Children's Health in the Digital Age

Towards an evidence-based integrative lighting score: a proposed multi-level approach

Background: Human circadian clocks are synchronized daily with the external light-dark cycle and entrained to the 24-hour day. There is increasing evidence that a lack of synchronization and circadian entrainment can lead to adverse health effects. Beyond vision, light plays a critical role in modulating many so-called non-visual functions, including sleep-wake cycles, alertness, mood and endocrine functions. To assess (and potentially optimize) the impact of light on non-visual functions, it is necessary to know the exact 'dose' (i.e. spectral irradiance and exposure duration at eye level) of 24-hour light exposures, but also to include metadata about the lighting environment, individual needs and resources.

Problem statement: To address this problem, a new assessment tool is needed that uses existing metrics to provide metadata and information about light quality and quantity from all sources. In this commentary, we discuss the need to develop an evidence-based integrative lighting score that is tailored to specific audiences and lighting environments. We will summarize the most compelling evidence from the literature and outline a future plan for developing such a lighting score using internationally accepted metrics, stakeholder and user feedback.

Conclusion: We propose a weighting system that combines light qualities with physiological and behavioral effects, and the use of mathematical modelling for an output score. Such a scoring system will facilitate a holistic assessment of a lighting environment, integrating all available light sources.

Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives

BACKGROUND

Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions.

OBJECTIVE

This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children.

METHODS

This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis.

RESULTS

Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps' functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy.

CONCLUSIONS

The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children's competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children's internet use, providing tailored or personalized content to suit users' characteristics, and considering the provision of training and information about the use of interventions and privacy agreements.

Alert for the high prevalence of vitamin D deficiency in adolescents in a large Brazilian sample

OBJECTIVE

To estimate the prevalence of vitamin D deficiency and severe deficiency in children and adolescents, in a large Brazilian sample.

METHODOLOGY

Results of 413,976 25(OH)D measurements in children and adolescents aged 0 to 18 years collected between 01/2014 and 10/2018 were obtained from the database of a Clinical Laboratory. In this population, 25 hydroxyvitamin D concentrations below 20 ng/mL are considered deficient, and below 12 ng/mL as severe deficiency. All measurements were performed by immunoassay and the results were distributed by gender, age group, seasonality, and latitude.

RESULTS

The mean of 25(OH)D levels was 29.2 ng/mL with a standard deviation of 9.2 ng/mL. Of the total samples, 0.8% had a concentration < 12 ng/mL, and 12.5% of the samples had a concentration < 20 ng/mL, with a higher prevalence in females. Children under 2 years of age had the lowest prevalence. The effects of latitude and seasonality were quite evident. In samples of female adolescents from the southern region in winter, 36% of vitamin D deficiency and 5% of severe deficiency were found.

CONCLUSION

In this large number of measurements of 25(OH)D in children and adolescents, 12.5% had a deficiency and 0.8% had severe deficiency. A greater deficiency was observed among adolescents, especially females, which raises questions about the need for supplementation during this period of life.

Genetic polymorphism in HTR2A rs6313 is associated with internet addiction disorder

Introduction

Internet addiction disorder (IAD) has grown into public health concern of global proportions. Previous studies have indicated that individuals with IAD may exhibit altered levels of serotonin and dopamine, which are known to play crucial roles in depression, anxiety, impulsivity, and addiction. Therefore, polymorphisms in the receptors that mediate the effects of serotonin and dopamine and affect their functional states as well as their activities are suspect. In this study, we aimed to investigate the association between IAD and rs6313 (T102C) polymorphism in the serotonin 2A receptor (5-HT2A) gene, (HTR2A).

Methods

Twenty patients with IAD and twenty healthy controls (HCs) were included in this study. Young's Internet Addiction Test (IAT), Self-Rating Anxiety Scale, Self-Rating Depression Scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Barratt Impulse Scale, Pittsburgh Sleep Quality Index (PSQI), and Social Support Rating Scale (SSRS) were used to assess the severity of internet addiction, mental status, impulsive traits, sleep quality, and social support. Genotyping was performed to identify rs6313 polymorphisms in the HTR2A gene of all participants.

