中小学校教学环境及与筛查性近视关联的多水平模型分析

曲爽笑; 杨东玲; 黄生垒; 齐文娟; 黄雨婷; 何鲜桂; 王菁菁; 罗春燕

doi:10.16835/j.cnki.1000-9817.2023.08.031

中小学校教学环境及与筛查性近视关联的多水平模型分析

doi: 10.16835/j.cnki.1000-9817.2023.08.031

1.
上海市疾病预防控制中心儿童青少年健康所，200336
2.
上海市眼病防治中心临床研究中心

基金项目:

上海市第五轮公共卫生体系建设三年行动计划项目 GWV-9.1

2022—2023年度上海市疾病预防控制青年骨干人才项目 22QNGG03

详细信息

作者简介:
曲爽笑(1990-)，女，山东烟台人，硕士，主管医师，主要研究方向为环境与儿童青少年健康

通讯作者:
罗春燕，E-mail：luochunyan@scdc.sh.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G478 R778.1⁺¹ R179
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出版历程
- 收稿日期: 2023-03-07
- 修回日期: 2023-04-19
- 网络出版日期: 2023-08-26
- 刊出日期: 2023-08-25

Teaching environmental health in primary and secondary schools in Shanghai and its association with screening myopia applying multilevel models

1.
Division of Child and Adolescent Health, Shanghai Municipal Center for Disease Control and Prevention, Shanghai(200336), China

摘要

摘要: 目的了解中小学校教室教学环境卫生状况及其与近视的关联，为儿童青少年近视精准防控提供依据。方法于2020年9—10月采用分层整群抽样法，在上海市16个区抽取中小学校以整班为单位进行调查，将教学环境检测教室与进行问卷调查学生所在的教室进行匹配，检测教室共470间，调查学生14 624名。由经过培训的专业技术人员采用激光测距仪、照度计等设备检测教学环境指标，并对学生进行视力检查和问卷调查。采用多水平模型分析教学环境与筛查性近视的关联。结果 2020年上海市中小学校教学环境各指标合格率分别为窗地比(93.0%)、教室人均面积(82.1%)、黑板照度均匀度(79.7%)、黑板尺寸(68.7%)、采光系数(67.0%)、黑板悬挂高度(66.9%)、课桌面平均照度(66.4%)、课桌面照度均匀度(63.6%)、黑板反射比(46.8%)、黑板平均照度(41.4%)、墙面反射比(33.2%)、课桌椅分配符合率(19.8%)。两水平Logistic模型分析结果显示，黑板面平均照度不合格与学生筛查性近视呈正相关(OR=1.24，95%CI=1.05~1.47，P < 0.05)。结论上海市中小学校教学环境现况不容乐观，教学环境尤其是课桌椅符合率有待改善，黑板面平均照度不合格与学生筛查性近视的发生呈正相关。学校近视防控工作应重点关注课桌椅分配符合情况，提高黑板面照度。
- 环境卫生 /
- 近视 /
- 合格鉴定 /
- 回归分析 /
- 学生
Abstract: Objective To understand the status of teaching environmental health in primary and secondary schools and explore its association with myopia, so as to provide a basis for precision myopia prevention and control. Methods From September to October 2020, a stratified cluster sampling method was used in 16 districts of Shanghai. After matching the teaching environment testing classrooms with the classrooms where the students were surveyed, totally 470 classrooms and 14 624 students were monitored. Trained professional technicians used laser range finder, luxmeter to measure parameters about teaching environmental health. Students were subject vision testing and questionnaires. Multilevel models was used to analyze the association between teaching environment and screening myopia. Results The qualified rates of each indicators of teaching environmental health were as follows: window to floor area ratio (93.0%), classroom area per capita (82.1%), uniformity ratio of illuminance of blackboard (79.7%), blackboard size (68.7%), daylight factor (67.0%), blackboard hanging height (66.9%), average illuminance on desk (66.4%), uniformity ratio of illuminance of desk (63.6%), reflectance of blackboard (46.8%), average illuminance on blackboard (41.4%), reflectance of wall (33.2%), desk and chair allocation compliance rate (19.8%). The results of two-level Logistic model analysis showed that unqualified average illuminance on blackboard was positively associated with screening myopia (OR=1.24, 95%CI=1.05-1.47, P < 0.05). Conclusion Teaching environmental health of primary and secondary schools in Shanghai is not optimistic, teaching environment especially the desk and chair allocation compliance rate need to be improved. The average illumination on blackboard is positively correlated with screening myopia, suggesting that myopia prevention and control can focus on improving the illuminance on blackboard.
- Environmental health /
- Myopia /
- Eligibility determination /
- Regression analysis /
- Students
注释:

