ABSTRACT
OBJECTIVE@#To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program.@*METHODS@#A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed.@*RESULTS@#NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035.@*CONCLUSION@#NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Subject(s)
Female , Humans , Pregnancy , Aneuploidy , Cost-Benefit Analysis , Noninvasive Prenatal Testing , Retrospective Studies , Trisomy 18 Syndrome/geneticsABSTRACT
Objective:To develop the Chinese version of measuring change in restriction of salt (sodium ) in diet in hypertensives(MCRSDH), and to test its reliability and validity.Methods:Authorization was obtained from the original authors of MCRSDH.Cross-cultural revision of the MCRSDH was conducted according to the guidelines from November 2020 to January 2021.Totally 700 patients with hypertension were recruited through convenience sampling from 4 community health service centers in 2 main urban districts of Changsha and investigated by the Chinese version of MCRSDH.Reliability and validity of the scale were assessed.Results:The correlation coefficient between each item and the total score ranged from 0.327-0.799 and 0.468-0.893 in MCRSDH initiation (MCRSDH-INIT)and MCRSDH sustenance(MCRSDH-SUST) respectively.The item of content validity index(I-CVI) of each item ranged from 0.802 to 1.000, and the scale of content validity index(S-CVI) was 0.914.Four factors were extracted by exploratory factor analysis(EFA)and could explain 68.511% of the total variance for MCRSDH-INIT.Three factors were extracted by EFA and could explain 76.558% of the total variance for MCRSDH-SUST.Values of factor loading ranged from 0.541 to 0.926 for MCRSDH-INIT, and from 0.586 to 0.888 for MCRSDH-SUST.The Confirmatory factor analysis indicated that χ 2/ df=1.732, GFI=0.902, CFI=0.945, RMSEA=0.046, NFI=0.931, TLI=0.936 for initiation model and χ 2/ df=1.248, GFI=0.937, CFI=0.971, RMSEA=0.018, NFI=0.943, TLI=0.937 for sustenance model.The cronbach's α coefficient of the scale was 0.901 and the test-retest reliability was 0.917. Conclusion:The Chinese version of the MCRSDH is reliable and valid, and can be used as a tool to MCRSDH in China.
ABSTRACT
With the vigorous development of the medical and health cause in China, the management of medical institutions by classification has become an objective requirement. It is imperative to combine the subjective basis and the objective basis and make a scientific distinction between non for profit and for profit hospitals. It is also important to use for reference international experience in this aspect and determine the rational proportion of the two kinds; to earnestly solve problems in understanding the reclassification and change the governments functions in managing the medical and health cause; and to strive for preferential policies so as to create a sound social environment for the transformation of public hospitals into for profit ones. Only by vigorously and steadily transforming existing public medical institutions by classification can a new system of management of medical institutions by classification be established in due course.