Results

The frequencies of the C and T alleles of HTR2A T102C were 28% and 72% in the IAD group and 53% and 47% in the HCs group, respectively, indicating that the differences between these two groups were significant. No significant difference was observed in the distribution of the CC, CT, and TT genotypes of HTR2A gene T102C between the IAD and the HCs groups. Additionally, there was no difference in the distribution of the frequencies of the HTR2A gene T102C CC and CT+TT genotypes between the two groups. However, the distribution between the TT and CC+CT genotypes showed an apparent statistical difference in the HTR2A gene T102C between the two groups. Correlation analysis indicated that the IAT score was positively correlated with the Y-BOCS and BIS scores for the CC+CT genotype in patients with IAD. Moreover, the IAT score was positively correlated with the PSQI score in patients with IAD carrying the TT genotype.

Conclusion

The present study demonstrates that rs6313 in HTR2A is associated with IAD, and that the T allele of rs6313 in HTR2A may be a risk factor for IAD.

Ground Rules for Preschooler Exposure to the Digital Environment: A Review of Studies

Background

The range of digital technologies that children use from an early age has expanded significantly. Most studies demonstrate that preschoolers now spend substantially longer on digital devices and start using them at a younger age. Finding a solution for this challenge has research merits and relevance, as the data on benefits and harm of early preschoolers' exposure to digital devices is contradictory. This poses a need to determine theoretically sound and practically validated criteria that could guide the duration and quality of children's exposure to the digital environment.

Objective

To review studies that contain recommendations on preschoolers' exposure to the digital environment, namely, exposure limits and evidence to justify the limitation of preschoolers' time on digital media.

Design

The analysis starts by identifying theoretical foundations that researchers use in their studies of children's behavior in the digital environment. This is followed by an overview of 40 studies that include research papers, official reports, and methodological recommendations made by healthcare and governmental organizations.

Results

The review identified the following ground rules for children's exposure to the digital environment: to provide for child's interaction with a digital device, to use educational applications that will develop skills appropriate to the child's age, to ensure mandatory supervision of children's engagement by an adult who limits the exposure according to child's age-related capabilities and creates conditions for active exploration of the real rather than a virtual world. Children's cognitive development suffers the most from passive intake of digital content.

Conclusion

The data herein can help to develop strategies to promote healthy and educational engagement of children with digital devices and media; however, the review highlights the insufficiency of psychophysiological research that would make it possible to practically validate the recommendations on the duration of preschoolers' exposure to the digital environment.

Determining the Impact of Lifestyle on the Health of Primary School Children in Slovenia Through Mixed Membership Focus Groups

Lifestyle choices made by children and adolescents can lead to a variety of health problems. It is therefore crucial to evaluate the state health-related lifestyles of primary school children's and identify areas for improvement. The aim of this study was to investigate the experiences and perspectives of those involved in educating current generations of primary school children about their lifestyle and the associated health implications of their behavior. Four focus groups were formed, comprising parents, primary school teachers, health professionals, and leisure activity teachers, with five participants in each group. Semi-structured interviews were conducted with each group as part of the qualitative research paradigm of the study. The study revealed three central themes, emphasizing the need to promote health and educate children about healthy behaviors, environmental influences, and health literacy. Community nurses need to take a proactive role in promoting school health. Although adults, peers, and the environment exert a strong influence on children's lifestyles, they often fail to live up to their responsibilities and allow harmful habits to form. To instill positive behaviors and an optimistic attitude towards a healthy lifestyle, all those involved in a child's education need to collaborate. Health-related topics should be included or reinforced in primary school curricula, and parents and school staff should receive appropriate training.

Effects of exercise or tai chi on Internet addiction in college students and the potential role of gut microbiota: A randomized controlled trial

OBJECTIVE

This study aimed to explore the effect of exercise or tai chi on Internet addiction disorder (IAD) among college students and clarified the abundance and population changes of gut microbiota in different groups. Thus explore the potential role of gut microbiota between exercise and IAD.