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表 1 上海市2020年不同组别中小学校教学环境各项目合格率比较

Table 1. Comparison of qualified rates of items on teaching environmental health among different primary and secondary schools of Shanghai in 2020

组别	选项	教室数	统计值	人均面积	黑板尺寸	黑板悬挂高度^*	课桌椅分配符合率	黑板反射比^*	采光系数	窗地面积比	墙面反射比	黑板面平均照度^*	黑板面照度均匀度^*	课桌面平均照度	课桌面照度均匀度
学段	小学	78		51(65.4)	59(75.6)	36(58.1)	20(25.6)	32(51.6)	56(71.8)	72(92.3)	25(32.1)	24(38.7)	50(80.6)	59(75.6)	58(74.4)
	中学	392		335(85.5)	264(67.3)	237(68.5)	73(18.6)	159(46.0)	259(66.1)	365(93.1)	131(33.4)	145(41.9)	275(79.5)	253(64.5)	241(61.5)
			χ²值	17.86	2.08	2.59	2.02	0.68	0.96	0.07	0.06	0.22	0.04	3.59	4.66
			P值	< 0.01	0.15	0.11	0.16	0.41	0.33	0.80	0.82	0.64	0.83	0.06	0.03
地区	城区	188		149(79.3)	139(73.9)	136(81.0)	57(30.3)	73(43.5)	120(63.8)	173(92.0)	75(39.9)	88(52.4)	138(82.1)	145(77.1)	137(72.9)
	郊区	282		237(84.0)	184(65.2)	137(57.1)	36(12.8)	118(49.2)	195(69.1)	264(93.6)	81(28.7)	81(33.8)	187(77.9)	167(59.2)	162(57.4)
			χ²值	1.76	3.96	25.43	21.90	1.30	1.44	0.44	6.35	14.14	1.09	16.21	11.60
			P值	0.18	< 0.05	< 0.01	< 0.01	0.26	0.23	0.51	0.01	< 0.01	0.30	< 0.01	< 0.01
注： ()内数字为合格率/%；* 小学62所，中学346所；城区168所，郊区240所。

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表 2 中小学教学环境不合格与筛查性近视的两水平Logistic模型分析(n=14 624)

Table 2. Two-level Logistic model of unqualified teaching environment and screening myopia in primary and secondary schools of Shanghai(n=14 624)

自变量	β值	标准误	t值	P值	OR值(95%CI)
教室人均面积	0.04	0.10	0.45	0.65	1.04(0.86~1.26)
黑板尺寸	0.07	0.10	0.67	0.51	1.07(0.88~1.29)
黑板悬挂高度	-0.06	0.09	-0.66	0.51	0.94(0.80~1.12)
课桌椅分配符合率	-0.04	0.10	-0.42	0.68	0.96(0.78~1.17)
黑板反射比	-0.09	0.08	-1.18	0.24	0.91(0.78~1.06)
采光系数	0.00	0.08	0.01	0.99	1.00(0.86~1.17)
窗地面积比	-0.05	0.14	-0.34	0.73	0.95(0.73~1.25)
墙面反射比	-0.16	0.08	-1.92	0.06	0.85(0.72~1.00)
黑板面平均照度	0.22	0.09	2.53	0.01	1.24(1.05~1.47)
黑板面照度均匀度	0.10	0.10	1.00	0.32	1.10(0.91~1.34)
课桌面平均照度	-0.07	0.09	-0.77	0.44	0.93(0.78~1.12)
课桌面照度均匀度	0.11	0.08	1.26	0.21	1.11(0.94~1.31)
注：教学环境指标均以合格为参照。

