Objective: To understand the current status and associated factors of sleep problems among preschool children in Hainan Province, so as to provide scientific evidence for improving sleep health in this population. Methods: From January 2021 to June 2022, a total of 4 105 preschool children aged 3-6 years from 62 kindergartens in Hainan Province were selected using stratified cluster random sampling method. Demographic information and lifestyle habits were collected through the Hainan Province Child Growth and Development Survey Questionnaire. The Children s Sleep Habits Questionnaire (CSHQ) was employed to assess sleep status. Unconditional binary Logistic regression model was applied to investigate the associated factors of sleep problems among preschool children. Results: The overall CSHQ score for children was 58.03±18.84, with 80.95% of preschool children exhibiting sleep related issues. The top three most prevalent sleep problem domains were bedtime resistance (72.42%), sleep anxiety ( 54.88 %), and parasomnias (38.86%). Logistic regression analysis revealed that higher family annual income ( OR=0.60, 95%CI = 0.45-0.79), higher maternal education level ( OR=0.53, 95%CI =0.32-0.89), regular or daily vitamin D supplementation ( OR=0.77, 95%CI =0.60-0.99), and fully self initiated eating behavior ( OR=0.71, 95%CI =0.59-0.85) were negatively related with children s sleep problems; in addition, screen exposure ( OR=1.27, 95%CI =1.06-1.51) and picky eating ( OR= 1.47 , 95%CI =1.21-1.78) were positively related to children s sleep problems (all P <0.05). Conclusion The high detection rate of sleep problems among preschool children in Hainan Province is multifactorially associated with family environment, dietary habits, and lifestyle behaviors.

Background China is a major coal producer and consumer country in the world. Coal workers' pneumoconiosis (CWP) is a primary factor endangering the occupational health of coal miners. Research on the disease burden of CWP and its changing trend is significant for disease prevention & control and associated policies. Objective To analyze the disease burden of CWP in China from 1990 to 2021 and its changing trend, and predict the disease burden from 2022 to 2035. Methods Using the Global Burden of Disease Study (GBD) database of 2021, numbers ofincident cases, prevalent cases, deaths, and disability-adjusted life years (DALYs) as well as crude and age-standardized rates of CWP in China were retrieved. Linear regression model was used to calculate the estimated annual percentage change (EAPC) of the age-standardized rates. Joinpoint regression model was used to analyze the temporal trend of disease burden and the disease burden of different sexes and age groups, and Bayesian age-period-cohort (BAPC) model was used to forecast the trend of CWP disease burden. Results In 1990, the incident, prevalent, and deaths cases of CWP in China were 3266, 18872, and 1561, respectively, and the DALYs of CWP were 44614.718 person-years. In 2021, the incident, prevalent, and deaths cases of CWP were 3446, 23975, and 1229, respectively, and the DALYs of CWP were 29610.754 person-years. From 1990 to 2021, the age-standardized incidence, prevalence, mortality, and DALYs rates of CWP in China all showed a downward trend, with the EAPCs of −3.121%, −2.532%, −4.018%, and −4.268%, respectively. The disease burden of CWP in China was mainly concentrated in the male population. The annual average percent change analysis indicated that each standardized rate showed a fluctuating downward trend in different periods. The BAPC model showed that from 2022 to 2035, the age-standardized rates of CWP in China would continue to decline steadily. In 2035, the age-standardized incidence, prevalence, mortality, and DALYs rates of CWP would be reduced to 0.10 per 100000, 0.74 per 100000, 0.03 per 100000, and 0.74 per 100000, respectively. Conclusion The disease burden contributed by CWP in China generally show a downward trend from 1990 to 2021, and it is expected that the age-standardized rates will continue to decline steadily from 2022 to 2035.

Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test and x 2 test,or Fisher's exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49％,83.78％,78.38％,18.92％and 32.43％in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59％,29.73％,27.03％,75.68％and 21.62％,respec-tively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(x 2=31.862,x2=44.048,x 2=39.141,and x 2=47.815,respectively,P＜0.05),with no significant differences in hypoechoic and blood flow signal(x2=2.840 and x2=2.193,P＞0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(x 2=56.582 and x 2=37.852,P＜0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test and x 2 test,or Fisher's exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49％,83.78％,78.38％,18.92％and 32.43％in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59％,29.73％,27.03％,75.68％and 21.62％,respec-tively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(x 2=31.862,x2=44.048,x 2=39.141,and x 2=47.815,respectively,P＜0.05),with no significant differences in hypoechoic and blood flow signal(x2=2.840 and x2=2.193,P＞0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(x 2=56.582 and x 2=37.852,P＜0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

Objective:To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China.Methods:A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test.Results:A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region ( χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference ( χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) ( χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant ( χ2=0.51, P=0.476). Conclusions:There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Objective To analyze the relationship between serum long chain non coding ribonucleic acid(ln-cRNA)ANRIL,microRNA(miR)-423-5p and airway inflammation and remodeling in children with bronchial asthma and its predictive value.Methods A total of 98 children with bronchial asthma treated in Haikou Ma-ternal and Child Health Hospital from June 2020 to December 2022 were selected.46 children with acute at-tack were selected as the attack group and 52 children with clinical remission were selected as the remission group.Another 50 children who were healthy during physical examination in the same period were selected as the health group.The relative expression levels of serum lncRNA ANRIL and miR-423-5p were detected by real-time fluorescence quantitative polymerase chain reaction.The serum inflammatory factor indicators[in-terleukin-13(IL-13),transforming growth factor-β1(TGF-β1),vascular endothelial growth factor(VEGF)]were detected by enzyme-linked immunosorbent assay.Airway remodeling indicators[bronchial thickness(T/D),pipe wall area/total cross-sectional area of gas pipeline(WA)]and lung function indicators[first second forced expiratory volume(FEV1),peak expiratory flow(PEF),maximum mid expiratory flow(MMEF)]were measured.The correlation between expression of serum lncRNA ANRIL,miR-423-5p and airway inflam-mation and remodeling indicators were analyzed by the Pearson method.The predictive value of serum ln-cRNA ANRIL and miR-423-5p in the diagnosis of bronchial asthma was analyzed by receiver operating charac-teristic(ROC)curve.Results The relative expression level of serum lncRNA ANRIL in remission and attack groups was higher than that in healthy group,and the relative expression level of serum miR-423-5p was lower than that in healthy group,with statistical significance(P＜0.05).The relative expression level of serum ln-cRNA ANRIL in the attack group was higher than that in the remission group,and the relative expression lev-el of serum miR-423-5p was lower than that in the remission group,with statistical significance(P＜0.05).The levels of serum VEGF,IL-13 and TGF-β1 in attack and remission groups were higher than those in healthy group,and the difference was statistically significant(P＜0.05).The levels of serum VEGF,IL-13 and TGF-β1 in attack group were higher than those in remission group,and the difference was statistically sig-nificant(P＜0.05).The levels of T/D and WA in the remission and attack groups were higher than those in the healthy group,and the levels of FEV,,PEF and MMEF were lower than those in the healthy group,with statistical significance(P＜0.05).The levels of T/D and WA in the attack group were higher than those in the remission group,and the levels of FEV1,PEF and MMEF were lower than those in the remission group,with statistical significance(P＜0.05).The results of Pearson correlation analysis showed that serum ln-cRNA ANRIL expression was positively correlated with airway inflammation and remodeling indicators,and negatively correlated with lung function indicators(P＜0.05).The expression of miR-423-5p was negatively correlated with airway inflammation and remodeling indexes,and positively correlated with lung function inde-xes(P＜0.05).ROC curve analysis showed that the area under the curve of lncRNA ANRIL and miR-423-5p alone and combined detection were 0.772,0.707 and 0.865 respectively,the predictive value of combined de-tection in diagnosing bronchial asthma was higher.Conclusion The relative expression level of serum lncRNA ANRIL increase in children with bronchial asthma,and miR-423-5p decrease,which promote airway inflamma-tion,remodeling,lung function decrease,and which has high diagnostic efficacy for children with bronchial asthma.

