Prevalence and factors associated with pentavalent vaccination: a cross-sectional study in Southern China.

BACKGROUND: Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives. A complex immunization schedule, however, may be burdensome to parents and lead to reduced vaccine compliance and completion. Thus, it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule. This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B conjugate (DTaP-IPV/Hib) vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations. METHODS: A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023. The study employed a stratified multistage cluster random sampling method. Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire. Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations. RESULTS: Of the 4818 valid responses, 95.3% of children were aged 3-4 years, and 2856 (59.3%) held rural hukou. Coverage rates of the DTaP-IPV/Hib vaccine, from 1 to 4 doses, were 24.4%, 20.7%, 18.5%, and 16.0%, respectively. Caregivers who are concerned about vaccine efficacy [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI): 1.30-1.79], the manufacturer (aOR = 2.05, 95% CI: 1.69-2.49), and a simple immunization schedule (aOR = 1.26, 95% CI: 1.04-1.54) are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib. In addition, caregivers in urban areas showed more concern about the vaccine price (P = 0.010) and immunization schedule (P = 0.022) in regard to vaccinating children. CONCLUSIONS: The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low. Factors such as lower socioeconomic status, cultural beliefs, concerns about vaccine safety, and cost may hinder caregivers from vaccinating their children. Further measures, such as health education campaigns to raise knowledge and awareness, and encouragement of domestic vaccine innovation, which would reduce out-of-pocket costs, could be implemented to improve the coverage of DTap-IPV/Hib vaccination.

Extreme Temperature Exposure and Risks of Preterm Birth Subtypes Based on a Nationwide Survey in China.

BACKGROUND: Previous studies have reported that ambient temperature may affect perinatal outcomes. However, whether extreme temperature affects the risk of preterm birth (PTB) remains controversial. Studies on the associations of extreme temperature with PTB subtypes are lacking. OBJECTIVES: We aimed to investigate the associations of extreme climate events with the risks of PTB and its subtypes, discerning possible modifiers. METHODS: Data on all singleton deliveries were obtained from the China Labor and Delivery Survey (CLDS), a nationwide investigation implemented in 2015 and 2016. PTB was defined as gestational weeks <37 and then categorized as early (24-34 wk) and late PTBs (35-36 wk), and clinical subtypes [spontaneous PTB, preterm premature rupture of the fetal membranes (PPROM), iatrogenic PTB]. Ambient temperature data were provided by the China National Weather Data Sharing System. Five heat indexes and five cold indexes were used to define heat waves and cold spells. Generalized linear mixed models with a random term by hospital unit were used to assess the associations of short-term prenatal extreme temperature exposure. The Cox proportional hazard regression model was applied to assess the nonlinear associations of low- or high-temperature exposure at the whole and different trimesters of pregnancy with the risk of PTB. Stratified analyses were conducted to assess the possible modification by geographic region and fetal sex. RESULTS: A total of 70,818 singleton births from 96 hospitals in China were included, among which 4,965 (7.01%) were PTBs. Exposure to extreme cold events 1 wk before delivery was associated with an increased PTB risk, with an adjusted odds ratio (aOR) [95% confidence intervals (CIs)] of 1.07 (95% CI: 1.04, 1.10) and 1.06 (1.04, 1.09) for the total days when the daily average temperature below the fifth percentile (fifth-days) and the 10th percentile (10th-days), 1.18 (1.04, 1.34) for the cold spells when the daily average temperature below the fifth percentile for two consecutive days (fifth-2D), 1.09 (1.03, 1.16) and 1.12 (1.06, 1.19) for the cold spells when the daily average temperature below the 10th percentile for three and two consecutive days (10th-3D and 10th-2D), respectively. Results of extreme temperature exposure during 2 weeks before delivery showed similarly significant associations. The association between cold spells and PTB tended to be stronger for late PTB than for early PTB. Cold spells were mainly associated with spontaneous PTB and late PPROM. A stratified analysis indicated that pregnant women in western and northern regions tended to be more sensitive to cold spells, and pregnant women with a female fetus appeared to be at a higher risk of PTB when exposed to cold spells. Pregnant women in late pregnancy were more susceptible to extreme temperatures. No significant or stable association was found between heat waves and preterm birth. DISCUSSION: Exposure to cold spells was associated with an increased risk of PTB, especially late, spontaneous PTB and PPROM. The associations appeared to be more pronounced in the north and west regions and in pregnancies with female fetuses. https://doi.org/10.1289/EHP10831.

