A Cross-Sectional Pilot Study of Parental Outdoor Play Preferences and Association With Child Overweight and Obesity.

Childhood obesity is highly prevalent among certain populations of New York. This cross-sectional pilot study examined the associations between parental attitudes about outdoor activities and body mass index (BMI). A questionnaire was distributed among parents of 1 to 13 aged children at ambulatory pediatric clinics. Of 104 children included in the study 57 were of normal weight and 47 were overweight or obese. Most parents of children with BMI <85% reported frequent playground utilization, considered longer hours to spend outside on weekdays, reported a larger total temperature range for outdoor playground utilization and a lower tolerable minimum temperature compared to parents of children with BMI ≥85%, p < .05. Only having a parent born outside of the United States remained a significant predictor of overweight and obesity in the final model. Parents of children with BMI < 85% are more willing to spend time outdoors, regardless of weather. Immigrant parents are protective against overweight.

The prevalence of myopia remains stable under tighter COVID-19 social restriction in preschoolers receiving a school-based eyecare program.

PURPOSE: This study investigated the impact of different levels of COVID-19 social restrictions (social distancing in 2020, large-scale home confinement in 2021) on myopia prevalence and behaviours in a preschool population with school-based eyecare programme. METHODS: Repeated cross-sectional surveys were conducted between August and December in 2019, 2020 and 2021. Children aged 5-6 years received ocular examinations, and questionnaires were answered by caregivers before the day of the examination. The main outcome measures were the changes in after-school time spent on homework, screen-based devices and outdoors. Secondary outcome was the change in myopia prevalence (spherical equivalent [SE] ≤ -0.5 D in either eye after cycloplegia). RESULTS: A total of 9997 preschoolers were included in the analysis. Under tighter restrictions, more preschoolers spent ≥1 h/day on screen-based devices (42.8% in 2019, 45.2% in 2020, 48.9% in 2021, p < 0.001), and fewer preschoolers spent ≥30 min/day on after-school outdoor activities (49.5% in 2019, 46.0% in 2020, 41.0% in 2021, p < 0.001) on weekdays. A similar trend was found on weekends. While more preschoolers spent ≥2 h/day on screen-based devices (35.3% in 2019, 38.5% in 2020, 43.0% in 2021, p < 0.001), fewer preschoolers spent ≥2 h/day on outdoor activities (41.7% in 2019, 41.7% in 2020, 34.0% in 2021, p < 0.001). The mean SE and myopia prevalence were stable (9.1% in 2019, 10.3% in 2020, 9.4% in 2021, p = 0.707). CONCLUSION: Our study showed dose-dependent effect of social restrictions on near-work and outdoor behaviours at home. The prevalence of myopia did not increase significantly with short-term cessation of school-based eyecare programmes.

Myopia Progression during the COVID-19 Era: A Systematic Review and Meta-analysis.

BACKGROUND: To evaluate myopia progression during the novel coronavirus disease 2019 (COVID-19) pandemic and its risk factors. METHODS: We searched PubMed, Scopus, and Web of Science to find literature until August 2022 related to COVID-19 pandemic and myopia progression. Outcomes of myopia progression included axial length (AL) and spherical equivalent (SE). Factors of screen time and outdoor activity time were analyzed. RESULTS: Thirty-three studies were included in this meta-analysis. Compared to the same period before the COVID-19 pandemic, myopia prevalence increased (OR = 1.11; 95% CI, 1.05-1.18). The outcomes of SE decreased -0.61 diopter (95% CI, -0.98 to -0.23), and AL increased 0.42 mm (95% CI, 0.13-0.7). Mean screen time was increased 6.25 hours/day (95% CI, 4.84-7.66), and outdoor activity time was decreased -1.52 hours/day (95% CI, -3.20 to -0.15). CONCLUSION: Establishing care policies is necessary to restrict behavioral changes and their consequences during the pandemic.

