翻转课堂联合文献学习应用于卫生统计学的教学效果调查

目的 从预防医学专业学生的角度评估在卫生统计学教学中实施翻转课堂联合文献学习模式的效果及可行性。方法 利用自研调查问卷，对预防医学专业116名本科生进行调查，分析学生对翻转课堂、文献学习教学以及自我创新、批判能力的评价情况并比较其考试成绩。结果 学生认为翻转课堂有利于提升统计学习的深度和广度81人、占69.8%，认为有利于培养剖析疑点难点的能力76人、占65.5%；认为文献学习有利于掌握教学内容79人、占68.1%，认为有利于培养剖析疑点难点的能力78人、占67.2%;2018级1班期末平均成绩为73.98分，及格率为85.5%，优秀率为25.8%，与2018级2班相比均略高，差异无统计学意义（P>0.05）。结论 学生对卫生统计学课程实施翻转课堂与文献学习的教学模式体验良好，可适当开展该模式，加强培养学生自主学习，从而提升其创新能力及教学效果。     

大学生肠道寄生虫感染及影响因素分析

目的 为了解大学生肠道寄生虫感染情况,给防治工作提供依据。方法 采用生理盐水直接涂片法、饱和盐水漂浮法和自行设计的调查问卷对莆田学院医学院一、二年级2014名学生进行肠道寄生虫感染及相关因素调查。结果 肠道寄生虫总感染率为9.98%（201/2014）。共查出肠道寄生虫6种,其中蛔虫感染率最高,达6.01%（121/2014）。男生总感染率为19.75%,高于女生总感染率4.44%,差异有统计学意义（P〈0.05）。不同年级之间和城乡之间的肠道寄生虫感染率差异均无统计学意义（P〉0.05）。Logistic回归分析有4个变量进入方程。结论 莆田学院医学院大学生肠道寄生虫感染率仍较高,男生的防病意识比女生差,应该加强男生的防病意识。     

基于慕课的高原性心脏病教学设计调查及初探

目的 探索慕课教学方式与传统教学方式相结合在高原性心脏病教学过程中的可行措施。目的 了解本科生对慕课教学的认知度及针对开设高原性心脏病慕课课程的必要性和具体课程设计的态度与想法,为之后高原性心脏病慕课课程及其他军队卫生学慕课课程的设计与实施提供依据。 方法 根据本科室2018年春季学期所有授课对象不同专业共206人,针对慕课课程的认知和课程需求设计调查问卷,以了解本科学生对慕课课程的认知及需求情况,为之后高原性心脏病慕课课程安排提供依据。 结果 2018年春季学期所有授课对象对于慕课授课形式完全了解仅有17人（8.5%）、大概了解为77人（37.26%）、听说过慕课但不了解其授课方式为84人（40.8%）、从未听说过慕课且完全不了解其授课方式为28人（13.44%）。另外,认为很有必要开设高原性心脏病慕课有33人（15.81%）、认为有必要开设高原性心脏病慕课有73人（35.61%）、对于是否开设高原性心脏病慕课觉得无所谓为86人（41.98%）、仅有14人（6.6%）认为开设高原性心脏病慕课是没有必要的。之后,对2018年春季学期所有授课对象对于高原性心脏病慕课课程需求也通过调查问卷进行了调查。 结论 军队院校临床医学专业本科生学生对慕课的了解和认识还不够普及。为了确保之后高原性心脏病慕课课程的顺利开展,应加大慕课课程的宣传力度,让慕课成为传统教学的延伸,能够真正走进新时代年轻军校学生的心里。     