Prenatal exposure to fine particulate matter and newborn anogenital distance: a prospective cohort study.

BACKGROUND: Considerable attention has been paid to reproductive toxicity of fine particulate matter (PM2.5). However, the relationship between prenatal PM2.5 exposure and anogenital distance (AGD) has not been well studied. We aim to investigate the potential effects of prenatal exposure to PM2.5 on newborn AGD. METHODS: Prenatal PM2.5 exposure of 2332 participates in Shanghai (2013-2016) was estimated using high-performance machine learning models. Anoscrotal distance (AGDas) in male infants and anofourchette distance (AGDaf) in female infants were measured by well-trained examiners within 3 days after birth. We applied multiple linear regression models and multiple informant models to estimate the association between prenatal PM2.5 exposure and AGD. RESULTS: Multiple linear regression models showed that a 10 µg/m3 increase in PM2.5 exposure during full pregnancy, the second and third trimesters was inversely associated with AGDas (adjusted beta = - 1.76, 95% CI: - 2.21, - 1.31; - 0.73, 95% CI: - 1.06, - 0.40; and - 0.52; 95% CI: - 0.87, - 0.18, respectively) in males. A 10 µg/m3 increase in PM2.5 exposure during the full pregnancy, the first, second, and third trimesters was inversely associated with AGDaf (adjusted beta = - 4.55; 95% CI: - 5.18, - 3.92; - 0.78; 95% CI: - 1.10, - 0.46; - 1.11; 95% CI: - 1.46, - 0.77; - 1.45; 95% CI: - 1.78, - 1.12, respectively) in females after adjusting for potential confounders. Multiple informant models showed consistent but slightly attenuated associations. CONCLUSION: Our study observed a significant association between gestational PM2.5 exposure during pregnancy and shortened AGD in newborns, and provided new evidence on potential reproductive toxicity of prenatal PM2.5 exposure.

Establishment and application of suitable technology for screening, diagnosis and evaluation of neonatal congenital heart disease in Hainan Province / 中国热带医学

@#Abstract： Objective　To establish a screening-diagnosis-evaluation system of neonatal congenital heart disease (CHD) suitable for Hainan Province based on the application of percutaneous blood oxygen saturation measurement and cardiac auscultation screening, and to provide a basis for further promotion of the evaluation effect. Methods　Screening agencies (all midwifery institutions) used the "double index method" to screen newborns for congenital heart disease. Those who were screened positive for any index were transferred to diagnostic institutions (the people's hospitals of all cities and counties and some tertiary hospitals) for echocardiography examination within 1 week. Those with abnormal results were transferred to the treatment institution (two tertiary hospitals) for reconfirmation and evaluation. All data were managed online. Results　In this study, 96 913 newborns born in midwifery institutions in 19 cities and counties were screened, with a response rate of 99.44%. The ratio of male infants (50 836) to female infants (46 077) was 1.10∶1. A total of 2 284 positive patients were screened by dual index method, and ultrasound diagnosis was performed, with the rate of cardiac ultrasonography of 98.07% (2 240/2 284) and a high response rate. A total of 238 cases of congenital heart disease were diagnosed (incidence rate of 0.25%), with the top three main types were ventricular septal defect, atrial septal defect, and patent ductus arteriosus. The sensitivity (88.24%) and Youden index (0.86) of dual-indicator screening for CHD detection were significantly higher than the other separate indicators. Through Kappa consistency test analysis, the consistency of dual-indicator screening with simple heart murmur screening results was excellent, with a Kappa coefficient value of 0.835 (>0.75); the consistency of dual-indicator screening and simple POX screening results was good, with a Kappa coefficient value of 0.429 (between 0.40-0.75), and the differences were statistically significant (P<0.001). By the end of the study, 136 children had undergone open-chest/occlusion surgery, with good postoperative recovery, and the rest were followed up. Conclusions　The neonatal CHD screening-diagnosis-assessment technology system established in this study, with close connections between various blocks, high screening response rate and echocardiography examination rate, is beneficial for the early diagnosis and treatment of CHD children, and has certain application value in institutions at all levels in Hainan Province, and is worth further promotion.