Clinical Profile of Refractive Errors Associated with Screen Time in Children Aged 5-15 Years in a Tertiary Care Hospital of Southern India during COVID Pandemic: A Prospective Study

Introduction: Refractive errors cannot be prevented, but it is important to detect them early to improve the quality of life and prevention of blindness. Refractive errors screening in children during COVID pandemic was difficult task as they were high-risk group. Increased near activity due to online classes and smart devices usage may increase the uncorrected refractive errors. The study emphasizes on the refractive errors screening during COVID pandemic. Aim(s): To study the clinical profile of refractive errors of the children aged 5-15 years in a tertiary care hospital in COVID pandemic in association with screen time, outdoor activity, type of gadget, amblyopia and educational status of mother. Material(s) and Method(s):This was a hospital based prospective analytical study conducted in children 5-15 yrs attending the Ophthalmology Outpatient Department of ESIC Medical College and Hospital from May 2021 to October 2021.Children were screened for refractive errors and compared with the refractive errors data of different children of same age referred from Paediatric Outpatient Department and who attended to Ophthalmology Outpatient Department for regular eye checkup in pre-pandemic time. Unaided visual acuity of all children were measured with the help of Snellen's chart. Children with refractive errors underwent Cycloplegic Retinoscopy followed by post-mydriatic test. Screen time and outdoor activity duration were recorded. Interpretation and analysis of obtained results was carried out using Statistical Package for Social Sciences version 22.0 for descriptive statistics. Non-parametric tests like Pearson Chi-square test were used to express the qualitative data.Data with p-value less than 0.05 was considered statistically significant. Result(s): A total of 790 children were screened out of which 358 (45.3%) presented with refractive error when compared with the pre pandemic prevalence 276 (34.9%) out of 790 children screened, presented with the refractive error. A total of 118 (33%) of the children presented with increased blink rate associated with increased screen time and dry eye. Rate of progression of more than 1D was observed in 44 (12.29%) of which Myopia 28 (7.8%) Astigmatism 10 (2.7%) and hypermetropia 6 (1.6%) in 6 months. A total of 286 (79.8%) children presented with myopia and 24 (6.7%) presented with hypermetropia, 48 (13.4%) presented with astigmatism. A total of 258 (72.06%) presented with screen time for 4-7 hrs, and 32 (8.9%) children presented with amblyopia. Conclusion(s): Refractive errors increased due to smart classes in schools or use of laptops, television viewing, computers or mobiles. Hence, this reinforces the need to screen all the school going children and children with the history of gadgets use. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

Myopia progression and associated factors of refractive status in children and adolescents in Tibet and Chongqing during the COVID-19 pandemic.

