Page 102 - 中国全科医学2022-30

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management mode by the community health center（CHC） in combination with schools in service coverage areas of the CHC
will provide a new idea for strengthening the health management of children and adolescents by the CHC. Objective To perform
posture assessment and vision screening in full-time students receiving the nine-year compulsory education in schools in the
service coverage area of Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area using a
CHC-school-based approach，to identify problems in disease screening and management for children and adolescents，to analyze
the practice and advantages of CHC-school-based disease screening and management，and to develop a CHC-school-based
health management model for children and adolescents. Methods This study was conducted from May to November 2021. Cluster
sampling was used to select grades 1-9 full-time students（n=11 318） in 225 classes of 6 primary schools and 3 middle schools
in the areas covered with health services delivered by the Chaohe Community Health Center of Zhengzhou Economic-Technological
Development Area. All of them received posture assessment and vision screening. Results Among the participants，6 260 were
male and 5 058 were female；7 979 were pupils，and 3 339 were junior high school students. The prevalence of abnormal posture
was 41.34%（4 679/11 318）. With the increase of grade，the prevalence of uneven shoulders，thoracic kyphosis，scoliosis，
O-shaped legs，and toe valgus increased，while that of knee hyperextension，flat feet and pes valgus decreased （P<0.05）.
The prevalence of 1，2，3 and 4 or more abnormal postures was 29.13%（3 297/11 318），8.60%（973/11 318），3.01%
（341/11 318），and 0.60%（68/11 318），respectively. Male students had higher prevalence of thoracic kyphosis，
scoliosis，flat feet and toe valgus，and lower prevalence of knee hyperextension，X-shaped legs，O-shaped legs and
foot valgus than female students （P<0.05）. The prevalence of abnormal vision was 74.99%（8 486/11 318）. The
prevalence of myopia，hyperopia，and astigmatism was 41.75%（4 725/11 318），26.14%（2 959/11 318） ，and 7.09%
（802/11 318），respectively. With the increase of grade，the prevalence of myopia increased and that of hyperopia decreased
（P<0.05）. Conclusion At present，the abnormal posture rate of children and adolescents in Zhengzhou is about 40%，and
the myopia rate exceeds 40%. With the increase of grade，the prevalence of uneven shoulders，thoracic kyphosis，scoliosis，
O-shaped legs，toe valgus and the prevalence of myopia increased，but there is a lack of effective and normal screening and
health management systems. As the hospital-school approach could improve the effectiveness and normalization of the health
screening and management for children and adolescents，so this approach is recommended to be used in further improvement of
the top-level design and efficacy assessment of health management in children and adolescents. In addition to CHC school-based
management，the health management of children and adolescents also involves the efforts of themselves and their families，which
is equally important as the former two.
【Key words】 Child health；Adolescent；Seated position；Sitting position；Vision screening；Health management；
Zhengzhou

儿童青少年是身心健康发展的关键时期，儿童青少 少年的体态研究多是体育学院或体育教师组织的调查分
年的健康不仅关系个人的健康成长，更关系整个民族的 析，或者从体育运动的角度分析如何预防或纠正不良体
健康素质。随着生活方式的改变，儿童青少年的健康问 态 ［6-8］ ，对儿童青少年的体态筛查和评价局限于 1 种或
题日益突出，其中肥胖或超重、近视、脊柱侧弯、代谢 2 种疾病，如脊柱侧弯、O 型腿、X 型腿，较少对儿童
异常等检出率逐年增加 ［1-3］ ，儿童青少年健康现状不容 青少年体态进行全面筛查评价，此外，缺乏从基层医疗
乐观。《“健康中国 2030”规划纲要》要求“加大学 机构联合学校综合预防、治疗的角度研究儿童青少年健
校健康教育力度，将健康教育纳入国民体系，并以中小 康问题。本研究采用整群抽样的方法进行调查，从医疗
学为重点，建立学校健康教育推进机制”，然而受卫生 视角筛查儿童青少年不良体态、视力健康问题，并探索
筹资结构和卫生保健服务覆盖广度和深度影响，针对儿 建立社区卫生服务中心与学校联合对儿童青少年的健康
童青少年的卫生人力投入不够 ［4］ ，学校卫生虽然是我 筛查机制及健康管理模式。
国公共卫生体系的重要组成部分，但是我国学校卫生工 1 对象与方法
作长期存在经费短缺、专业技术人员数量不足、从业人 1.1 研究对象 2021 年 5—11 月于郑州市经济技术开
员专业素养不高等问题 ［5］ 。儿童青少年时期是人体发 发区整群抽样潮河社区卫生服务中心服务辖区所有学
育的高峰期，模仿能力和身体可塑性极强，但是其肌肉 校，包括 6 所小学、3 所中学的 225 个班级共计 11 318
力量和养成正确体态的意识较薄弱，极易在日常生活和 名学生，按照年级分层，对 1~9 年级所有在校学生进行
运动过程中形成不良体态，严重者可引发疼痛或身体局 体态检查和视力检查。郑州市经济技术开发区在郑州市
部损伤，这段时期身体姿态正确不仅能够促进骨骼肌肉 开启以财政经费支持学校聘用校医政策，潮河社区卫生
的正常发育，同时可以避免许多疾病。目前关于儿童青 服务中心 2020 年底率先探索校医双重身份管理试点，