Effect analysis of combined immunological blockade mother-to-child transmission of hepatitis B virus in Hainan Province from 2015 to 2020 / 中国热带医学

@#Abstract: Objective　To analyze the influencing factors of mother-to-child transmission of hepatitis B virus after combined immunological blockade, and to evaluate the effect of mother-to-child blockade, and to provide a basis for health policies and health interventions for preventing mother-to-child blockade of hepatitis B virus. Methods A total of 11 363 pairs of HBsAg positive pregnant women and their infants aged 7-12 months in Hainan Province from 2015 to 2020 were included in the study. The general situation, the situation of health care and delivery in this pregnancy and perinatal period, the detection of hepatitis B markers, the situation of antiviral therapy, the general situation of mother and infant during delivery and the implementation of blockade measures for mother-to-child transmission of hepatitis B were collected and analyzed. Results Among the 11 363 pairs of HBsAg positive pregnant women and their infants delivered in hospitals in Hainan province from 2015 to 2020, the positive rate of HBsAg in children at 7-12 months after birth was 1.47 %, and the difference in HBsAg positive rate of infants born in different years was not statistically significant (P>0.05). There were no significant differences in the positive rate of HBsAg among children born to pregnant women with different nationalities, educational levels, occupations, delivery modes, delivery places, obstetric operations and perineal laceration, abnormal perinatal period, children with different genders and premature delivery and perinatal (all P<0.05). There was significant difference in HBsAg positive rate among infants born to pregnant women of different ages, the positive rate of HBsAg of infants born to young pregnant women was higher than that of older pregnant women (P<0.05). The rate of antiviral therapy was low in HBeAg positive pregnant women, and the positive rate of HBsAg in their infants was 2.54%, which was higher than 0.83% in HBeAg negative pregnant women (P<0.05). Conclusions Combined immunological blockade with hepatitis B vaccine and hepatitis B immunoglobulin can effectively prevent the mother-to-child transmission of HBV. HBsAg-positive women can give birth at the right age, and HBeAg-positive pregnant women can be treated with antiviral therapy to block mother-to-child transmission, providing the important basis for the formulation of hepatitis B prevention and control strategies and measures.

Awareness of human papillomavirus vaccine knowledge and willingness to receive human papillomavirus vaccination among women in Hainan Province / 预防医学

Objective@#To investigate the awareness of human papillomavirus (HPV) vaccine knowledge among women in Hainan Province and the willingness to receive HPV vaccination among women and their daughters, so as to provide insights into HPV vaccine promotion and cervical cancer control. @*Methods@#Women aged 20 to 64 years who participated in the cervical cancer screening program in Hainan Province from July 2021 to February 2022 were enrolled, and participants' demographics, awareness of knowledge about HPV vaccine, and willingness to receive HPV vaccination among themselves and their daughters using a questionnaire survey. The factors affecting willingness to receive HPV vaccination were identified using a multivariable logistic regression model.@*Results@#A total of 4 300 questionnaires were allocated and 4 023 valid questionnaires were recovered, with an effective recovery rate of 93.56%. The respondents had a mean age of (35.52±6.48) years, and their daughters had a mean age of (8.93±4.83) years. There were 826 participants knowing HPV vaccine-related knowledge, with an awareness rate of 20.35%. The proportions of willingness to receive HPV vaccination were 75.07% among respondents and 71.36% among their daughters. Multivariable logistic regression analysis identified age (20 to <30 years, OR=1.474, 95%CI: 1.167-1.862; 30 to <40 years, OR=1.455, 95%CI: 1.199-1.765), urban-registered residence (OR=1.251, 95%CI: 1.016-1.541), monthly household income (3 000 to <5 000 Yuan, OR=1.568, 95%CI: 1.314-1.873; 5 000 Yuan and more, OR=1.231, 95%CI: 1.014-1.496), affordable fees for a single dose of HPV vaccination (100 to <500 Yuan, OR=1.358, 95%CI: 1.159-1.590; 500 Yuan and higher, OR=1.609, 95%CI: 1.188-2.180), and awareness of HPV vaccine-related knowledge (OR=4.473, 95%CI: 3.416-5.855) as factors affecting respondents' willingness to receive HPV vaccination, and participation in New Rural Cooperative Medical Insurance (OR=1.652, 95%CI: 1.087-2.511), affordable fees for a single dose of HPV vaccination (100 to <500 Yuan, OR=1.905, 95%CI: 1.633-2.221; 500 Yuan and higher, OR=1.683, 95%CI: 1.275-2.223), awareness of HPV vaccine-related knowledge (OR=3.625, 95%CI: 2.847-4.615), daughter's active request for HPV vaccination (OR=1.695, 95%CI: 1.293-2.222), and frequency of sexual health education for daughters (frequently, OR=2.142, 95%CI: 1.789-2.564; occasionally, OR=1.707, 95%CI: 1.416-2.059) as factors affecting the willingness to receive HPV vaccination among respondents' daughters. @*Conclusions@#The awareness of HPV vaccine-related knowledge is low among women aged 20 to 64 years in Hainan Province, and the women's and their daughters' willingness to receive HPV vaccination is associated with age, household registration, economic level, price of HPV vaccine and awareness of HPV vaccine-related knowledge.

