Approaches for drawing causal inferences from epidemiological birth cohorts: A review

Large-scale population-based birth cohorts, which recruit women during pregnancy or at birth and follow up their offspring through infancy and into childhood and adolescence, provide the opportunity to monitor and model early life exposures in relation to developmental characteristics and later life outcomes. However, due to confounding and other limitations, identification of causal risk factors has proved challenging and published findings are often not reproducible. A suite of methods has been developed in recent years to minimise problems afflicting observational epidemiology, to strengthen causal inference and to provide greater insights into modifiable intra-uterine and early life risk factors. The aim of this review is to describe these causal inference methods and to suggest how they may be applied in the context of birth cohorts and extended along with the development of birth cohort consortia and expansion of “omic” technologies.     

Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort

Astrom AN, Ekback G, Ordell S, Unell L. Socio‐behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort. Community Dent Oral Epidemiol 2011; 39: 300–310. © 2010 John Wiley & Sons A/S Abstract – Objectives: Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life‐course stage at which they would be expected to operate, this study assessed the impacts of socio‐behavioral and disease‐related factors on tooth loss between ages 50 and 65. Methods: In 1992, all 50‐year‐olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8888 subjects, 6346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4143 (65%) completed postal follow‐ups at ages 55, 60 and 65. Results: For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50–85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life‐stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle‐age and early‐old‐age life stage). Conclusion: Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease‐related factors and socio‐behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life‐course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early‐older age.     

A virtual reality dental simulator predicts performance in an operative dentistry manikin course

This study was designed to test the ability of a virtual reality dental simulator to predict the performance of students in a traditional operative dentistry manikin course. Twenty-six dental students were pre-tested on the simulator, prior to the course. They were briefly instructed and asked to prepare 12 class I cavities which were automatically graded by the simulator. The instructors in the manikin course that followed were unaware of the students' performances in the simulator pre-test. The scores achieved by each student in the last six simulator cavities were compared to their final comprehensive grades in the manikin course. Class standing of the students in the simulator pre-test positively correlated with their achievements in the manikin course with a correlation coefficient of 0.49 (P = 0.012). Eighty-nine percent of the students in the lower third of the class in the pre-test remained in the low performing half of the class in the manikin course. These results indicate that testing students in a dental simulator, prior to a manikin course, may be an efficient way to allow early identification of those who are likely to perform poorly. This in turn could enable early allocation of personal tutors to these students in order to improve their chances of success.     

儿科学早临床长学制医学生开展临床课程的可行性研究

目的　分析儿科学早临床长学制医学生开展临床课程的可行性,为后续课程改革提供依据。方法　纳入重庆医科大学附属儿童医院长学制儿科学医学生90人,包括早临床组（G1,二年级第三学期,n=47）和临床见习组（G2,四年级第七学期,n=43）。对两组进行问卷调查,从临床兴趣、学习方法、学习能力进行对比。两组分别抽取24名、20名学生参与一次临床课程教学,对比组间形成性评价和随堂测试得分,以了解两组学习表现和学习效果的差异。运用SPSS 22.0进行数据分析。计数资料比较采用卡方检验,不满足卡方检验条件时采用Fisher精确检验。计量资料进行正态性检验,正态分布资料的组间比较采用两独立样本t检验,偏态分布资料的组间比较采用Mann-Whitney U检验。结果　两组学生临床兴趣及早临床兴趣差异无统计学意义（P=0.252、1.000）。学习方法有部分差异：G1组课后学习时间更长（Z=-2.36,P=0.018）,利用课余时间学习更多（Z=2.53,P=0.011）,学习方式更依赖于作业（P=0.020）,预习率更高（Z=-5.07,P<0.001）。学习能力有部分差异：G2组文献检索能力更强（χ²=10.57,P=0.001）,G2课堂及延展课堂表现得分更高（t=-3.18,P=0.004;t=-10.14,P<0.001）。学习效果方面,G2仅一道多选题正确率高于G1（t=-2.46,P=0.022）。结论　儿科学早临床长学制医学生有一定的兴趣和能力接受临床课程。充分的课前准备和恰当的课程设计有助于学生临床思维的早期培养。     

