Congenital heart disease (CHD) is one of the major types of birth defects in the world, which is the leading cause of death in children. However, the current situation of delayed diagnosis of CHD is not optimistic, making the early detection, diagnosis and treatment of children with CHD a hot research topic.
To establish and apply the appropriate technology system for screening, diagnosis and evaluation of CHD in neonates in Hainan Province, evaluate operational effect of the technology for its further promotion.
In accordance with the requirements of the Program of Neonatal CHD Screening Project issued by the National Health Commission, the relevant literatures were reviewed to establish the appropriate technology system for screening, diagnosis and evaluation of CHD in neonates, in which screening staff perform CHD screening on liveborn neonates within 6-72 hours after birth using integration of cardiac murmur auscultation and transcutaneous pulse oximetry (POX) , in all midwifery institutions of 17 cities and counties in Hainan province, as well as the local neonatology departments or neonatal intensive care units (NICUs) . Positive results of heart murmur auscultation and/or POX were considered positive for screening. 31 diagnostic facilities authorized by Hainan Provincial Health Commission were responsible for the echocardiography examinations for liveborn neonates with positive screening results. The qualified cardiovascular physicians and cardiac surgeons in the 6 certified tertiary hospitals reviewed the diagnosis results and made necessary re-evaluations, suggested or implemented medical intervention and proposed suggestions on clinical follow-up (3 to 12 months) according to the conditions. Screening, diagnosis, evaluation and treatment data were filled, uploaded and managed online through the neonatal CHD screening information management network. The operational effectiveness of this appropriate health technology was evaluated in 17 cities (counties) in Hainan Province from 2020-01-01 to 2021-12-31.
From 2020-01-01 to 2021-12-31, the count of liveborn neonates in Hainan Province was 206 761, 204 442 of them were included in the screening program with an overall screening rate of 98.88% and screen-positive rate of 2.86% (5 847/204 442) . A total of 527 cases diagnosed with CHD by echocardiography, showing a CHD prevalence of 2.58‰ (527/204 442) , and atrial septal defect as the most common CHD lesion with a composition ratio of 38.14% (201/527) , including 291 insignificant type CHD cases (55.22%) , 142 significant type CHD cases (26.94%) , 88 serious type CHD cases (16.70%) and 6 critical type CHD cases (1.14%) . The sensitivity of auscultation, POX and combination of 2 indicators for CHD screening was 67.93%, 37.00% and 93.35%, respectively, and the specificity was 98.07%, 99.28% and 97.30%, respectively. Neonates with positive results for both indicators (heart murmur auscultation and POX) were more likely to suffer from severe CHD (severe and critical types) than those with positive results for a single indicator (P<0.001) . A total of 94 cases with severe CHD were treated promptly. A total of 4 cases with severe CHD died, the standardized mortality of neonates aged 0-1 year with CHD was 1.96/100 000, the mortality rate of neonates with severe CHD was 4.26% (4/94) .
The combination of two indicators (heart murmur auscultation and POX) for CHD screening is favorable to promotion for the characteristics of noninvasion, simplicity, ease of operation and reliability. The establishment of appropriate technology system for screening, diagnosis, and evaluation of neonatal CHD is of great significance for its advantages in the timely diagnosing and treatment of CHD, especially in severe CHD, and reduction of mortality in neonates with CHD.
Promoting appropriate health technology to rural and urban communities is an important measure to improve the technical level and service capacity of primary care institutions. The First Affiliated Hospital of Xinjiang Medical University carried out the promotion of appropriate health technology in southern Xinjiang.
To evaluate the effect of appropriate technology promotion for stroke rehabilitation in southern Xinjiang, understand the needs of rehabilitation workers in southern Xinjiang for appropriate technology promotion for stroke rehabilitation and the goals they hope to achieve by participating in appropriate technology promotion for stroke rehabilitation projects, providing a basis for health administrative departments to implement appropriate rehabilitation technology promotion work.
The rehabilitation workers from the rehabilitation medicine departments of 8 people's hospitals, affiliated township health centers and communities health centers, federation of the disabled, civil affairs system and other rehabilitation institutions in 8 deep poverty-stricken counties which were considered as sample source sites by using a multi-stage sampling method in July 2018. The appropriate technology promotion for stroke rehabilitation was performed followed by a investigation by using self-designed questionnaire. The monthly outpatient volume, hospitalization volume and treatment income of the rehabilitation medicine department of people's hospitals before (January 1, 2018 to June 30, 2018) and after participation (July 1, 2020 to December 31, 2020) in technology promotion for stroke rehabilitation projects were compared.
The appropriate technology promotion for stroke rehabilitation in acute, subacute and convalescent stages, as well as community and family rehabilitation of stroke was performed from January 1, 2018 to June 30, 2018, involving motor function rehabilitation training, functional electrical stimulation, mandatory exercise therapy techniques, constraint induced movement therapy (CIMT) , mirror therapy, management and rehabilitation training of dysphagia, daily living activities training and rehabilitation care of stroke patient. A total of 384 valid questionnaires were collected. Among the 384 rehabilitation workers, 63.3% (243/384) identified the appropriate technology promotion within districts (counties) as very meaningful; 46.1% (177/384) thought the project was very applicable in their local area; 37.5% (144/384) believed that the technology for stroke rehabilitation can be carried out in their medical institutions with a slight improvement of the relevant conditions; 46.9% (180/384) believed that the difficulty level of the appropriate technology promotion project was easy in terms of operation skills; after the training, 42.2% (162/384) claimed to be knowledgeable about the technology and need to learn and receive further training. The monthly outpatient volume and monthly treatment income of the rehabilitation medicine department of people's hospitals after participating in stroke rehabilitation technology promotion projects increased significantly compared with before participation (P<0.05) . In terms of technology promotion for stroke rehabilitation, rehabilitation workers have the highest demand for practical training〔63.0% (242/384) 〕, and the lowest demand for teaching rounds〔19.8% (76/384) 〕. The percentages of workers who expected to improve operational ability〔77.1% (296/384) 〕and theoretical level 〔65.6% (252/384) 〕by participating in the appropriate technology promotion for stroke rehabilitation project ranked 1st and 2nd, respectively.
The promotion work of appropriate technology for stroke rehabilitation has achieved significant results. At present, there is a huge demand for rehabilitation of stroke patients in southern Xinjiang, but the overall rehabilitation medical service capacity is far from meeting the social needs. A series of initiatives can be taken to effectively improve the level of rehabilitation therapy in southern Xinjiang, including strengthening the promotion of appropriate health technology, encouraging rehabilitation workers to participate in further education and training, actively carrying out telehealth services, and accelerating the construction of medical associations.