METHODS

A total of 93 subjects diagnosed with mild IAD were randomly assigned to the exercise group, the tai chi group, and the control group. The intervention groups received exercise or tai chi for 8 weeks and the control group was evaluated without any intervention. Fecal samples were collected after the intervention.

RESULTS

1) Analysis found a significant intervention effect with the exercise group showing an average decrease of 8.84 points on the Internet addiction test (IAT) compared with the control group (95%CI -15.41 to-2.27, P = 0.004). But there was no significant difference between the control group and the tai chi group. 2) Both exercise (P = 0.018) and tai chi (P = 0.026) could significantly relieve fatigue symptoms. 3) The relative abundance of the Betaproteobacteria, Porphyromonadaceae, Sutterellaceae, and Alistipes were significantly decreased in the exercise group compared with the control group, and the relative abundance of Escherichia was significantly increased in the exercise group. 4) The relative abundance of Betaproteobacteria, Sutterellaceae, and Escherichia had significant differences between the improved group and the no-improved group.

CONCLUSION

Exercise intervention has a considerable effect on treating IAD. Exercise and tai chi might have effectiveness in relieving the symptoms of fatigue. Exercise intervention regulates the gut microflora and changes the abundance of microflora to improve IAD.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT05529368.

Research trends related to problematic smartphone use among school-age children including parental factors: a text network analysis

PURPOSE

This study aimed to identify the main keywords and research topics used in research on problematic smartphone use (PSU) among children (6-12 years old), including parental factors.

METHODS

The publication period for the literature was set from January 2007 to January 2022, as smartphones were first released in 2007. In total, 395 articles were identified, 230 of which were included in the final analysis. Text network analysis was performed using NetMiner 4.5.

RESULTS

Research on this topic has steadily increased since 2007, with 40 papers published in 2021. Eight main research topics were derived: group 1, parental attitudes; group 2, children's PSU behavior and parental support; group 3, family environment and behavioral addiction; group 4, social relationships; group 5, seeking solutions; group 6, parent-child relationships; group 7, children's mental health and school adaptation; and group 8, PSU in adolescents.

CONCLUSION

Parental factors related to PSU have been studied in various aspects. However, more active research on school-age children's PSU needs to be conducted due to the paucity of research in this population compared to studies conducted among adolescents. The results of this study provide useful data for selecting research topics in the field of PSU.

A comprehensive review on emerging trends in the dynamic evolution of digital addiction and depression

Introduction

Using digital addiction as an umbrella term to cover any type of addictions to digital technologies such as the internet, smartphones, social media, or video games, the current study aimed to reveal the intellectual structure and evolution of research addressing digital addiction-depression relationship.

Methods

The study combined bibliometric and science mapping analysis methods for this purpose. Data for the study was gathered from Web of Science Core Collection after a comprehensive process of data search/extraction, and 241 articles were included in the final data set. A period-based, comparative science mapping analysis was performed using the SciMAT software.

Results

The analysis of data over three periods, Period 1 (1983-2016), Period 2 (2017-2019), and Period 3 (2020-2022) showed that internet addiction was the most significant theme across all three periods, which was followed by social media addiction. Depression, which emerged as a significant theme during Period 1, was later covered under anxiety disorder theme. Research interest was mostly on factors related to both addiction and depression such as cognitive distortion, insomnia, loneliness, self-esteem, social support, alexithymia, as well as cybervictimization or academic performance.

Discussion

The results suggested that much research is warranted on the digital addiction-depression relationship in different age cohorts, especially children and elderly. Similarly, the current analysis showed that this line of research particularly focused on internet, gaming and social media addiction, and evidence with regard to other types of digital addiction or related compulsive behaviors was almost absent. In addition, research was mostly inclined to understanding cause-effect relationships, which is significant, but preventive strategies seemed to be barely addressed. Likewise, the smartphone addiction-depression relationship arguably garnered less research interest, so future research would contribute to the field in this respect.

