الفهرس 
The spineOnly 14 pages are availabe for public view
 |  | from | 130 |  |  |
| | | from | 130 | | |
Abstract
The effects that backpacks can potentially have on the body are numerous. Ranging from no noticeable change in upright posture, postural stability and/or pain to the assumption of a position of trunk flexion accompanied by pain and postural instability, there is growing concern regarding health effects due to backpack wear.
Studies from different countries showed that heavy backpack carried by students is one of the factors that might cause disturbance in the maturing musculoskeletal system.
The aims of this study were; to study the school bag concerning the weight, the size of bag relative to trunk size, the methods of carriage, duration of carriage, method of transport to school, and presence or absence of the desirable bag features, also to determine the percentage of the bag weight in relation to the student’s body weight, to determine the association between relative school bag weight and perception of stability of students, subjective pain, pain site, and its impact on medical utilization, and lost school time, and to construct a backpack safety program to students carrying backpack 10% or more of their body weight and the available teachers, and to assess the changes in the belief, knowledge, and behavior of the students towards the backpack use after program implementation.
The study was conducted in Primary and preparatory schools (public and private) of Alexandria Governorate. The study included 1029 students, were chosen randomly based on educational zones, type of school, and sex. A sub-sample 130 of students carrying school bags more than10% of their body weight were subjected to an intervention school bag safety program. An equal number of matched controls with the same criteria were selected. Both groups were subjected to the pre and posttests.
For conduction of the study, the following tools, and techniques were used:
• A structured interview questionnaire to collect data about socio-demographic characteristics of the students, leisure activities and school achievement of the students, family characteristics of students, musculoskeletal disorders related to school bag carriage by students, students’ subjective perception of stability during carrying bag, students’ knowledge about school bag characteristics: students’ believes related to school bag use, and self-reported students’ practices related to school bag use.
• Observation of school bag and students’ practices to it collect data related to school bag characteristics, school bag method of use, and observed signs
• Also weight, height, back’s height, bi-acromial width, bi-iliac width of students and weight, height, and width of school bag were measured. BMI, relative bag weight (%), and relative bag area (%) were calculated.
• Reassessment of the knowledge, beliefs, and behavior of students towards backpack use as well as measurement of the student and bag weights done 3 weeks after the end of intervention program for both the intervention and control groups.
The study revealed the following results:
• The mean bag’s weight as a percentage of student’s body weight was 9.82±8.21%, ranging from 5.47%±1.80% to 11.10%±2.75% which is within the recommended limit of less than 10% of BW. However 44% of students carried school bags that weigh more than 10% of their body weight.
• It was found that the mean relative bag weight of students was maximum at the fourth grade (11.10%±2.75%) and decreased significantly and steadily to 10.10%±2.42% in the fifth grade, 9.10%±2.54% in the sixth grades, 7.95%±2.41% in the first preparatory grade, 6.76%±2.29% in the second preparatory and 5.47%±1.80% in the third preparatory.
• No significant difference was found between males and females in the mean relative school bag weight except in the first (7.49%±2.60% vs 8.36%±2.17% respectively), and third preparatory (4.96%±1.79% vs 5.88%±1.74% respectively) grades where girls had significantly higher mean relative bag weight than boys.
• The study revealed risk factors of having relative school bag weight more than 10% of student’s body weight. In contrast to governmental Arabic schools all school types showed significant more risk of having relative school bag more than 10% of body weight that increased from 3.35 (95% CI: 1.70 - 6.67) in governmental language schools to 9.29 (95% CI: 4.64 - 19.04) in private language schools and 3.74 (95% CI: 2.34-6.01) in private Arabic schools.
• Another factor that had association with the increased risk of having relative school bag weight more than 10% was students’ age where younger students were more likely to carry school bags heavier than 10% of their body weight. The age group 8-<10 years were about 32 times more likely to carry heavy school bag compared to the age group 14-16 years followed by students aged 10-<12 years (OR = 18.55, 95% CI: 9.20- 38.52) and 12-<14 years (OR= 6.82, 95% CI: 3.33 - 14.37).
• The study found that Students of highly educated fathers, mothers, professional fathers and working mothers were more likely to carry heavy school bag relative to their body weight as the odds ratios in all these cases were all significant and around two.
• The study showed that when student was the only one choosing the school bag, the percentage having a bag more than 10% body weight was minimum (31%) and when parents chose the bag or share its choice the bag weight was more likely to be heavy as the percentage with schoolbag greater than 10% of their body weight was over 40% and odds ratio was about two.
• As regards the believes of the students about the school bag use, students who had poor believes, were about two times (CI: 1.03-2.45) more likely to have relative school bag weight more than 10% compared to students who had good believes about school bag use.
• We didn’t find any significant association between having relative school bag weight more than 10% and gender, student’s birth order, family income, crowding index, or the student’s knowledge about school bag characteristics.
• Observation of bags showed that in 15.1% of cases there was only one shoulder built in 22.6% of cases, neither the shoulder built nor the bag back was padded, the number of partitions was one or two in 44.7% of cases and almost all cases had neither pressure built inside bag nor waist built (98%). Most of the students’ backpacks (80.7%) were without wheels.
