,3 ± 4,0 dB nos olhos direito e esquerdo, respectivamente (p=0,58). Não houve diferença estatisticamente significativa entre os olhos dos dois grupos (p=0,1512). Em relação à estabilidade de fixação (avaliada no grupo microperimetria no "expert mode"), a média das porcentagens dos pontos de fixação dentro do 1 grau central da mácula (P1) ± DP foi de 87,9 ± 11,5% no olho direito e de 93,8 ± 6,6% no olho esquerdo. O teste t pareado não mostrou diferença estatística entre os olhos (p=0,140). O valor médio de P2 ± DP foi de 95,5 ± 4,9% no olho direito e 98,5 ± 2,1% no olho esquerdo. Foi demonstrado um aumento na porcentagem de pontos de fixação no segundo olho testado quando comparado ao primeiro (teste t pareado= 2,364; p=0,034). Houve correlação negativa entre o limiar de sensibilidade macular do olho direito e a duração do exame nos dois grupos (microperimetria no "expert mode": r=-0,717; p=0,0026; microperimetria no "fast mode": r=-0,843; p <0,0001). Conclusão: O limiar médio de sensibilidade macular foi maior no segundo olho testado no grupo microperimetria no "fast mode" e foi semelhante nos dois olhos no "expert mode". Nossos dados sugerem que a compreensão do exame pelo indivíduo pode impactar nos resultados da microperimetria.(AU)