ESA的翻转课堂结合SPOC教学在康复医学科实习教学中的应用

目的　探讨ESA[engage（投入）-study（学习）-activate（活用）]的翻转课堂结合小规模限制性在线课程（small private online course,SPOC）教学在康复医学科实习教学中的应用。方法　将2018年1月至2020年10月在康复医学科实习的87例学生,分为对照组（n=43）和观察组（n=44）。对照组采用常规教学,观察组采用ESA的翻转课堂结合SPOC教学。比较两组实习生的个体考核成绩以及团队考核成绩,并评估分析实习生对教学效果的评价以及实习生认可度情况。采用SPSS 22.0进行卡方检验和t检验。结果　观察组的病史采集评分、专科查体评分、治疗方法评分、个体考核成绩总分、人文沟通评分、参与度评分、团队考核成绩总分均优于对照组（P<0.05）;两组的辅助检查评分、诊断评分、团队协作评分比较,差异无统计学意义（P>0.05）;观察组的学习效率、课堂互动能力、自主学习能力、理论与实际相结合能力、基础知识掌握、临床创新思维能力、团队协作能力7个维度评分均高于对照组（P<0.05）;观察组对教学的认可度为97.73%（43/44）,高于对照组的81.40%（35/43）。结论　ESA的翻转课堂结合SPOC教学可以提高实习生的个体考核成绩和团体考核成绩,改善教育环境,教学效果优于常规教学,可以提升实习生的认可度,从而在医学教学中具有重要的应用价值。     

儿科学网络在线课程结合翻转课堂的混合式教学建设

混合式教学已经成为当今高等教育教学信息化改革的重要内容。儿科学网络在线课程结合翻转课堂的混合式教学是指以网络在线课程、翻转课堂及在线交流平台为核心内容,通过网络课堂教学结合线上作业、测验、讨论和考试,最大程度调动学生的学习积极性,以达到最优化的课程效果。本文重点介绍了复旦大学《儿科学》网络在线课程结合翻转课堂的混合式教学模式的建设情况及成效。     

基于SPOC与交互工具相融合的混合教学模式在护理双语教学中的运用

目的　探讨基于小规模限制性在线课程（small private online course,SPOC）与交互工具相融合的混合教学模式在妇产科护理学双语教学改革中的应用效果。方法　便利选取重庆医科大学2018级护理本科生作为研究对象,试验组336名、对照组332名。试验组采用基于SPOC与交互工具相融合的混合教学模式,对照组采用传统的线上线下教学方法进行教学。采用学习成绩、在线学习及课堂表现等形成性评价指标,比较两组学生的教学效果。采用SPSS 26.0统计学软件进行t检验和卡方检验。结果　试验组期末考试成绩为（67.84±8.65）分、对照组为（66.50±7.29）分,试验组双语章节试题得分为（5.32±1.90）分、对照组为（4.95±1.92）分,两组比较差异有统计学意义（P<0.05）。试验组在线学习表现及课堂表现均高于对照组,差异有统计学意义（P<0.05）。试验组大部分学生认为采用基于SPOC与交互工具相融合的混合教学模式可培养其自主学习能力、提高其专业知识掌握程度和英语水平。结论　基于SPOC与交互工具相融合的混合教学模式可有效培养学生自主学习能力,提升教学效果。     

中医药优秀文化融入思政课教学的三重维度

中医药优秀文化融入思政课教学是中医药高等院校思想政治教育工作适应新形势的新需要,是思政课落实立德树人根本任务的新使命,是推动马克思主义理论学科建设的新发展。从逻辑理路来看,中医思维是马克思主义方法论中国化的有益补充,中医美德是社会主义核心价值观的重要源泉,中医历史是“四史”教育的传统资源,中医榜样是中华民族精神的生动体现。从主题跟进、内容升华、话语转换、技术革新、实践拓展等5个方面可以实现中医药优秀文化融入思政课教学。     

紫杉醇：具有里程碑意义的天然抗癌药物

紫杉醇是从红豆杉树皮中分离得到的微量单体成分,作为世界上最优秀的植物抗癌药,紫杉醇及其衍生物是临床上常用的广谱抗癌药。自20世纪70年代发现紫杉醇后,科学家对此类化合物的构效关系、结构修饰、药理药效方面开展了大量研究,并开发出泰素、多西他赛、卡巴他赛、拉洛他赛、信立他赛、康莫他赛等抗癌药。直到40年后的今天,科学家对紫杉醇的研究依然活跃,对其生物合成、真菌培养、新剂型开发等方面也成为新的研究方向。作为源于天然的单体成分开发成新药的成功典范,紫杉醇类化合物的研发历程对当前开发天然新药提供有益的借鉴。本文对紫杉醇的研发及最新进展进行综述,回顾其开发历程及相关研究,以期为天然药物的开发带来新的思考。