• Concerning the backpack’s method of use, 22.8% of students carried the bag on one shoulder. Almost all students (99%) didn’t put material on the bag’s back or carry additional bags but they didn’t use middle built. Books were put inside bag without order by 31.8% of students. Almost all (99.8%, 99.7%) of the students incorrectly pull up or put down the bag, 35.3% of students had difficulty in bag carriage and 16.4% of students encountered difficult walking while carrying the backpack. The place of bag on student’s pack was not suitable in 53.3% of cases.
• There was observed redness seen in 3.1% of the students. Nearly half (45.9%) of the students their backs were leant forward while carrying the bag, for 13.1% of the students leant on one side, and 1.1% leant backward and 39.9% had straight back.
• In current study the results showed that 79.3% reported that they feel back pain due to carrying school bag and 20.7% were non-pain reporters. Of the pain reporters, 18% indicated pain in the neck region, 67% in the shoulders, and 53.8% in the back. Concerning the degree of pain, 95.2% of pain reporters had insignificant pain, while 3.1% of them had significant pain not affecting usual performance, and 1.7% had significant pain affecting usual performance. Regarding the impact of pain, the study showed that 4.3% of the students had lost school time, 4.6% had lost sports time, and 2.7% were unable to do other daily activities due to their backpack related pain. About 3% of the students went to the physician because of pain and 5.6% had numbness of either arms or hands or both during carrying the bag.
• Multiple logistic regressions of factors related to musculoskeletal pain intensity. After adjusting for demographic data, and family characteristics, the most significant predictors of suffering moderate to severe musculoskeletal pain were family income, family history of back pain, Sports hours/wk., hours stayed on TV, Computer or Video games/day, sleeping hours/day, BMI, self-reported and observed practices related to school bag carriage and student’s knowledge. That adjusted odds ratios indicated that students more likely to report moderate to severe musculoskeletal pain related to school bag are belonging to families with at least sufficient income (OR = 3.63, 95% CI: 1.31- 10.09), and with positive family history of back pain (OR = 3.31, 95% CI: 2.02- 5.41). Students who practice exercise more than two hours per week were more likely to report moderate to severe musculoskeletal pain (OR = 23.87, 95% CI: 11.83- 48.18).
• Considering hours for TV/Computer/Video games/day, students who stayed for less than one hour (OR = 2.14, 95% CI: 1.28- 3.59) and those staying two hours or more (OR = 3.17, 95% CI: 1.80- 5.58) are more likely to have moderate to severe musculoskeletal pain in contrast to students who stayed one to less than two hours.
• Sleeping for seven hours or more per day was found to be protective against suffering moderate to severe musculoskeletal pain (OR = 0.24, 95% CI: 0.13- 0.48).
• Fair to good practices whether self-reported or by observation were found to be protective against moderate to severe musculoskeletal pain. On the other hand students who had better knowledge about school bag carriage were more likely to report musculoskeletal pain (OR = 1.69, 95% CI: 1.04- 2.73).
• Regarding BMI of students the category <19 only was found to be significantly associated with higher risk of pain suffering (OR = 2.10, 95% CI: 1.32- 3.34).
• The study showed nearly a quarter of the students had experienced falls and half of the students had perceived sense of fall (PSOF) during backpack wear. Falling at least once, Feeling of fall twice or more while carrying the bag, were significantly more represented among those with relative school bag weight >10% of their body weight (P<0.05).
• The study showed nearly a quarter of the students had experienced falls and half of the students had perceived sense of fall (PSOF) during backpack wear. Falling at least once, Feeling of fall twice or more while carrying the bag, were significantly more represented among those with relative school bag weight >10% of their body weight (P<0.05).
• The mean relative school bag weight changed significantly after intervention in both study groups. However, the mean change didn’t differ significantly between the two groups.
• Concerning the effect of intervention program on the knowledge, believes, self-reported practices and observed practices, the mean change in the scores post intervention was significantly higher among the intervention than the controls.
Based on the previous findings the study recommended the following:
• Ministry of education authorities at a high level should understand in depth the extent of the problems caused by backpacks and should study the problems and how to solve them accompanied with health professionals and school staff.
• School administrators can utilize a variety of venues to share information periodically on backpack safety with parents, students, and staff such as e-school newsletters, and school webpage. Print backpack safety tips on the back of the school supply lists that are distributed to families. Provide children with storage facilities (lockers) for materials not needed on a daily basis. Backpack safety and injury prevention educational materials can be integrated into the physical education or health education curriculum.
• The importance of teachers in all phases of their work: selecting books, planning the week as members of the class councils, planning the work for the days ahead, and educating their students about the problem. They could continue to pay attention to the problem throughout the year, highlighting awareness of it among pupils and parents and making sure that children are not asked to bring books to school unnecessarily. They also could organize book sharing between classmates
• Parents remain the best advocates for safety promotion and should represent the group most likely to help to significantly reduce the number of backpack related injuries. Educational programs for the parents regarding desirable backpack features, warning signs that the bag is heavy, and the proper way of loading and wearing the bag should be applied. As parents could educate their children about the problem, they could check bag’s weight and what their children are carrying to school each day to make sure that they aren’t taking items relevant to that day’s activities. Parents should not try to save money by buying the biggest backpack that they find but they have to make sure the backpack is appropriate to their child’s size. Children are fashion conscious and vulnerable to peer pressure, so parents should take their child with them when buying their backpack.