异常生育史与遗传性家族史、孕期危险因素的多重对应分析

目的 分析异常生育史与遗传性家族史、孕期危险因素暴露的多重对应关系,为进一步完善出生缺陷监测系统和降低出生缺陷发生率提供新的科学依据。方法 对2003至2015年西安市各级开设产科的医疗保健机构分娩的孕28周至生后7 d的围产儿进行出生缺陷监测,并收集相关资料。结果 共监测围产儿1 236 937例,其中出生缺陷患儿10 619例,平均出生缺陷发生率为0.86%(0.70%~1.15%)。多重对应分析显示生育出生缺陷患儿(既往生育1个或2个出生缺陷患儿)与自然流产史、遗传性家族史、有毒有害物质接触史有关,既往生育≥3个出生缺陷患儿与遗传性家族史接近相同区域且距离更近,关系更密切。有自然流产史产妇(257/10 619)再次生育出生缺陷患儿类型依次为先天性心脏病、多指(趾)、神经管缺陷、先天性脑积水、唇裂合并腭裂、单纯唇裂;生育过出生缺陷患儿的产妇(135/10 619)再次生育出生缺陷患儿类型依次为唇裂合并腭裂、无脑畸形、脑积水、神经管缺陷、唇裂、马蹄内翻足。结论 异常生育史与孕期危险因素暴露和遗传性家族史均相关,既往生育≥3个出生缺陷患儿与遗传性家族史关系更密切。     

河南农村人群血脂异常预测的简易指标筛选

目前,我国成人血脂异常患病率已达18.60％,全国血脂异常患者总人数约为1.6亿[1-2].许多研究显示,体质指数(body mass index, BMI)、腰围(waist circumference,WC)与血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)水平呈正相关,而与高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平呈负相关[3-6].     

中国成年人高血压患病区域聚集性及危险因素的多水平模型分析

目的 分析中国成年人高血压的区域聚集性及危险因素,探讨多水平模型在高血压危险因素研究中的应用.方法 采用多阶段随机抽样方法,于2000-2001年从中国10地区共抽得年龄在35～74岁之间的15 540人作为研究对象,采用MLwiN 2.02软件对数据进行二水平logistic回归模型拟合.结果 高血压的患病存在地区聚集现象,方差成分系数为3.1%.在调整了年龄和性别的影响后,全身型肥胖人群(BMI≥28 kg/m2)和超重人群(BMI 24～27.9 kg/m2)分别为BMI正常人群(18.5～23.9 kg/m2)患高血压风险的4.50(95%CI:4.00～5.06)和2.26(95%CI:2.07～2.46)倍;中心型肥胖人群(男性腰围≥85 cm或女性≥80 cm)为正常腰围人群患高血压风险的2.62(95%CI:2.42～2.83)倍;片油三酯、总胆固醇、血糖、低密度脂蛋门胆固醇含量升高或者高密度脂蛋白胆固醇含量降低者患病风险分别为正常者高血压患病风险的2.10(95%CI:1.89～2.33)、2.08(95%CI:1.84～2.35)、1.85(95%CI:1.60～2.14)、1.58(95%CI:1.38～1.81)和1.49(95%CI:1.32～1.69)倍,饮酒人群为不饮酒人群患高血压风险的1.15(95%CI:1.05～1.27)倍.结论 高血压的发生不仪与个体肥胖、血糖升高、血脂异常和饮酒等危险因素有关,还受所居住区域环境因素的影响;在高血压的一级预防中,既要关注高危人群,还要重视以一般人群为基础的群体预防控制工作.     

中国成年人高血压患病区域聚集性及危险因素的多水平模型分析

Objective To analyze the region cluster and risk factors of hypertension in the Chinese adult population and to explore the application of multilevel regression model in the risk factors of hypertension. Methods Multi-stage random sampling technique was used to choose 15 540 individuals aged 35-74 years from 10 regions in China. Two-level logistic regression models were fitted under MLwiN 2.02 software. Results The region cluster of hypertension existed and variance portion coefficient was 3.1%. After adjusting for the age and gender, overall obese people (BMI≥28 kg/m2) were 4.50(95%CI: 4.00-5.06) times, overweight people (BMI=24-27.9 kg/m2) were 2.26 (95%CI: 2.07-2.46) times more likely to be hypertensive as compared with those of normal BMI (18.5-23.9 kg/m2), and those centrally obesive people (Waist circumference≥85 cm in male or 80 cm in female) were 2.62 (95%CI: 2.42-2.83) times more likely to be hypertensive as compared with those of normal WC. The age-and gender-adjusted odds ratios (Ors) of triglyceride (TG), serum total cholesterol (TC), glucose, low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) and drinking alcohol were 2.10 (95% CI: 1.89-2.33) , 2.08 (95% CI: 1.84-2.35) , 1.85 (95% CI: 1.60-2.14) , 1.58 (95% CI: 1.38-1.81), 1.49(95%CI: 1.32-1.69) and 1.15(95%CI: 1.05-1.27), respectively. Conclusion The prevalence of hypertension was not only affected by individual risk factors, such as obesity, drinking alcohol, abnormal glucose and serum lipids profile, but also affected by the geographic environment where people resided in. Population-and risk factors targeted strategies, proved a promising way to reduce individual risk of hypertension in the primary prevention of hypertension.     