Objectives: To investigate myopia progression and associated factors of refractive status among children and adolescents in Tibet and Chongqing in China during the COVID-19 pandemic. Methods: A population-based cross-sectional study was conducted to compare rates of myopia and high myopia, axial length (AL), spherical equivalent (SE), outdoor activity time, digital device use, and frequency of visual examinations for children and adolescents affected by myopia in Chongqing and Tibet in 2021. Results: A total of 2,303 students from Chongqing and 1,687 students from Tibet were examined. The overall prevalence of myopia and high myopia in these two groups were 53.80 and 7.04% vs. 43.86 and 1.30%, respectively in each case. The Chongqing students had a longer AL than the group from Tibet (23.95 vs. 23.40 mm, respectively; p < 0.001). The mean SE of the students with myopic parents in Tibet was lower than that of the students in Chongqing with myopic parents (-2.57 ± 2.38 diopters (D) vs. -2.30 ± 2.34 D, respectively) (p < 0.001). Conversely, the mean SE of the students from urban areas in Chongqing was lower than that of the students in Tibet (-2.26 ± 2.25 D vs. -1.75 ± 1.96 D, respectively; p < 0.001). The Chongqing students exhibited lower SE (-2.44 ± 2.22 D) than their Tibetan counterparts (mean SE: -1.78 ± 1.65 D (p = 0.0001) when spending more than 2.5 h outdoors. For example, 61.35% of the students in Tibet spent more than 2.5 h outdoors daily, compared with 43.04% of the students in Chongqing. Correspondingly, the proportion of students using digital devices in Tibet (64.43%) was lower than that in Chongqing (100%). For the latter, 38.62% of the students in Chongqing spent more than 2.5 h online using digital devices compared to 10.49% of the students in Tibet. Greater monitoring of visual status was observed for the Chongqing students (mean SE: -1.90 ± 1.98 D) compared with students in Tibet (mean SE: -2.68 ± 1.85 D) (p = 0.0448), with the frequency of optimal examinations being every 6 months. Outdoor activity time was identified as a common risk factor for myopia in both of the populations examined, with odds ratios (ORs) of 1.84 (95% CI: 1.79-1.90) in Chongqing and 0.84 (95% CI: 0.73-0.96) in Tibet. Digital screen time was associated with myopia and high myopia in Chongqing, with ORs of 1.15 (95% CI: 1.08-1.22) and 1.06 (95% CI: 0.94-1.77), respectively. Digital screen time was also found to be a risk factor for high myopia in Tibet (OR: 1.21, 95% CI: 0.77-1.61). The type of digital devices used was also associated with myopia and high myopia in Tibet (OR: 1.33, 95% CI: 1.06-1.68 and OR: 1.49, 95% CI: 0.84-2.58, respectively). Finally, examination frequency was found to correlate with high myopia in the Tibet group (OR: 1.79, 95% CI: 0.66-2.71). Conclusion: Based on our data, we observed that the prevalence of refractive errors in children and adolescents was significantly lower in Tibet than in Chongqing. These results are potentially due to prolonged outdoor activity time, and the type and time of use for digital devices that characterize the group of children and adolescents from Tibet. It is recommended that parents and children in Chongqing would benefit from increased awareness regarding myopia progression and its prevention.

Impacts of COVID-19 Restrictions on Young Children's Outdoor Activity: A Systematic Review.

We sought to identify and synthesise available evidence to aid the understanding of the impact that COVID-19 restrictions had on the outdoor activity of children aged from birth to 12 years. Seven databases (Education Research Complete, ERIC, MEDLINE, PsycINFO, SPORTDiscus, Psychology and Behavioural Sciences Collection, WHO COVID-19 Database) were searched for relevant journal articles in English published from 2020 on. Four qualitative and eleven quantitative studies were included after screening. JBI's Critical Appraisal Tools were used for quality assessment. All qualitative studies showed an increase in outdoor activity. Less than half of the quantitative studies indicated an increase. Family demography, home characteristics, access to outdoor spaces, and parental support/encouragement/co-play were influential factors. The evidence also supports the recommendation for educators to increase children's outdoor play time to adhere to the physical distancing guidance and sanitisation requirements. Limited evidence suggests that when COVID-19 restrictions led to decreased outdoor activity, it was associated with less peer socialisation. We identified significant gaps in understanding of the impact of COVID-19 restrictions on young children's outdoor activity.

Let Us Avoid a 'Myopic View' in Times of COVID-19.

The COVID-19 pandemic has affected people from almost all facets of life and it's impact is extremely palpable among students. In this review paper, we discuss about the risk factors for myopia progression that were exacerbated by the pandemic, which are supported by evidence from studies published recently. It is imperative that measures are put in place to address the rising incidence of myopia so as to prevent the impending myopia pandemic.

Outdoor Activities Associated with Lower Odds of SARS-CoV-2 Acquisition: A Case-Control Study.