Digital Addiction and Sleep

In 2020, the World Health Organization formally recognized addiction to digital technology (connected devices) as a worldwide problem, where excessive online activity and internet use lead to inability to manage time, energy, and attention during daytime and produce disturbed sleep patterns or insomnia during nighttime. Recent studies have shown that the problem has increased in magnitude worldwide during the COVID-19 pandemic. The extent to which dysfunctional sleep is a consequence of altered motivation, memory function, mood, diet, and other lifestyle variables or results from excess of blue-light exposure when looking at digital device screens for long hours at day and night is one of many still unresolved questions. This article offers a narrative overview of some of the most recent literature on this topic. The analysis provided offers a conceptual basis for understanding digital addiction as one of the major reasons why people, and adolescents in particular, sleep less and less well in the digital age. It discusses definitions as well as mechanistic model accounts in context. Digital addiction is identified as functionally equivalent to all addictions, characterized by the compulsive, habitual, and uncontrolled use of digital devices and an excessively repeated engagement in a particular online behavior. Once the urge to be online has become uncontrollable, it is always accompanied by severe sleep loss, emotional distress, depression, and memory dysfunction. In extreme cases, it may lead to suicide. The syndrome has been linked to the known chronic effects of all drugs, producing disturbances in cellular and molecular mechanisms of the GABAergic and glutamatergic neurotransmitter systems. Dopamine and serotonin synaptic plasticity, essential for impulse control, memory, and sleep function, are measurably altered. The full spectrum of behavioral symptoms in digital addicts include eating disorders and withdrawal from outdoor and social life. Evidence pointing towards dysfunctional melatonin and vitamin D metabolism in digital addicts should be taken into account for carving out perspectives for treatment. The conclusions offer a holistic account for digital addiction, where sleep deficit is one of the key factors.

Sleep problems, sleep duration, and use of digital devices among primary school students in Japan

BACKGROUND

There is growing concern that screen time and media use in school-age children can negatively affect children's sleep. These negative effects are explained by three main underlying mechanisms: reduced sleep, time allocated for more media consumption; increased mental, emotional, or psychological stimulation by media content; and the effects of light emitted by digital devices on circadian rhythms and sleep physiology and arousal. In this study, we focused not only on sleep duration, but also on sleep problems. We conducted a large-scale survey to examine the relationship between excessive use of digital devices, Internet addictive behaviour, sleep duration, and sleep problems.

METHODS

We conducted a cross-sectional study of children enrolled in 20 public primary schools in Nagoya City, Japan. Children's parents/guardians completed a questionnaire including the brief sleep questionnaire for Japanese children which is a shortened version of the 'Children's Sleep Habits Questionnaire'. Logistic regression analyses were used to identify associations between sleep problems and grade, sex, weekday sleep time, weekend sleep time, ownership of digital devices, frequent checking of digital devices, use of digital devices for more than 4 hours per day, and Internet addiction.

RESULTS

In total, 8172 responses were received (91.6% response rate). After excluding incomplete responses, we analysed complete datasets for 6893 children with a mean age of 9.0 years. When adjusted for sex, grade, sleep duration on weekdays, and sleep duration on weekends, failure to control (odds ratio [OR] = 1.48; 95% confidence interval [CI]: 1.29-1.70; p < .001), more use than intended (OR = 1.27; 95% CI: 1.12-1.44; p < .001), and use to escape a dysphoric mood (OR = 1.30; 95% CI: 1.03-1.64; p = .027) were associated with children's sleep problems. A shorter weekday and a longer weekend sleep duration indicated a higher likelihood of sleep problems.

CONCLUSIONS

After adjusting for sleep duration, a relationship was found between the three Internet addictive behaviours and sleep problems, but not ownership of digital devices. Parents and teachers may need to address screen media-related sleep problems in children, as these problems may be influenced by psychological factors.