Objective: To investigate the screen exposure status and influencing factors among 6-12 year-old children in Hainan Province, so as to provide insights into screen exposure intervention for children. Methods: Children aged 6-12 years from 18 counties (cities) in Hainan Province were selected using multi-stage stratified cluster sampling method from December 2020 to July 2021. Demographic information, parents' educational level, family type and screen time was collected using questionnaire surveys. The screen exposure rate of children was analyzed, and factors affecting screen exposure were identified using a multivariable logistic regression model. Results: A total of 27 501 children were surveyed, including 13 901 boys (50.55%) and 13 600 girls (49.45%). The mean age was (9.22±1.86) years. Among them, 3 925 children had screen exposure, with a screen exposure rate of 14.27%. Multivariable logistic regression analysis showed that gender (female, OR=0.859, 95%CI: 0.796-0.926), age (OR=1.078, 95%CI: 1.049-1.108), ethnicity (ethnic minorities, OR=1.147, 95%CI: 1.041-1.254), place of residence (rural area, OR=0.869, 95%CI: 0.801-0.944), father's educational level (high school or technical secondary school, OR=0.879, 95%CI: 0.788-0.981; college degree or above, OR=0.686, 95%CI: 0.589-0.818), mother's educational level (college degree or above, OR=0.706, 95%CI: 0.588-0.846), family type (others, OR=1.250, 95%CI: 1.105-1.414), and annual family income (>100 000 Yuan, OR=0.741, 95%CI: 0.619-0.885) were the influencing factors for screen exposure among children aged 6-12 years. Conclusion The screen exposure among children aged 6-12 years in Hainan Province was affected by gender, age, ethnicity, place of residence, parental education level, family type and annual family income.

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.

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.

Abstract: Objective　To evaluate the free thalassaemia screening programme for preconception and pregnancy in Hainan Province, and to provide a theoretical basis for optimizing the screening process for thalassaemia. Methods From November 2020 to July 2021, a survey was conducted on 10 396 adults with Hainan household registration who participated in the Epidemiological Survey of Thalassemia in Hainan Residents in 19 cities and counties of Hainan Province. All of them underwent routine blood tests, haemoglobin electrophoresis tests and genetic tests for thalassaemia. The optimal diagnostic cut-off values for mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and haemoglobin adult type 2 (HbA2) were determined using screening test indexes such as receiver operating characteristic curve and sensitivity. The diagnostic effectiveness of different primary screening programs for thalassemia gene carriers was evaluated. Results Using the existing MCV single-indicator thalassemia primary screening protocol in Hainan Province, where individuals with MCV<82 fL undergo thalassemia gene testing, resulted in a high missed diagnosis rate (34.06%) and low sensitivity (65.94%). The optimal cut-off values for MCV screening for alpha-and beta-thalassaemia were 84.45 fL and 79.05 fL, respectively; the optimal cut-off values for MCH screening for alpha-and beta-thalassaemia were 27.95 pg and 25.15 pg, respectively. The optimal cut-off value for HbA2 screening for alpha-thalassaemia was less than 2.55% and greater than 3.35% for beta-thalassaemia. The "combined HbA2 or MCH or MCV screening protocol" with the cut-off values recommended in this study had a better performance in primary screening for thalassemia, with the highest sensitivity (92.96%) and negative predictive value (92.67%) and the lowest underdiagnosis rate (7.04%), statistically significant differences compared with the existing protocol (P<0.05). Conclusions The current process of screening for thalassemia in Hainan Province may lead to missed diagnoses. The combined use of MCV, MCH and HbA2 for thalassemia screening, adopting locally suitable cutoff values for primary screening indicators, can improve the incidence of missed reporting of thalassemia and enhance diagnostic effectiveness.