硕士生医学统计学实验课改革初探

医学统计学是医学硕士生的一门必修课,是医学科研必不可少的工具,然而硕士生的统计应用能力与教学目标期望值有较大差距。该文分析了当前实验课教学的现状与不足,深入思考了当前医学统计学教学改革的方向,提出了PBL与统计软件SPSS紧密结合的教学模式,并详细阐述了实施及考核方案。该教学模式以解决医学实际问题为出发点,着重培养学生正确利用统计理论和统计分析软件为科研服务的能力。该模式将极大地激发学生的学习热情,有助于形成系统的统计知识体系和科研思路以及增强医学硕士生的统计实践能力。     

利用EPI Info进行1:R的配比卡方检验

对EPI Info计算1:R的配比卡方检验的方法进行了介绍,并将其计算结果与SPSS、Stata进行比较,简化了1:R的配比卡方检验的计算。     

医学英汉双语角在七年制组织学与胚胎学PBL教学中的应用

我国临床医学七年制的教育目标是培养高层次临床医学人才,要求学生掌握宽厚的医学知识和技能,具备一定的科研能力、终身学习能力和国际交流能力.通过教学实践我们认为以问题为基础的教学(problem based learning,PBL教学)在强化基础理论,锻炼临床思维等方面确有优势,然而单纯的PBL教学在提高专业外语能力方面的优势并不突出. 医学英汉双语角(medical English-Chinese corner,MECC)[1]是以提高七年制学生和来华留学生医学外语水平并有效促进其临床能力为目的,以医学知识水平近似的中外医学生为会话双方,以英汉两种语言为交流媒介,以医学知识为会话内容的,规定话题的,阶梯性语言训练模式.实践证明该模式在提高医学外语交流能力方面效果突出[2].因此,我们大胆将MECC与PBL结合起来在七年制组织学与胚胎学教学中进行实践,取得了较好的效果与反响.     

陕西省麟游县大骨节病病情下降特点的流行病学调查

目的分析麟游县大骨节病历史重病区病情下降的特点，回顾可能促使病情下降的因素。方法将1978年全民普查临床患病率分为轻、中、重病情三层，每层随机抽取1／3的行政村，进行全民大骨节病临床检查和流行病学调查。结果临床检查25656人，检出大骨节病患者3489例，患病率13．6％。患者主要分布在30—60岁年龄组，以50～59岁为最高（3239％）。0—20岁年龄组患病率显著低于其他年龄组（1.43％）。结论麟游县大骨节病病情明显下降，尤以青少年儿童下降为著，可能是综合因素的作用结果。     

门静脉梗阻患儿胆汁郁积研究

本研究描述了8例门静脉梗阻患儿因胆管畸形而引起的胆汁郁积。对1986～2000年121例门静脉海绵样变性患儿进行临床、生化和放射线检查后发现,8例患儿有黄疸、瘙痒、伴(或)血清转氨酶升高、伴(或)γ-谷氨酰转肽酶(γ-GT)活性增高。患儿的肝内和(或)肝外胆管呈扩张和狭窄共存表现。外科门脉系统减压(门脉系统或Rex吻合术)有效地改善了所有儿童的胆汁郁积现象。结论:门静脉梗阻患儿可能由于海绵状瘤对胆管的压迫而产生胆汁郁积的临床症状。门静脉梗阻患儿胆汁郁积研究@Gauthier- Villars M. @Franchi S. @Gauthier F. @O. Bernar…     

中国成年人高血压患病区域聚集性及危险因素的多水平模型分析

Objective To analyze the region cluster and risk factors of hypertension in the Chinese adult population and to explore the application of multilevel regression model in the risk factors of hypertension. Methods Multi-stage random sampling technique was used to choose 15 540 individuals aged 35-74 years from 10 regions in China. Two-level logistic regression models were fitted under MLwiN 2.02 software. Results The region cluster of hypertension existed and variance portion coefficient was 3.1%. After adjusting for the age and gender, overall obese people (BMI≥28 kg/m2) were 4.50(95%CI: 4.00-5.06) times, overweight people (BMI=24-27.9 kg/m2) were 2.26 (95%CI: 2.07-2.46) times more likely to be hypertensive as compared with those of normal BMI (18.5-23.9 kg/m2), and those centrally obesive people (Waist circumference≥85 cm in male or 80 cm in female) were 2.62 (95%CI: 2.42-2.83) times more likely to be hypertensive as compared with those of normal WC. The age-and gender-adjusted odds ratios (Ors) of triglyceride (TG), serum total cholesterol (TC), glucose, low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) and drinking alcohol were 2.10 (95% CI: 1.89-2.33) , 2.08 (95% CI: 1.84-2.35) , 1.85 (95% CI: 1.60-2.14) , 1.58 (95% CI: 1.38-1.81), 1.49(95%CI: 1.32-1.69) and 1.15(95%CI: 1.05-1.27), respectively. Conclusion The prevalence of hypertension was not only affected by individual risk factors, such as obesity, drinking alcohol, abnormal glucose and serum lipids profile, but also affected by the geographic environment where people resided in. Population-and risk factors targeted strategies, proved a promising way to reduce individual risk of hypertension in the primary prevention of hypertension.