Consciousness Beyond Neural Fields: Expanding the Possibilities of What Has Not Yet Happened

In the field theories in physics, any particular region of the presumed space-time continuum and all interactions between elementary objects therein can be objectively measured and/or accounted for mathematically. Since this does not apply to any of the field theories, or any other neural theory, of consciousness, their explanatory power is limited. As discussed in detail herein, the matter is complicated further by the facts than any scientifically operational definition of consciousness is inevitably partial, and that the phenomenon has no spatial dimensionality. Under the light of insights from research on meditation and expanded consciousness, chronic pain syndrome, healthy aging, and eudaimonic well-being, we may conceive consciousness as a source of potential energy that has no clearly defined spatial dimensionality, but can produce significant changes in others and in the world, observable in terms of changes in time. It is argued that consciousness may have evolved to enable the human species to generate such changes in order to cope with unprecedented and/or unpredictable adversity. Such coping could, ultimately, include the conscious planning of our own extinction when survival on the planet is no longer an acceptable option.

Prevalence and Factors Associated With the Risk of Delayed Sleep-Wake Phase Disorder in Japanese Youth

BACKGROUND

Delayed sleep-wake phase disorder (DSWPD) is more prevalent among the younger generation. However, the prevalence of this disorder in Asia, particularly Japan, has not yet been elucidated. Furthermore, the impact of DSWPD morbidity on daytime functioning and factors associated with the presence of the disorder remain unclear.

METHODS

A web-based survey was conducted among youth aged 15-30 years. In total, 7,810 individuals completed the questionnaire. The questionnaire included items on sociodemographic variables as well as the Japanese version of the Biological Rhythms Interview of Assessment in Neuropsychiatry self-report (J-BRIAN-SR), which assesses the risk of DSWPD, sleep behaviors and possibly related lifestyle variables, productivity loss [WHO Health and Work Performance Questionnaire (HPQ)], and health-related quality of life (HRQOL). The risk of DSWPD was indicated by a J-BRIAN-SR score greater than or equal to 40 points and days of absence ≥4 days per month. After comparing these variables for participants at risk of DSWPD and those who were not, the factors associated with the risk of DSWPD were examined using logistic regression analysis, with sociodemographic and lifestyle variables as independent variables.

RESULTS

The overall prevalence of participants at risk DSWPDs was 4.3%. Compared with participants without DSWPD, those at risk of DSWPD presented significantly worse HPQ and HRQOL scores. The risk of DSWPD was positively associated with the presence of currently treated diseases, length of nighttime liquid crystal display (LCD) viewing, and being a high school/university students. It was negatively associated with habitual exercise.

CONCLUSION

The risk of DSWPD seemed to be consistent with reports from Western countries, and individuals possibly affected by the disorder were thought to have deteriorated daytime functioning. In addition, lifestyle specific to youth, such as long-term LCD viewing at night and relatively loose social constraints, could be associated with the presence of DSWPD in this generation.

Neuropsychological Correlates of Internet Addiction

The Internet, mobile phones, and other similar tools are often necessary for the current functioning of both private life and business. During these two years of pandemic (2019-2021), Internet use, especially different games and mobile phones, were indispensable for the global population. Internet addiction is defined as a psychological dependence on the internet, regardless of the type of activity once logged on. Many studies have confirmed the correlation of stress, depression, and anxiety with internet addiction. It has also been proven that internet addiction, per se, increases the risk of depression, anxiety, and stress. Moreover, the COVID-19 pandemic has generated and promoted social isolation along with unmonitored and increased screen time, all of which are the main causes of internet addiction. The aim of this article is to give a short review of internet addiction research, terminology, and symptoms related to brain functioning. The source material was articles cited in the database, PubMed. Our interest was especially oriented towards the personality characteristics of users and addicted persons as well as neuroimage findings among affected people. We selected the newest articles, published in the period of 2012-2021, of which there are more than 2000. The selected obtained results will be presented and discussed.

Semiprivate space and access to online education during COVID-19: empirical tests from China

Purpose

Although the use of online technology has generated excitement over its potential to increase access to education, most existing research has focused on comparing online and in-person student performance. This study provides empirical evidence that semiprivate space at the family level affects students' access to online education.