Access to recreational physical activities, particularly in outdoor spaces, has been a crucial outlet for physical and mental health during the COVID-19 pandemic. There is a need to understand how conducting these activities modulates the risk of SARS-CoV-2 infection. In this case-control study of unvaccinated individuals conducted in San Francisco, California, the odds of testing positive to SARS-CoV-2 were lower for those who conducted physical activity in outdoor locations (adjusted odds ratio [aOR]: 0.16, 95% confidence interval [CI]: 0.05, 0.40) in the two weeks prior to testing than for those who conducted no activity or indoor physical activity only. Individuals who visited outdoor parks, beaches, or playgrounds also had lower odds of testing positive to SARS-CoV-2 (aOR: 0.28, 95% CI: 0.11, 0.68) as compared with those who did not visit outdoor parks, beaches, or playgrounds. These findings, albeit in an unvaccinated population, offer observational data to support pre-existing ecological studies that suggest that activity in outdoor spaces lowers COVID-19 risk.

A Systematic Review of Objective Factors Influencing Behavior in Public Open Spaces.

As a significant part of outdoor built-environment, public open spaces are closely associated with people's daily lives. Studies of outdoor behavior in these spaces can shed light on users' environmental perceptions and contribute to the promotion of physiological and psychological health. Many recent studies are case studies focused where observations, surveys and interviews have been conducted to understand the factors influencing people's behavior on one or few sites or city environments. There have been few reviews related to this topic, and none have been based on the systematic understanding of influencing factors. This paper presents a systematic review of interactions between behavior and the built environment in public open spaces, and highlights the impacts of diverse and objective influencing factors. Followed the rules of PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 109 papers published in 2000-2021 were selected and reviewed. The distribution of the studied interactions is analyzed, and the impacts of four distinct factors: personal background, location and context, environmental component, and climate stimuli, are extracted, categorized, and specified. Moreover, outdoor health benefits are discussed based on which, crucial factors that require emphasis after the outbreak of COVID-19 are identified. Throughout this paper, behavioral influencing processes, including objective influencing factors, subjective feedback, and the relationships involved, are considered to provide a comprehensive picture. With the robust classification of existing factors, architects, urban designers, policy makers and fellow researches could be easier to get a more comprehensive trend from the past. This paper also provides guidance for future research, especially given that COVID-19 has created huge changes to outdoor needs and customary behavior. Systematic Review Registration: http://www.prisma-statement.org/.

Children's vision health during the COVID- pandemic

During the peak months of the COVID-19 pandemic, several countries elected to close schools and adapted to online learning. The aim of the article is to review the impact of lockdown measures instituted during the COVID-19 pandemic on children's vision health and to make recommendations for mitigating potential visual impairment. Methods: We reviewed studies focused on digital device usage, near work, and outdoor time in relation to myopia onset and progression in children during the COVID-19 pandemic. Studies focused on the relation between screen time, asthenopia and dry eyes in children during COVID-19. Results: Increased digital screen time, near work and limited outdoor activities were found to be associated with the onset and progression of myopia during the COVID-19 pandemic period. Screen time was positively associated with asthenopia and dry eye in children during COVID-19. Conclusion: The COVID-19 pandemic has led to dramatic changes in many aspects of daily life. Online learning has become the mainstream public learning mode during the pandemic. Several studies indicate accelerated myopic progression during the COVID-19 pandemic in children and the increase has been found to be related to excessive use of digital screen devices and the decrease of outdoor activities duration. Also prolonged screen time, and online-course time can significantly increase asthenopia and dry eye risk. Several studies have recommended to decrease screen time and to increase outdoor activities. [ FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Streetscapes as Surrogate Greenspaces During COVID-19?

In 2020, the spread of COVID-19 (SARS-CoV-2) globally led to severe crisis, disruption and hardship in both private and public life. In such times of distress, access to urban greenspaces is essential for physical and mental wellbeing. However, globally implemented lockdowns deprived many people of freely visiting greenspaces. Inequality in access to urban greenspaces was apparent at global scales. Consequently, many people took to streets for outdoor activities due to its easy accessibility. We, therefore, aimed to study the usage and relevance of streetscapes for outdoor activities during a crisis. We hypothesised that streetscapes supported diverse outdoor activities, functioning as surrogate urban greenspaces. We distributed an online questionnaire to over 400 international respondents. Our results clearly showed that people used streetscapes during this period for a variety of activities, many of which were also reported as their main physical activity. Walking was the most frequent activity in streetscapes globally, and independent from sociocultural characteristics. Other activities reported such as jogging and cycling also aligned generally with main physical activities of people, but differed between countries and people's sociocultural background. In summary, more than one third of respondents from lower-income countries reported not having had access to a greenspace, whereas 8% reported the same in high-income countries. Our results highlight the important role of streetscapes in facilitating people's regular physical activities during the pandemic. Recognising streetscapes as important public outdoor spaces within residential neighbourhoods could help counteract the inequality in greenspace access, an issue that seems more relevant than ever before.