Effects of a Smartphone-Based Out-of-Hospital Screening App for Neonatal Hyperbilirubinemia on Neonatal Readmission Rates and Maternal Anxiety: Randomized Controlled Trial.

BACKGROUND: Neonatal hyperbilirubinemia is one of the leading causes of neonatal readmission-especially severe hyperbilirubinemia and its complications-and it influences disease burden as well as neonatal and maternal health. Smartphones have been shown to have satisfactory accuracy in screening neonatal bilirubin levels, but the impact of this technology on neonatal health care service and maternal health outcomes is still unknown. OBJECTIVE: The aim of this study was to evaluate the impact of a smartphone-based out-of-hospital neonatal jaundice screening program on neonatal readmission rates for jaundice and related maternal anxiety. METHODS: This was a 2-arm, unblinded, randomized controlled trial with 30 days of intervention and follow-up periods. From August 2019 to August 2020, healthy mother-infant dyads were recruited on-site from 3 public hospitals in Hainan, China. Intervention group mothers used the smartphone app to routinely monitor neonatal jaundice at home under the web-based guidance of pediatricians. Control group participants received routine care. The primary study outcome was the neonatal readmission rate due to jaundice within 30 days of the first hospital discharge. The secondary outcome was the maternal anxiety score associated with neonatal jaundice. The data were collected through a self-assessed questionnaire. All participants were included in the analysis (intention-to-treat). RESULTS: In this study, 1424 mother-infant dyads were recruited, comprising 1424 mothers and 1424 newborns. The median age of the mothers was 29 (IQR 26-32) years, and there were 714 (50.1%) male neonates. These mother-infant dyads were randomly assigned to the intervention group and the control group, with 712 dyads in each group; only 1187 of these dyads completed the follow-up. We found that the adjusted 30-day neonatal readmission rate due to jaundice reduced by 10.5% (71/605, 11.7% vs 141/582, 24.2%; 95% CI 5%-15.9%; odds ratio 0.4, 95% CI 0.3-0.5; P<.001) and the relevant maternal anxiety mean score decreased by 3.6 (95% CI -4.4 to -2.8; ß=-3.6, 95% CI -4.5 to -2.8; P<.001) in the intervention group compared to those in the routine care group. CONCLUSIONS: Our study shows that the smartphone-based out-of-hospital screening method for neonatal hyperbilirubinemia decreased the neonatal readmission rate within 30 days from the first discharge and improved maternal mental health to some degree, thus demonstrating the usefulness of this screening app for follow-up in pediatric care. TRIAL REGISTRATION: China Clinical Trial Registration Center, ChiCTR2100049567; http://www.chictr.org.cn/showproj.aspx?proj=64245.

The role of individual service and team-based service price in the online environment: A view from the price difference.