Design/methodology/approach

Students from 1,565 low-income households in China were surveyed, and a multivariate logistic regression analysis was conducted on the hypothesized factors that affect access to online education at home.

Findings

The results show that the absence of computers, smartphones and broadband networks at home severely hinders children's access to online education, and even leads to their exclusion from it. Children with their fathers or paternal grandfathers as guardians have a lower probability of receiving online education at home. It was also found that the higher the education level of the head of the household, the more likely it is that children will receive online education at home.

Originality/value

This study is one of the first to examine online accessibility at the family level. It also demonstrates that the semiprivate space at the family level may limit opportunities for students who would otherwise pursue online education at home.

Sleep disturbances in children with cystic fibrosis, primary ciliary dyskinesia and typically developing children during COVID-19 pandemic

AIM

We aimed to investigate sleep disturbances in children with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) and typically developing (TD) children during the COVID-19 pandemic.

METHODS

Primary care givers of children with CF and PCD aged 3-16 years were asked to enrol in the study. Primary care givers of TD children were included as control group. The Sleep Disturbance Scale for Children (SDSC) was used, and questions related to sleep habits during the pandemic were asked. Results of the three groups were compared.

RESULTS

Primary care givers of 33 children with CF, 16 children with PCD and 66 TD children were included in the study. There were no differences in terms of age and gender between the three groups. Changes in sleep patterns during the pandemic were more common among TD children and their families, with 75% of the children and 80% of their families sleeping later than before. The sleep initiation and maintenance disorder scores were higher in TD children (P = 0.001), whereas the sleep breathing disorder scores were higher in children with PCD (P = 0.001), and the sleep hyperhidrosis scores were higher in children with CF and PCD (P = 0.011). No relationships were found between sleep parameters and clinical findings of children with lung disease.

CONCLUSIONS

Children's sleep habits have changed during the pandemic. Children with chronic lung diseases and even TD children may experience sleep disturbances during this period.

Examining risk factors related to digital learning and social isolation: Youth visual acuity in COVID-19 pandemic

Background

Around the globe, various self-quarantine, social distancing, and school-closure policies were implemented during the coronavirus disease-19 (COVID-19) outbreak to reduce disease transmission. Many economies/territories were compelled to consider digital learning modalities. In particular, increased digital learning engagement with digital devices and mounting psychosocial stress due to social isolation are likely to pose adverse risks for youth visual health globally. This study examines the association between increased digital device use, psychosocial stress, and myopia symptoms among Chinese youth during the COVID-19 pandemic.

Methods

This is a retrospective observational population study consisting of 3918 participants enrolled in primary, secondary, and university in China. Participants are recruited through an online survey, which included self-reported information on daily digital device use, psychosocial stress level, condition of visual acuity, and demographic information. We utilize statistical tools including χ² test, paired sample t test, and multiple multivariate logistic regression.

Results

Each hour increase in digital device use is associated with 1.25 odds ratio OR (95% confidence interval (CI) = 1.21-1.30; P < 0.001) increased risk of developing myopic symptoms, each additional hour of digital device use weighted by near-view and blue-light exposure is associated with OR = 1.04 OR (95% CI = 1.03-1.05; P < 0.001) and OR = 2.25 (95% CI = 1.94-2.60; P < 0.001) increased risk respectively. Subjects reporting under stressful conditions are between OR = 1.98 (95% CI = 1.67-2.36; P < 0.001) and OR = 2.03 (95% CI = 1.71-2.42; P < 0.001) more likely to develop myopic symptoms, relative to those citing less stress.

Conclusions

The COVID-19 pandemic led to favorable conditions for myopigenic behavioral changes characterized by extended sedentary engagement with digital devices, which are significantly associated with higher risks of myopia incidence. Relatedly, psychosocial stress accompanying prolonged social isolation during the pandemic is a less noticeable, albeit significant risk factor for myopia development.