西部三省中学生结核病防治相关知识抽样调查结果分析

目的 了解中学生结核病相关知识信念和行为现状,为更好开展学校结核病健康教育提供参考依据。 方法 在四川、贵州、云南活动性结核病患者较多的3个流行病学调查（简称“流调”）抽样点及2个流调点邻县,采用便利抽样法每县抽取1所学校。采用自行设计的问卷对5所学校的高二学生进行调查,问卷内容包括结核病防治核心信息、态度行为及健康教育现状等。共计发放问卷443份,回收有效问卷437份,问卷有效率98.6%。分别统计各条结核病相关信息的知晓率、总知晓率、态度和总得分。 结果 调查对象对10条结核病防治信息的总知晓率为54.3%（2375/4370）,其中关于诊疗相关政策及疾病危害的知晓率较低,分别为23.9%（209/874）和23.8%（104/437）。结核病综合知识得分6分（P₂₅=4,P₇₅=7）。7.0%（30/430）的学生表示得病后会隐瞒病情, 21.2%（91/430）会与身边结核病患者保持距离,0.5%（2/430）的学生表示不和结核病患者来往。65.7%（287/437）的学生从未主动了解过结核病知识,96.3%（420/436）的学生认为学校有必要开展结核病健康教育。 结论 西部地区中学生结核病相关知识偏低,存在消极态度。应当由卫生部门和教育部门共同合作,采用多种手段开展学校结核病相关知识的健康教育。     

湖南省肺结核门诊辅助诊疗单病种付费的可行性研究

目的 探索肺结核门诊辅助诊疗单病种全额付费在湖南省实施的可行性。方法 通过问卷调查和电话访谈的方式,了解全省131个县（市、区）肺结核门诊医疗保障的现状;通过现场访谈的形式,调查10个县（市、区）新型农村合作医疗（简称“新农合”）部门和疾病预防控制机构（简称“疾控机构”）共40名工作人员对“单病种付费”实施利弊的看法。结果 湖南省131个县（市、区）中有118个将肺结核门诊纳入了新农合报销,报销方式分为按比例报销、按额度报销和按病例包干定额付费3种,但报销比例（30%～80%）和额度（每例200～1500元/年）存在较大差别;根据省级指导标准,全省各非试点县（市、区）尚需每年增加1014万元肺结核门诊医疗保障。调查的6个试点县中,2个县试点前后基金负担无明显变化（增加幅度介于－5%～5%）,3个县略有增加（增加幅度介于5%～10%）,1个县显著增加（增加幅度10%以上）。 结论 肺结核门诊辅助诊疗单病种付费政策可以因地制宜地在湖南省逐步推广实施。     

口腔实习生临床接诊伴心血管疾病患者的现状调查分析

目的 调查分析口腔专业的实习生对接诊伴有心血管系统疾病的患者的相关知识的掌握程度以及对相关培训指导的需求情况,为制定优化相关教学方案提供参考。 方法 以三所医学院正在进行临床实习的口腔学生为调查对象,借助微信小程序“问卷星”完成问卷的发放和回收,调查内容包括:调查对象基本情况、对接诊伴心血管疾病患者的态度、相关培训现状及需求、相关知识测验题。 结果 本次调查共计回收60份有效问卷。被调查的实习生中80%曾在门诊接诊过伴心血管疾病患者,88.33%的实习生表示若接诊此类患者时会比较担心、需要寻求上级医生指导。76.67%的实习生希望通过包含实操课的专题培训的教学形式来获取心血管患者的接诊知识。相关知识测验从心血管疾病基础知识、心血管疾病与口腔健康的关系、伴心血管疾病患者接诊要点这三个方面进行了考查,96.67%的实习生得分率不到50%;其中掌握情况最好的知识点是高血压的诊断标准,28.33%的实习生可以准确掌握其内涵。内科学考试成绩较为优异的学生在本次问卷答题中的得分相对较高。 结论 口腔实习生在接诊伴心血管疾病患者方面存在明显的知识短板,相关教学培训的形式和质量都亟待改善。     

慢性乙型肝炎患者疾病相关认知度及抗病毒治疗现状调查分析

目的调查CHB患者疾病相关知识的认知情况及其抗病毒治疗现状,分析患者对疾病相关知识的认知度与接受抗病毒治疗的相关性。方法依据CHB疾病相关知识设计调查问卷,对2011年10月至2013年10月首都医科大学附属北京地坛医院收治的CHB队列中部分患者进行问卷调查。结果本次调查共发放问卷930份,回收有效问卷881份（有效率94.73%）。将患者对疾病相关知识的认知程度分为较差、一般、较好3个层次。881例患者中,对预防知识的认知较差、一般、较好比例分别为17.71%、30.76%、51.53%,对基础知识的认知比例分别为22.02%、38.71%、39.27%,对治疗知识的认知比例分别为57.43%、15.89%、26.67%。正在进行抗病毒治疗的患者548例,占患者总数的62.20%,疾病相关综合知识认知较差组CHB患者抗病毒比例明显低于其他组CHB患者。结论目前患者对CHB疾病相关知识认知较差,医务人员应加强对患者的宣教。     