Different from the traditional medical market, the online medical market allows physicians considerable discretion in setting prices of their services, which is beginning to be paid close attention to. Physicians face a challenge with the introduction of various service styles. Guided by transaction utility theory and price fairness, this study aims to investigate the influence of pricing strategy on service demands from the price difference perspective by focusing on two typical service models: individual service and team-based service. Moreover, team characteristics (response speed and team size) are also considered. The data collection was done in March 2018 and repeated in May 2018, and physicians who provide both individual service and team-based services are included in our study. Finally, a dataset consisting of 1,100 teams with 1,100 physician leaders from 14 departments such as obstetrics and gynecology department were collected from an online medical platform in China. Empirical results support most of our hypotheses. A negative influence of team-based price was observed. As a substitute service, a higher individual service price will make patients turn to team-based service. Moreover, individual service prices negatively moderated the relationship between team-based service prices and demands. By calculating the price difference between the individual service price and the team-based service price, we found a negative role of the price difference affecting patient purchase decisions. Although we did not find a significant effect of team size, a quick response can attract more patients. Price fairness provides a proper framework for understanding pricing strategy in individual and team-based service in an online environment. Understanding the effects of prices from a price difference perspective has both theoretical and practical contributions. Specifically, this study contributes to knowledge on price fairness, online medical platforms, and virtual teams, and provides management suggestions.

Development and validation of a maternal anxiety for neonatal jaundice scale in China.

BACKGROUND: Maternal anxiety induced by neonatal jaundice has adverse effects on maternal and infant health, but there was no specific tool to identify the anxiety level of mothers. This study aims to develop a Maternal Anxiety for Neonatal Jaundice Scale (MANJS) and to validate it in the target population. METHODS: An initial 11-items MANJS was developed through literature review, expert panel consultation, and a pilot-test. Subsequently, mothers of neonates with jaundice were recruited from the Maternal and Child Health Hospital of Hainan Province, China, from June to December 2018, for a formal questionnaire survey. Based on the data collected, the scale was validated for construct validity, convergent validity, discriminant validity, content validity, and internal consistency reliability after the items screening. RESULTS: The reliability and validity of MANJS were validated in 1127 mothers of jaundiced neonates. After the item with cross-loadings was removed using exploratory factor analysis, MANJS consisted of two dimensions and 10 items, with a cumulative variance contribution of 74.36% and factor loadings above 0.6 for all items. The confirmatory factor analysis identified three items with cross-factor loading or error correlation and then they were removed orderly. The further confirmatory factor analysis showed a good construct validity for the 7-item MANJS, with standardized root mean square residual (SRMR) = 0.029, root mean square error of approximation (RMSEA) = 0.068, comparative fit index (CFI) = 0.961, Tucker-Lewis index (TLI) = 0.937, incremental fit index (IFI) = 0.961, normed fit index (NFI) = 0.954, goodness of fit index (GFI) = 0.998, adjusted goodness of fit index (AGFI) = 0.996, respectively. The average variance extracted values (AVE) of the two factors were 0.80 and 0.72, and the combined reliability (CR) were 0.94 and 0.88, respectively. Cronbach's alpha was 0.90 for the MANJS, and split-half reliability was 0.72. CONCLUSIONS: MANJS was demonstrated to have satisfactory reliability and validity in evaluating maternal anxiety caused by neonatal jaundice among Chinese postpartum women.

Serum vitamin D status among healthy children in Hainan, South China: a multi-center analysis of 10,262 children.