Understanding risks of refractive error among Chinese children amidst pandemic disruptions: results from a rapid survey.

BACKGROUND: Despite effectiveness in delaying the spread of the pandemic, frequent and extended disruption to children's livelihoods have fomented new norms in which learning routines encounter immense change. In particular, increased sedentary e-learning engagement with electronic screens and exposure to stressful circumstances are likely to pose adverse risks for children's vision development. METHODS: This present study examines the link between near-sighted refractive error, and sedentary exposure to electronic screens, psychosocial stress level, and outdoor activities. A Rapid Survey Methodology (RSM) design was utilized to collect information on subject's vision condition, sedentary electronic screen use, and level of psychosocial stress, in addition to detailed socio-demographic background characteristics. RESULTS: This study involves 2234 subjects enrolled in 1st to 6th grade in primary schools. Every 1 diopter hour increase in electronic screen use per day is associated with 1.036 OR (95% CI =1.024-1.047, p-value< 0.050), while every 1 h • W m- 2 sr- 1 of illuminance-weighted electronic screen use per day is associated with 2.285 OR (95% CI =1.829-2.855, p-value< 0.050) increased likelihood of near-sighted refractive error. Higher level of psychosocial stress is associated with 2.441 OR (95% CI =1.870-3.187, p-value< 0.050) and 2.403 OR (95% CI =1.839-3.141, p-value< 0.050) increased likelihood of near-sighted refractive error. Frequency of outdoor activity is not significantly associated with increased likelihood of near-sighted refractive error (p-value> 0.050). CONCLUSIONS: Findings in this study show that many factors, including grade level and prior vision condition, contribute to increased risks of near-sighted refractive error during the COVID-19 pandemic. More strikingly, pandemic-related behavioral modifications such as lengthy sedentary electronic screen use and elevated levels of psychosocial stress are two critical channels affecting children's eye health.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic.

PURPOSE: To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population. DESIGN: Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). PARTICIPANTS: Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis. METHODS: Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants. MAIN OUTCOME MEASURES: The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age. RESULTS: The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors. CONCLUSIONS: This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

Social Distancing and Outdoor Physical Activity During the COVID-19 Outbreak in South Korea: Implications for Physical Distancing Strategies.

The novel coronavirus disease (COVID-19) outbreak has put the entire world in a pandemic situation. In response, strict screening, quarantine protocols, and contact tracing have been conducted in South Korea. The purpose of this study was to examine effects of social distancing on the Public Bicycle Sharing System (PBSS) during the COVID-19 outbreak. We used the PBSS public dataset of Seoul, South Korea. Difference-in-differences (DID) analysis was used. In the DID approach, the 2 groups are distinguished based on designated year. Cases of PBSS use were observed in 2 time periods: pre- and post-strict social distancing in Seoul, Korea. Average PBSS usage per day doubled during 2019-2020 (30 697 vs 77 996, P < .001). Commuters and weekend users increased during the social distancing period in 2020 compared with the same period in 2019. DID analysis showed statistically significant positive effects of high levels of social distancing on PBSS usage, commuters, weekend users, and new subscribers. In conclusion, social distancing during the COVID-19 outbreak increased outdoor physical activity. Meaningful outdoor physical activity during the COVID-19 pandemic can be safe from infection and psychologically stabilized as long as keeping meticulous physical distancing, such as hand hygiene, wearing facial masks, and surface cleaning of public resources.