新疆预防医学本科生专业认同感调查

目的调查新疆高校预防医学本科生的专业认同感,为高校相关教育工作提供参考依据。方法 2017年9—11月在新疆2所大学577名预防医学本科生中开展问卷调查,收集调查结果后进行统计学分析。结果预防医学本科生专业认识、专业价值观、专业期望、专业学习投入得分分别为(8.77±1.30)分、(6.81±1.72)分、(6.73±1.27)分和(4.41±1.01)分,对于专业认识,不同性别(t=-3.799)、年级(F=11.180)、预防医学专业志愿填报(F=7.746)和自我转专业意向(F=41.342)差异均有统计学意义(P0.01),对于专业价值观,不同年级(F=10.923)、家中不同亲属关系从事预防医学领域工作(F=7.334)、预防医学专业志愿填报(F=64.392)、自我转专业意向(F=23.041)差异均有统计学意义(P0.01),对于专业期望,不同预防医学专业志愿填报(F=4.951)、自我转专业意向(F=126.271)差异均有统计学意义(P0.01);在学习投入方面,不同性别(t=-3.208)、年级(F=6.135)、家中不同亲属关系从事预防医学领域工作(F=6.867)、预防医学专业志愿填报(F=4.478)、自我转专业意向(F=17.720)差异均有统计学意义(P0.05);女生、大一大二年级、父母或近亲从事预防医学相关工作、志愿填报时自主选择预防医学专业、不愿意转专业的本科生专业认同感总体得分较高,专业认同情况较好。结论新疆预防医学本科生的专业认同感较高;高校教育工作者应根据预防医学的专业特点及学生的实际情况,采取早期培养专业兴趣等措施,有针对性地提高学生的专业认同感。     

ERCP诊治胆总管结石131例回顾性分析

目的探讨内镜下逆行胰胆管造影技术（ERCP）对胆总管结石的诊治作用及并发症预防。方法对2007年1月至2011年9月期间在我院行ERCP诊治的131例胆总管结石病例进行回顾性分析,统计ERCP术中选择性胆管插管、造影、取石过程以及术后发生各种并发症情况。结果①ERCP选择性胆管插管成功率为94．6％（124/131）,胆总管结石取出成功率是96．8％（120/124）;②ERCP诊断胆总管结石准确率为96．9％（127／131）,MRCP诊断胆总管结石准确率为90．1％（118/131）：③ERCP总并发症为6．9％（9／131）：穿孔1例（0。8％）、出血2例（1．5％）和胰腺炎6例（4．6％）。结论ERCP联合MRCP是诊治胆总管结石首选的诊治方案,提高医生操作水平能减少ERCP手术并发症的发生。     

广东省公众结核病防治知识知晓情况调查

目的 了解广东省大众结核病防治知识知晓率情况,为有效开展结核病健康促进工作提供科学依据。 方法 采用分层整群等比例随机抽样方法,全省共抽取49 514名调查对象,采用结核病防治知识调查问卷进行面对面调查。调查共发放调查问卷49 514份,收回合格问卷49 514份,合格率100%。 结果 调查人群结核病防治知识的总知晓率为78.4%（194 183/247 570）,其中60岁以上人群知晓率偏低［67.5%（32 265/47 765）］。户籍人口总知晓率为80.8%（166 838/206 505）,明显高于流动人口的66.6%（27 345/41 065）,差异有统计学意义（Z=63.96,P<0.01）。调查对象对结核病的症状和结核病能否治愈知晓率较高,分别为82.6%（40 904/49 514）和83.6%（41 369/49 514）。有28.9%（14 298/49 514）的调查对象表示怀疑得了结核病后不知前往何处检查。 结论 广东省公众结核病防治知识知晓率较高,但今后应采取更多综合的健康促进措施进一步提高公众结核病防治知晓。     

Primary care internal medicine: a challenging career choice for the 1990s

A career in primary care internal medicine can be challenging and rewarding, yet during the last decade fewer medical students have selected training in internal medicine. We wish to inform medical students, their advisors, and other physicians about the field of primary care internal medicine. We define the discipline, compare it with traditional internal medicine and with family practice, and describe features of strong primary care internal medicine training programs. We discuss common misconceptions and concerns about training programs and the career and give examples of career paths chosen by graduates of primary care programs. We encourage students to consider the option of primary care internal medicine when making career decisions and provide faculty advisors unfamiliar with primary care internal medicine training programs with a reference resource.     