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参考文献(26)

[1]	HOBDAY R. Myopia and daylight in schools: a neglected aspect of public health?[J]. Perspect Public Health, 2016, 12(136): 50-55.
[2]	NEGILONI K, RAMANI K, SUDHIR R. Do school classrooms meet the visual requirements of children and recommended vision standards?[J]. PLoS One, 2017, 12(4): e174983.
[3]	许华茹, 张睿, 杨柳. 济南市中小学校教学环境监测结果[J]. 中国学校卫生, 2020, 41(9): 1422-1424. doi: 10.16835/j.cnki.1000-9817.2020.09.041 XU H R, ZHANG R, YANG L. Monitoring of teaching environmental health in primary and secondary schools in Jinan[J]. Chin J Sch Health, 2020, 41(9): 1422-1424. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2020.09.041
[4]	钱红丹. 无锡市2014—2015年学校教室和生活环境卫生现状[J]. 中国学校卫生, 2017, 38(1): 131-133. doi: 10.16835/j.cnki.1000-9817.2017.01.041 QIAN H D. Current status of teaching and living environmental health in 2014-2015 in Wuxi[J]. Chin J Sch Health, 2017, 38(1): 131-133. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2017.01.041
[5]	赵金辉, 郭欣, 赵海, 等. 北京市2019年中小学校教学环境卫生监测[J]. 中国学校卫生, 2020, 41(10): 1562-1565. doi: 10.16835/j.cnki.1000-9817.2020.10.032 ZHAO J H, GUO X, ZHAO H, et al. Monitoring of teaching environmental health in primary and secondary schools in 2019 in Beijing[J]. Chin J Sch Health, 2020, 41(10): 1562-1565. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2020.10.032
[6]	中华人民共和国国家卫生健康委员会. 国家卫生健康委员会2019年4月29日例行新闻发布会文字实录[EB/OL]. (2019-04-29)[2023-01-07]. http://www.nhc.gov.cn/xcs/s7847/201904/e9117ea8b6b84f48962e84401d305292.shtml. National Health Commission of PRC. Transcript of the National Health Commission routine press conference on April 29, 2019[EB/OL]. (2019-04-29)[2023-01-07]. http://www.nhc.gov.cn/xcs/s7847/201904/e9117ea8b6b84f48962e84401d305292.shtml. (in Chinese)
[7]	陶芳标, 潘臣炜, 伍晓艳, 等. 户外活动防控儿童青少年近视专家推荐[J]. 中国学校卫生, 2019, 40(5): 641-643. doi: 10.16835/j.cnki.1000-9817.2019.05.001 TAO F B, PAN C W, WU X Y, et al. Expert recommendation for outdoors activities as myopia prevention and control in children and adolescents[J]. Chin J Sch Health, 2019, 40(5): 641-643. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.05.001
[8]	黄坤, 汤灼明, 陈金, 等. 教室采光照明与中小学生视力不良关系[J]. 中国学校卫生, 2020, 41(9): 1299-1302, 1306. doi: 10.16835/j.cnki.1000-9817.2020.09.006 HUANG K, TANG Z M, CHEN J, et al. Relationship between classroom lighting and poor vision of primary and middle school students[J]. Chin J Sch Health, 2020, 41(9): 1299-1302, 1306. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2020.09.006
[9]	上海市疾病预防控制中心. 2020年上海市学生常见病和健康影响因素监测与干预工作手册: 学校环境健康影响因素调查表监测细则[Z]. 上海: 上海市疾病预防控制中心, 2020. Shanghai Municipal Center for Disease Control and Prevention. 2020 Workbook on surveillance and intervention of common diseases and health influencing factors of students in Shanghai: monitoring rules for the questionnaire on health influencing factors of school environment[Z]. Shanghai: Shanghai Municipal Center for Disease Control and Prevention, 2020. (in Chinese)