Background: There are limited data regarding the prevalence and risk factors relating to vitamin D deficiency (VDD) in children of Hainan, a tropical city with abundant sunlight in China. To gather and analyze the serum VD levels of healthy children in Hainan, so as to understand their VD nutritional status and improve the representative data of VD nutritional status in south China. Methods: Children who presented to the outpatient clinic for physical examination at 4 hospitals in the Hainan Province from 2012 to 2020 were enrolled in this study. The serum 25-hydroxyvitamin D (25-OHD) levels was analyzed. 25-OHD levels <50 nmol/L is considered VDD, 50-75 nmol/L is vitamin D insufficiency (VDI), and ≥75 nmol/L is VD sufficient (VDS). Results: The average serum 25-OHD level was 94.63±49.99 nmol/L [95% confidence interval (CI): 93.67-95.60]. VDD was detected in 13.98% of participants (1,435 cases), VDI was detected in 30.60% of participants (3,140 cases), and 55.42% presented with VDS (5,687 cases). The average 25-OHD level of boys was significantly higher than that of girls (t=3.67, P<0.001). The average serum 25-OHD levels in the following age groups 0-1, 1-3, 3-7, 7-14, and 14-18 years were 105.92±57.39, 100.55±53.22, 86.35±39.19, 73.61±34.21, and 54.97±19.19 nmol/L, respectively. These results suggested that with an increase in age, the 25-OHD levels decreased. The average 25-OHD levels of children with a body mass index (BMI) <85th percentile were significantly higher than that of children in the overweight and obese group (F=7.393, P=0.001). Conclusions: A certain proportion of all age groups showed vitamin D deficiency and insufficiency in Hainan. A formal recommendation for vitamin D supplementation should be considered, especially in autumn and winter seasons for children over 7 years old, and in those with BMI ≥85th percentile or BMI ≥95th percentile.

Associations between prenatal exposure to polybrominated diphenyl ethers and physical growth in a seven year cohort study.

Although evidence suggests that prenatal exposure to polybrominated diphenyl ethers (PBDEs) alter offspring's physical growth, most studies rely upon physical growth at a single timepoint, and little is known regarding their longitudinal effects over time. In the current study, we determined the associations between prenatal PBDEs exposure and child physical growth by following up 207 mother-child pairs from the Laizhou Wan Birth Cohort (LWBC) from pregnancy until the children were seven years old. Child physical growth including weight, height, and body mass index (BMI) was assessed at birth, and at one, two and seven years of age. Prenatal exposure to PBDEs was quantified by measuring eight PBDE congeners (BDE-28, BDE-47, BDE-85, BDE-99, BDE-100, BDE-153, BDE-154, and BDE-183) in maternal serum samples collected upon hospital admission for delivery. Linear mixed models were applied to examine the associations between prenatal PBDEs exposure and repeated measures of child physical growth, and to determine whether these associations were modified by child's sex. Our findings indicated that BDE-28, BDE-85, BDE-153, BDE-183, and Σ7PBDEs were positively associated with child weight z-score; and that BDE-28, BDE-47, BDE-85, BDE-99, BDE-153, and Σ7PBDEs were positively associated with child height z-score. In addition, these associations were modified by the child's sex as reflected by pronounced positive associations among boys, while negative associations were noted among girls. In conclusion, our findings indicated the sex-specific associations between prenatal PBDE exposures and child physical growth during the first seven years of life.

Surveys of Drosophila suzukii (Diptera: Drosophilidae) and Its Host Fruits and Associated Parasitoids in Northeastern China.

Spotted-wing drosophila, Drosophila suzukii (Matsumura), is a worldwide quarantine pest that is currently undergoing a rapid range expansion in the Americas, Europe, and parts of Africa. It feeds and breeds on soft-skinned fruits such as raspberries, blueberries, and cherries, and can cause significant economic losses to fruit production. This study investigated the occurrence of D. suzukii and its wild host fruits and parasitoids in Liaoning, Northeast China for the first time. Sentinel traps were used to monitor D. suzukii adults, and suspected fruits were collected weekly in four different locations (Wafangdian, Faku, Fengcheng, and Shenyang). The results showed that D. suzukii were distributed in the sweet soft-skinned fruit-production areas of Liaoning, and raspberry was the most infested fruit. During the field survey, four species of wild berries from non-crop habitats were found infested by D. suzukii, and two species of parasitoids (Leptopilina japonica and Asobara japonica) were collected. D. suzukii adult-population dynamics throughout the survey period (June to October) were similar in different survey locations; adult fly populations increased and peaked in August, and then declined until the fly was no longer detectable in October.

Exosomal miR-122 promotes adipogenesis and aggravates obesity through the VDR/SREBF1 axis.