The effect of home education on myopia progression in children during the COVID-19 pandemic

Objectives

To evaluate the effect of the COVID-19 pandemic restrictions on myopia progression (MP) in school age children.

Methods

A total of 115 children aged 8–17 years with a diagnosis of myopia who had been followed-up for at least three years, were included in this study with a retrospective and single-centre design. The subjects’ age, the history of myopia in the family, the time spent in front of a screen, the digital devices used during home education (computer, tablet, smartphone, television), the time spent in open air (hours/day), the refractive error (RE) (spherical equivalent value) detected before the home education period and the changes in the myopia over the years, were recorded.

Results

The mean age was 12.06 (±2.29) years. Only the right eyes were included. The glasses use duration was 3.57 (±0.74) years. The annual MP amount 0.49 (±0.26), 0.41 (±0.36) and 0.54 (±0.43) dioptres (D) for the 2017, 2018 and 2019 years before home education, respectively, (p > 0.05), and 0.71 (±0.46) D in 2020, during home education. The increase in MP amount in 2020 compared to the 2019 and 2018 years was statistically significant (p < 0.003). MP was statistically significantly less in children who participated in open-air activities for 2 h a day and those who lived in detached houses (p = 0.004, p = 0.006, respectively).

Conclusion

During home confinement, education programmes of school children should be designed while taking into account preventive measures for MP, in particular for allowing children to spend at least 2 h of outdoor time per day.

Precocious Puberty and Covid-19 Into Perspective: Potential Increased Frequency, Possible Causes, and a Potential Emergency to Be Addressed

A significant increase in precocious puberty, rapidly progressive puberty and precocious menarche has been reported in Italy since the initial lockdown because of the pandemic, and this could represent a new emergency to be addressed during this pandemic. There is a need, therefore, for further understanding and research. Many causes could account for this. Initially, it was thought that the changes in life-style, in screen time, and sleeping habits could be the cause but if considered individually these are insufficient to explain this phenomenon. Likely, changes in central nervous mediators, and an increase in catecholamines could contribute as a trigger, however, these aspects are poorly studied and understood as well as the real perceptions of these children. Finally, staying more indoors has certainly exposed these children to specific contaminants working as endocrine disruptors which could also have had an effect. It would be of utmost importance to compare this phenomenon worldwide with appropriate studies in order to verify what is happening, and gain a new insight into the consequences of the covid-19 pandemic and into precocious puberty and for future prevention.

The relevance of daylight for humans

Daylight is ubiquitous and is crucial for mammalian vision as well as for non-visual input to the brain via the intrinsically photosensitive retinal ganglion cells (ipRGCs) that express the photopigment melanopsin. The ipRGCs project to the circadian clock in the suprachiasmatic nuclei and thereby ensure entrainment to the 24-hour day-night cycle, and changes in daylength trigger the appropriate seasonal behaviours. The ipRGCs also project to the perihabenular nucleus and surrounding brain regions that modulate mood, stress and learning in animals and humans. Given that light has strong direct effects on mood, cognition, alertness, performance, and sleep, light can be considered a "drug" to treat many clinical conditions. Light therapy is already well established for winter and other depressions and circadian sleep disorders. Beyond visual and non-visual effects via the retina, daylight contributes to prevent myopia in the young by its impact on eye development, and is important for Vitamin D synthesis and bone health via the skin. The sun is the most powerful light source and, dependent on dose, its ultraviolet radiance is toxic for living organisms and can be used as a disinfectant. Most research involves laboratory-based electric light, without the dynamic and spectral changes that daylight undergoes moment by moment. There is a gap between the importance of daylight for human beings and the amount of research being done on this subject. Daylight is taken for granted as an environmental factor, to be enjoyed or avoided, according to conditions. More daylight awareness in architecture and urban design beyond aesthetic values and visual comfort may lead to higher quality work and living environments. Although we do not yet have a factual basis for the assumption that natural daylight is overall "better" than electric light, the environmental debate mandates serious consideration of sunlight not just for solar power but also as biologically necessary for sustainable and healthy living.