[10]	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 采光测量方法: GB/T 5699—2017[S]. 北京: 中国标准出版社, 2017. General Administration of Quality Supervision, Inspection and Quarantine of the PRC, Standardization Administration of the PRC. Method of daylighting measurements: GB/T 5699-2017[S]. Beijing: Standards Press of China, 2017. (in Chinese)
[11]	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 照明测量方法: GB/T 5700—2008[S]. 北京: 中国标准出版社, 2008. General Administration of Quality Supervision, Inspection and Quarantine of the PRC, Standardization Administration of the PRC. Measurement methods for lighting: GB/T 5700-2008[S]. Beijing: Standards Press of China, 2008. (in Chinese)
[12]	中华人民共和国卫生部, 中国国家标准化管理委员会. 学校卫生综合评价: GB/T 18205—2012[S]. 北京: 中国标准出版社, 2012. Ministry of Health of the PRC, Standardization Administration of the PRC. Comprehensive appraisement for health in schools: GB/T 18205-2012[S]. Beijing: Standards Press of China, 2012. (in Chinese)
[13]	中华人民共和国住房和城乡建设部, 中华人民共和国国家质量监督检验检疫总局. 中小学校设计规范: GB 50099—2011[S]. 北京: 中国标准出版社, 2011. Ministry of Housing and Urban-Rural Development of the PRC, General Administration of Quality Supervision, Inspection and Quarantine of the PRC. Code for design of school: GB 50099-2011[S]. Beijing: Standards Press of China, 2011. (in Chinese)
[14]	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 学校课桌椅功能尺寸及技术要求: GB/T 3976—2014[S]. 北京: 中国标准出版社, 2014. General Administration of Quality Supervision, Inspection and Quarantine of the PRC, Standardization Administration of the PRC. Functional sizes and technical requirements of chairs and tables for educational institutions: GB/T 3976-2014[S]. Beijing: Standards Press of China, 2014. (in Chinese)
[15]	中华人民共和国卫生部, 中国国家标准化管理委员会. 中小学校教室采光和照明卫生标准: GB 7793—2010[S]. 北京: 中国标准出版社, 2010. Ministry of Health of the PRC, Standardization Administration of the PRC. Hygienic standard for day lighting and artificial lighting for middle and elementary school: GB 7793-2010[S]. Beijing: Standards Press of China, 2010. (in Chinese)
[16]	中华人民共和国卫生部, 中国国家标准化管理委员会. 标准对数视力表: GB 11533—2011[S]. 北京: 中国标准出版社, 2011. Ministry of Health of the PRC, Standardization Administration of the PRC. Standard for logarithmic visual acuity charts: GB 11533－2011[S]. Beijing: Standards Press of China, 2011. (in Chinese)
[17]	中华人民共和国卫生部, 中国国家标准化管理委员会. 学生健康检查技术规范: GB/T 26343—2010[S]. 北京: 中国标准出版社, 2010. https://www.cnki.com.cn/Article/CJFDTOTAL-HOCE202304008.htm
[18]	中华人民共和国国家卫生健康委员会. 中小学生屈光不正筛查规范: WS/T 663—2020[S]. 北京: 中国标准出版社, 2020. National Health Commission of the PRC. Specification for screening of refractive error in primary and secondary school students: WS/T 663-2020[S]. Beijing: Standards Press of China, 2020. (in Chinese)
[19]	中华人民共和国教育部等八部门关于印发《综合防控儿童青少年近视实施方案》的通知[EB/OL]. (2018-08-30)[2023-01-07]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html. Ministry of Education of the PRC and other 7 departments issued a notice of Implementation Plan of Comprehensive Prevention and Control of Myopia in Children and Adolescents[EB/OL]. (2018-08-30) [2023-01-07]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html. (in Chinese)