OBJECTIVE: This study examined the effects of miR-122-enriched exosomes on the expression of vitamin D3 receptor (VDR) and sterol regulatory element-binding transcription factor 1 (SREBF1) and their roles during adipogenesis. METHODS: The roles of miR-122, SREBF1, and VDR were investigated during adipogenesis. The relationships between VDR and miR-122 or SREBF1 were assessed by dual-luciferase reporter and chromatin immunoprecipitation assays. The potential role of miR-122/VDR/SREBF1 was evaluated in high-fat diet-induced obese male mice. RESULTS: High levels of miR-122 were found only in adipose tissue-derived exosomes (Exo-AT) and Exo-AT-treated cells. Overexpression of miR-122 promoted adipogenesis, and inhibition of miR-122 prevented adipogenesis by regulating VDR, SREBF1, peroxisome proliferator-activated receptor gamma, lipoprotein lipase, and adiponectin. Knockdown of Srebf1 or overexpression of VDR could inhibit adipogenesis. However, exosomal miR-122 could reverse their inhibitory effects. The dual-luciferase reporter assay and chromatin immunoprecipitation assays confirmed that VDR was a direct target of miR-122. It could bind to the BS1 region of the SREBF1 promoter and inhibit SREBF1 expression. Moreover, miR-122 inhibition could alleviate obesity in high-fat diet-induced obese male mice, possibly through upregulating the VDR/SREBF1 axis. CONCLUSION: MiR-122-enriched Exo-AT promoted adipogenesis by regulating the VDR/SREBF1 axis.

Effect evaluation of supplementary food nutrition package for infants aged 6-24 months in rural areas of Hainan / 中国热带医学

@#Abstract: Objective To analyze the effect of nutrition package on the nutritional status and prevalence of children in rural areas of Hainan Province, and provide scientific basis and suggestions for further improving the nutritional and health status of children in this region. Methods　Four cities and counties were randomly selected as the intervention group, and four cities and counties matched with the intervention group in terms of population, economy, social culture, maternal and child health work foundation of township health centers, physical nutrition and health status were selected as the control group.With the combination of monitoring and prospective cohort study, infants in the intervention group and the control group were studied from June 1, 2020, and they were intervened for 12 months with supplementary food nutrition package. Before and after intervention, the nutrition and health status of infants aged 6-24 months in the intervention group and the control group were investigated to evaluate the nutritional and health effects of supplementary food nutrition package for infants aged 6-24 months in rural Hainan Province. Results　A total of 999 infants were investigated, including 427 in the intervention group and 572 in the control group. After 12 months of nutritional intervention, there was no significant difference in weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) and weight-for-height Z-score (WHZ) between the intervention group and the control group (P>0.05). The rate of emaciation of the intervention group was 1.64%, which was significantly lower than 3.67% of the control group (P<0.05). There were no significant differences in the rate of growth retardation (2.81% and 3.32%, respectively) and underweight (0.47% and 1.92%, respectively) between the intervention group and the control group (P>0.05). The rate of respiratory infection and diarrhea in the intervention group were 9.13% and 1.17%, which were significantly lower than corresponding 23.25% and 3.15% in the control group (P<0.05). The hemoglobin of the intervention group and the control group were 117.24 g/L and 114.51 g/L respectively, and the rates of anemia were 11.11% and 22.84% respectively, the differences were statistically significant (P<0.05). Conclusions　The intervention of nutrition package in rural areas of Hainan Province has achieved the expected results, and supplementary food nutrition package has reduced the incidence of malnutrition and respiratory infection and diarrhea in recent two weeks in infants and anemia to a certain extent. We should attach great importance to the supplementary nutrition package for right-age children and promote the growth and health of children in rural areas through supplementary nutrition package, and continuously improve the nutrition and health level of children in Hainan Province.

Mediastinal and subglottic hemangioma in an infant: a case report and literature review.