科研作为医学生第二课堂教学的实践

为了适应国家建设和发展的需要,培养创新能力强的高素质医学人才,作者在医学本科生中开展了科研作为第二课堂教学的活动。从建立科研小组、课题申报、项目实施、结题报告及论文撰写、论文的口头报告等全过程对医学生进行训练,使医学生学到了第一课堂不能学到的东西,学生的素质得到全面提高。因此,科研是培养医学生的创新精神、提高综合素质的有效途径。     

Physician incentives and disclosure of payment methods to patients

OBJECTIVE: There is increasing public discussion of the value of disclosing how physicians are paid. However, little is known about patients' awareness of and interest in physician payment information or its potential impact on patients' evaluation of their care. DESIGN: Cross-sectional survey SETTING: Managed care and indemnity plans of a large, national health insurer. PARTICIPANTS: Telephone interviews were conducted with 2,086 adult patients in Atlanta, Ga; Baltimore, Md/Washington DC; and Orlando, Fla (response rate, 54%). MEASUREMENTS AND MAIN RESULTS: Patients were interviewed to assess perceptions of their physicians' payment method, preference for disclosure, and perceived effect of different financial incentives on quality of care. Non-managed fee-for-service patients (44%) were more likely to correctly identify how their physicians were paid than those with salaried (32%) or capitated (16%) physicians. Just over half (54%) wanted to be informed about their physicians' payment METHOD: Patients of capitated and salaried physicians were as likely to want disclosure as patients of fee-for-service physicians. College graduates were more likely to prefer disclosure than other patients. Many patients (76%) thought a bonus paid for ordering fewer than the average number of tests would adversely affect the quality of their care. About half of the patients (53%) thought a particular type of withhold would adversely affect the quality of their care. White patients, college graduates, and those who had higher incomes were more likely to think that these types of bonuses and withholds would have a negative impact on their care. Among patients who believed that these types of bonuses adversely affected care, those with non-managed fee-for-service insurance and college graduates were more willing to pay a higher deductible or co-payment in order to get tests that they thought were necessary. CONCLUSIONS: Most patients were unaware of how their physicians are paid, and only about half wanted to know. Most believed that bonuses or withholds designed to reduce the use of services would adversely affect the quality of their care. Lack of knowledge combined with strong attitudes about various financial incentives suggest that improved patient education could clarify patient understanding of the nature and rationale for different types of incentives. More public discussion of this important topic is warranted.     

Survey of Master’s Gerontology Students Spanning Over 40 Years

The University of South Florida’s master’s degree in gerontology is a long-established program that focuses on a multidisciplinary approach to population aging. This study identifies graduate students’ needs in preparation for a professional career in gerontology. An online survey was distributed to graduates and those currently enrolled (N = 56) in order to better understand expectations for the program, identify outcomes of graduation, and obtain program recommendations for future students. The program’s 40 year history was well represented with participants ranging from the first graduating class to current students. Results indicated high satisfaction in students’ expectations of the program, educational experience, and assessment of faculty. Further, 68% of graduates reported success in gaining age-related employment shortly after graduation. However, students echoed well-known barriers in gerontology, reporting tough competition for jobs versus those with licensure, and challenges in promoting their nonclinical gerontology degree to employers. Respondents recommended more applied coursework and assistance with career planning to enhance employment opportunities upon graduation. Implications of these findings are discussed in further detail.     