[20]	金星, 葛振兴, 范忠飞, 等. 上海市中小学校教学环境卫生现况调查[J]. 中国卫生监督杂志, 2014, 21(4): 349-351. https://www.cnki.com.cn/Article/CJFDTOTAL-WSJD201404014.htm JIN X, GE Z X, FAN Z F, et al. Survey of teaching environmental health in primary and secondary schools in Shanghai[J]. Chin J Health Insp, 2014, 21(4): 349-351. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WSJD201404014.htm
[21]	明佳, 陈嘉明, 童晶, 等. 优化课桌椅配置是改善重庆市中小学教学环境卫生状况的突破口: 基于2017-2018年度国家双随机调查的实证研究[J]. 中国卫生法制, 2020, 28(4): 95-98. https://www.cnki.com.cn/Article/CJFDTOTAL-WSFZ202004024.htm MING J, CHEN J M, TONG J, et al. Optimizing the allocation of desks and chairs as the most important task in improving the teaching environment of primary and secondary shools in Chongqing: an study based on the national double-random survey in 2017-2018[J]. Chin Health Law, 2020, 28(4): 95-98. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WSFZ202004024.htm
[22]	杨玉娟, 冯晓刚, 罗春燕, 等. 应用坐姿矫正器改善小学生读写姿势的效果研究[J]. 上海预防医学, 2022, 34(3): 223-226. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI202203008.htm YANG Y J, FENG X G, LUO C Y, et al. Effect of applying sitting posture corrector on improving reading and writing posture of elementary school students[J]. Shanghai J Prev Med, 2022, 34(3): 223-226. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI202203008.htm
[23]	蒋思彬, 王政和, 余红, 等. 教室灯光改造对中小学生视力及视力不良的影响[J]. 照明工程学报, 2019, 30(3): 15-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGX201903008.htm JIANG S B, WANG Z H, YU H, et al. Effect analysis of classroom lighting renovation on visual acuity and poor eyesight among elementary and secondary schools[J]. Chin Illuminat Engineer J, 2019, 30(3): 15-18. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGX201903008.htm
[24]	陶然, 杨招庚, 温勃, 等. 教室灯光改造对四年级小学生的视力影响研究[J]. 中国儿童保健杂志, 2020, 6(28): 668-671. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202006018.htm TAO R, YANG Z G, WEN B, et al. Effects of classroom lighting environment improvement on vision of fourth-grade pupils[J]. Chin J Child Health Care, 2020, 6(28): 668-671. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202006018.htm
[25]	他卉, 曹应琼, 何琳, 等. 四川省中小学校教学环境与视力分析[J]. 现代预防医学, 2018, 45(20): 3748-3751, 3759. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201820026.htm TA H, CAO Y Q, HE L, et al. Analysis on the teaching environment and vision of primary and secondary schools in Sichuan Province[J]. Mod Prev Med, 2018, 45(20): 3748-3751, 3759. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201820026.htm
[26]	张磊, 黄春萍. 工作相关肌肉骨骼疾患的机构聚集性: 基于杭州市16家机构的多水平统计模型分析[J]. 环境与职业医学, 2019, 36(12): 1119-1124. https://www.cnki.com.cn/Article/CJFDTOTAL-LDYX201912008.htm ZHANG L, HUANG C P. Institutional clustering of work-related musculoskeletal disorders: multilevel statistical model analysis of 16 institutions in Hangzhou[J]. J Environ Occup Med, 2019, 36(12): 1119-1124. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-LDYX201912008.htm