We performed a retrospective analysis of the clinical manifestations, laboratory and imaging examinations, treatment, and prognosis of a male infant who was diagnosed with mediastinal and subglottic hemangioma in our hospital. The clinical features of this patient were coughing, wheezing, and dyspnea. Enhanced computed tomography of the neck and chest showed a diffuse abnormality in the right-upper mediastinum. He was diagnosed with a hemangioma after a physical examination combined with bronchoscopy. The clinical symptoms were relieved by oral propranolol. We also investigated the clinical characteristics, treatment, and prognosis of mediastinal and subglottic hemangioma in infants in the previous literature, and searched for case reports of this disease in China and in other countries. We only identified three previous cases of mediastinal and subglottic hemangioma in infants, indicating that this condition is rare. In the proliferative stage, surrounding organs and tissues are compressed, which can be life-threatening. Most of these children develop wheezing, shortness of breath, dyspnea, cyanosis, and other symptoms within 2 months. Enhanced computed tomography and magnetic resonance imaging combined with soft bronchoscopy can confirm the diagnosis of this disease, and oral propranolol achieves a favorable effect.

Ambient air pollution and birth defects in Haikou city, Hainan province.

BACKGROUND: Evidence shows exposure to ambient air pollution during pregnancy was associated with an increased risk of adverse birth outcomes, such as preterm birth, low birth weight and intrauterine growth retardation, but the results for birth defects have been inconsistent. METHODS: The data on birth defects was collected from the Birth Defects Monitoring Network of Haikou city. Air pollution data for PM10, SO2 and NO2 were obtained from Haikou Environmental Monitoring Center. Logistic regression analysis was used to evaluate these associations. RESULTS: The risk of birth defects was related to PM10 levels (adjusted OR = 1.039; 95% CI = 1.016-1.063) and SO2 levels (adjusted OR = 0.843; 95% CI = 0.733-0.969) for the second month of pregnancy. In the third month of pregnancy, the risk of birth defects was also related to PM10 levels (adjusted OR = 1.066; 95% CI = 1.043-1.090) and SO2 levels (adjusted OR = 0.740; 95% CI = 0.645-0.850). CONCLUSION: The study provides evidence that exposure to PM10 and SO2 during the second and third month of pregnancy may associated with the risk of birth defects.

Epidemiologic characteristics of birth defects in the Hainan Province from 2000 to 2010, China.

BACKGROUND: Although the prevalence of congenital malformations is high in China, little information is available on the Hainan Province. METHODS: Data used in this study were collected from 2000 to 2010 by monitoring newborns (including both live births and stillbirths) in the Hainan Province. Comparison analyses were conducted by performing χ(2) tests. RESULTS: The data showed an increasing temporal trend of the birth defect prevalence in the Hainan Province; however, the rate of birth defects changed over time. CONCLUSION: The Hainan Province is confronted with the challenge to reduce the prevalence of birth defects. Interventions should focus on the rural areas where a higher prevalence of birth defects is observed.

Hepatitis B surface antigen prevalence among 12,393 rural women of childbearing age in Hainan Province, China: a cross-sectional study.

BACKGROUND: Hepatitis B virus (HBV) infection is highly endemic in China and it threats human health seriously. The hepatitis B surface antigen (HBsAg) prevalence among women of childbearing age plays an important role in mother to child transmission of HBV, as 30%~50% of chronic carriers can be attributed to maternal-infantile transmission. However, there are few studies which have reported on the prevalence of HBsAg among women of childbearing age in China. This study aimed to determine the prevalence of HBsAg and its associated risk factors among rural women of childbearing age in Hainan, which is the highest hepatitis B virus endemic province in China. METHODS: A cross-sectional, population-based study, which included 12,393 rural women aged 15~49 years, enrolled by a multistage stratified cluster sampling, was carried out in Hainan province, China, from November 2007 to December 2008. Blood samples were obtained from each study participant, and screened for HBsAg. RESULTS: The overall HBsAg prevalence of childbearing age women was 9.51%. Risk factors for HBsAg positivity among rural women were: lower education level (OR=1.206), lower family monthly income (OR=1.233), having an HBsAg-positive family member (OR=1.300), without an immunization history (OR=1.243), tattooing (OR=1.190), body piercing (OR=1.293), vaginoscopy history (OR=1.103) and history of induced abortion (OR=1.142). CONCLUSIONS: There is a high HBsAg seroprevalence rate among rural women of childbearing age in Hainan province. Hence, it is necessary to take preventive measures to reduce the seroprevalence of HBsAg and to control its associated risk factors.