Density of familial alcoholism and its effects on alcohol use and problems in college students

Background:  Previous studies of family history of alcoholism (FHA) in college students have typically relied on dichotomous indices of paternal drinking. This study examined the prevalence of FHA and its effects on alcohol use and problems using a density measure in a sample ( n  =   408) of college students.
Methods:  Undergraduate students completed an anonymous survey in exchange for course credit. Data was collected between 2005 and 2006.
Results:  Using a density measure of FHA, we observed an overall prevalence rate of 65.9% and a rate of 29.1% for FHA in both first and second-degree relatives. Structural equation modeling (SEM) was used to investigate relations among FHA, alcohol use/problems and previously identified etiological risk factors for alcohol use disorders (AUD). Results indicated a significant positive association between FHA and alcohol-related problems and this relationship was mediated by age of onset of drinking, behavioral undercontrol and current cigarette use. Behavioral undercontrol also mediated the relationship between gender and alcohol problems. Additionally, FHA was associated with an earlier age of onset of drinking and this was related to greater alcohol use.
Conclusions:  Assessing density of FHA in future trajectory research may capture a greater number of students at risk for acute alcohol-related problems and/or future development of AUDs. Future preventive interventions with this population, which should begin well before the college years, may benefit from considering personality factors and incorporating smoking cessation to help identify at-risk students and assist those who wish to cut down on their alcohol use but find that smoking acts as a trigger for increased drinking.     

广西大型艾滋病预防展览短期效果评价

目的 通过评价艾滋病预防展览效果,说明健康教育行为干预在预防HIV中的作用。方法 1998年5月16～23日在南宁调查参观展览的市民和大学生322名,各分参观前后两组。采用定性和定量研究分析展览会对观众知识、态度、行为的影响。结果 参观后市民预防知识总分增加17.0％,学生8.6％,非传播途径正确回答率明显高于参观前,观众防范意识增强,96％的市民和99％的学生认识到AIDS离我们并不遥远。市民组拟采取预防行为由参观前的每人3种上升为参观后的5种,学生组采用不吸毒,正确使用避孕套比例高于参观前。结论 展览会能起到普及艾滋病预防知识、促进行为改变的效果,建议在全国巡回展出。     

PBL临床寄生虫学与检验教学效果探讨

在华北煤炭医学院生物科学系2004、2005和2006级医学检验专业本科生(151人)教学中,通过问题的形式阐明学习目的和任务,经选题、查阅文献、课题实施及论文撰写的方法,探讨PBL教学的效果。结果表明PBL教学能够激发学生主动学习的积极性,提高临床寄生虫检验的观片、涂片、压片、染色及动物接种等技术能力,能培养学生质疑、分析和解决问题及创新思维能力,有利于增强学生团队合作精神及人际沟通能力,创造了师生平等、和谐的学习氛围,教学效果显著。     

The role of person-environment interactions in increased alcohol use in the transition to college

Aims Even among those at risk for problematic alcohol use, there is variability in developmental trajectories of drinking and related problems. This prospective study examined the role of person–environment interactions in increased drinking during the transition to college. Design The authors followed a sample of recent high school graduates to test whether protective environmental factors could delay increases in drinking among those high in trait‐level risk factors. Setting Participants completed web‐based surveys. Participants A sample of 1784 students in the incoming class of 2004 at a large public United States university completed high school and first‐semester‐of‐college assessments. Measurements Participants completed self‐report measures of alcohol use, alcohol‐related problems, perceived awareness and caring from parents and other adults, sensation seeking and impulsivity. Findings In the transition to college, high sensation seekers from more protective high school parental environments increased their alcohol use and problems more than did other students. Increases in alcohol problems were also high among more impulsive students from less protective environments. Whereas high sensation seekers drank equivalently in college regardless of high school‐perceived awareness and caring, those who had greater high school‐perceived awareness and caring did not experience as many alcohol‐related problems in college. Conclusions Differences in drinking trajectories may be a function of person–environment interactions. Risk associated with high sensation seeking may be masked among adolescents in protective environments, but its emergence in the college transition predicts increases in alcohol use and related problems.     

Predictors of final specialty choice by internal medicine residents

BACKGROUND: Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE: To identify factors that predict the clinical practice of residents following their training. DESIGN: Prospective cohort study. PARTICIPANTS: Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS: Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS: International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P < .001). Residents with higher loan indebtedness more often became generalists (P = .001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05 < P < .10). In a logistic regression, graduation from a U.S. medical school (odds ratio [OR] 3.02; 95% confidence interval [CI], 1.00 to 9.10, P = .049) and perception of low future income (OR 1.65; 95% CI, 1.06 to 2.56, P = .03) predicted entry into general medicine, with trends apparent for higher debt (P = .05) and greater comfort caring for patients with psychological problems (P = .07). CONCLUSION: Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process.