Beijing (Peking)---Myopia and Obesity Comorbidity Intervention (BMOCI)

Implementation Research on the Construction and Scale up Regarding to"Comorbidity-Co-causes-Joint-prevention" Comprehensive Demonstration District of Myopia and Obesity Among Children and Adolescents in Beijing Guided by RE-AIM Framework

Based on the RE-AIM framework, this project intends to integrate the prevention and control measures of myopia and obesity, and establish a set of key suitable technical packages and guarantee systems for the "comorbidity-common-cause-common prevention" of myopia and obesity in children and adolescents. Hetongzhou District selected 24 intervention schools (about 20,000) and 12 control schools (about 10,000) to apply the application, integrate the resources of the "family-school-community-medical institution", and establish a comprehensive combination of myopia and obesity in children and adolescents In the prevention and control demonstration area, a one-year intervention study was conducted to evaluate the comprehensive intervention effect of myopia and obesity in children and adolescents in the demonstration area, and to promote it through the regional monitoring system in Beijing. This project is the first time to establish a district-level comprehensive prevention and control demonstration area for children and adolescents with myopia and obesity that can be promoted, including key appropriate technology packages and promotion and application strategies. Healthy Beijing 2030" plan laid the foundation.

The investigators plan to follow the child every three months for a year. Data were collected every 3 months for a total of 5 follow-up data collections (baseline, 3 months, 6 months, 9 months, and 12 months). The contents of each follow-up included questionnaire collection, anthropometric measurement, body composition measurement, visual acuity measurement, blood pressure measurement, venous blood extraction, etc., as well as family questionnaire, school questionnaire, community hospital and project hospital intervention doctor questionnaire. In the first, third and fifth follow-up visits, 2-3 ml of venous blood should be collected. Myopia and activity records: including nighttime lighting, wake-sleep cycles, and movement. As well as family questionnaires, school questionnaires, community hospitals and project hospital intervention doctor questionnaires. All inspection items are operated by trained and qualified doctors and professional health technicians. The inspection will be arranged in the school, and the whole process is the same as the regular physical examination in the school. The child required 3 venous blood collections, urine and saliva collections during the year (at the initial stage and at the 3rd follow-up, respectively). Blood sample testing: 2-3ml of venous blood (about 1/2 of the bottle cap of mineral water) is drawn each time for blood routine and blood biochemistry. The blood process is safe. Blood samples include: blood biochemical indicators (fasting blood glucose (FBG), insulin, total cholesterol (TCHO), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) )). Hormone testing: Collect saliva samples in the morning and purchase ELISA kits to measure levels of thyroid hormones, estradiol and testosterone. Urine sample testing: use polypropylene urine cups and urine collection tubes (without PAEs plasticizers) to collect 10 mL of urine from the research subjects, and reserve the sample to collect the first excretion after getting up in the morning, before breakfast and before exercising. Before urinating in the middle of the urine, students should be asked to clean the urethral opening and surrounding skin with warm water to avoid the contamination of secretions. The collected urine samples were uniformly stored in a 5mL centrifuge tube and stored in a -20°C refrigerator. Urine PAEs and their metabolites: Ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to detect seven PAEs metabolites in students' urine: monomethyl phthalate (MMP), phthalic acid Monoethyl ester (MEP), mono-n-butyl phthalate (MBP), mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-phthalate) Hydroxyhexyl) ester (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP). The content of the family and student questionnaires will include general conditions of children, general conditions of parents and families, as well as daily diet, physical activity and sleep. The name of the child will only be used for tracking and will be deleted after one year of observation to ensure that the information of the child and participants will not be leaked. All members of the project team have signed a confidentiality agreement, and all information in the questionnaire will not be leaked to the outside world.

The intervention consisted of four components: a) Create supportive school and family environment, b) Health lifestyles education and related compulsory physical activities, c) Instruct and promote school physical education, d) Self-monitor obesity related behaviors. Four types of outcomes including anthropometric, behavioral, blood chemical and physical fitness were measured to assess the effectiveness of the intervention program.

The intervention group adopted an intervention strategy based on the RE-AIM framework with 22510S as the core. 22510S is a set of intervention strategies where "2" is 2 hours or more of outdoor physical activity per day for school-aged children, of which 1 hour should be moderate-to-vigorous physical activity; "2" is no more than 2 hours per day of television viewing or screen-based electronics use. "5", school-age children should eat 5 portions of vegetables and fruit the size of an adult's fist, about 300 to 500 grams of cooked or chopped raw vegetable leaves and about 200 to 400 grams of fruit per day; "1", 1 portion of meat per day, equivalent to 1 adult hand The "1" is to eat one portion of meat per day, the size and thickness of one adult hand, about 80 to 110 grams; the "0" is to not drink sugary drinks; and the "S" is for school-age children to get a reasonable amount of sleep each day.

Refer to the "Guidelines for the Prevention and Control of Myopia in Children and Adolescents" issued by the National Health Commission in 2019 to check the vision of children.

Use an electronic scale and check its accuracy and sensitivity before use. The accuracy error shall not exceed 0.1%, that is, the error per 100kg shall be less than 0.1kg.

A tape ruler was used to measure horizontally around the midpoint of the line between the anterior superior iliac crest and the lower edge of the 12th rib (the thickest part of the waist was selected for obese patients);

Find the exact position, gently pinch the skin and subcutaneous tissue (do not pinch muscle tissue) with the left thumb and index finger at the tested part, and the distance between the two fingers is 3 cm;

Using the bioelectrical impedance method, the students hold the hand electrode of the body composition tester, stand on the foot electrode, and complete the measurement in 40 ~ 60 seconds.

The upper arm medical electronic sphygmomanometer certified by the international standard scheme is used for measurement.

The collected urine samples are stored in a 5ml centrifuge tube and stored in a refrigerator at - 20 ℃.

Put the photometer on the bedside table of the bedroom and program it to continuously collect light information every 60 seconds.

Children wear three-axis Actigraph GT3X + activity recorder (removed when taking a bath) in their nonpreferred hands for 24 hours for 7 consecutive days.

Children wear three-axis Actigraph GT3X + activity recorder (removed when taking a bath) in their non-preferred hands for 24 hours for 7 consecutive days.

"Parent Questionnaire" is taken home by students for parents to fill out, and brought back to school to give to teachers within a limited time.

Inclusion Criteria: At 6-17 years old。 The physical examination information at school is complete. There is no transfer plan within one year. Exclusion Criteria: There are ophthalmic device diseases, such as keratitis, corneal ulcer, etc.; History of ophthalmic surgery, such as laser surgery; Visual problems such as color weakness and color blindness; Suffering from major organ diseases or endocrine diseases; History of heart, lung, kidney and other important organ diseases; Abnormal physical development; Can not participate in school sports activities; Have any weight loss behaviors such as inducing vomiting or taking weight loss drugs;