本研究旨在了解医学类本科生自主学习能力现状,分析相关影响因素的作用.研究结果显示,学习目标、课外活动频率、兼职情况及对所学专业态度直接影响大学生自主学习能力;学习动机、教师教学模式及性别可通过直接和间接作用共同影响学生自主学习能力.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的应用叉生分析法分析先天性心脏病（CHD）基因与环境因素的交互作用,为CHD的病因研究提供新的分析方法。方法采用以医院为基础的病例对照研究方法,对2012年7月—2013年10月在山东省4家医院胸外科住院的137例CHD患儿及同期住院的132例无CHD及其他畸形的其他疾病患儿母亲进行问卷调查,并采集患儿空腹外周静脉血进行DNA提取和基因检测;应用叉生分析方法分析CHD致病基因（MTHFRC677T位点突变）与环境因素（孕期患病情况）的交互作用。结果病例组和对照组患儿CC、CT、TT基因型分别占20.44%和36.36%、38.69%和40.91%、40.87%和22.73%,C、T等位基因分别占39.78%和57.58%、60.22%和42.42%,2组患儿全基因型、等位基因频率比较,差异均有统计意义（P&lt;0.010）;叉生分析显示,CHD致病MTHFR基因C677T位点突变与环境因素（孕期患病情况）基于相加模型的交互作用差异有统计学意义（U=2.060,P=0.020）,各评价指标:SI=4.85,AP=70%,AP*=79%,RERI=5.64;基于相乘模型交互作用差异无统计学意义（P&gt;0.05）。结论 MTHFR基因C677T位点突变与孕期患病对CHD具有相加交互作用。</span>

目的 用实验的方法阐述稀菌液中细菌数量服从泊松分布的定义及其原理,并介绍它在微生物检验中菌落计数方面的应用.方法 将ATCC25922和ATCC29213 2种菌株接种到血平板经18 h～24h培养后,用无菌生理盐水配成0.5麦氏单位约为108 cfu/ml的菌液,然后经过系列梯度稀释,得到目标浓度范围约为1 cfu/ml～5 cfu/ml的系列菌悬液各200 ml,然后从中取出1ml倾注培养,每种浓度进行100次并菌落计数,计数结果采用单样本Kolmogorov-Smimov 法检验1ml的菌液中的细菌是否服从泊松分布.结果 浓度范围为0.56 cfu/ml～ 6.38 cfu/ml的10个菌液每毫升的细菌数量分布均服从泊松分布,P均＞0.05.结论 将稀菌液服从泊松分布的原理应用到菌落计数漏检率和检出限估算方面具有重要意义.

Objective: To understand the present menstruation condition of girl students,and to explore specific measures and strategies for effective prevention of primary dysmenorrhea,in order to take timely measures to improve university women students' quality of life. Methods: Questionnaires were used to conduct a questionnaire survey of 600 female students of different specialties and different departments. Results: The prevalence rate of primary dysmenorrhea in female college students was 69. 78%. The single factor analysis and multivariate Logistic regression analysis found that factors like mother with dysmenorrhea history,dietary and fear in menstrual period were the influencing factors of primary dysmenorrhea( P <0. 05). Primary dysmenorrhea had little relation to age,menstrual quantity or other factors( P > 0. 05). Medical students and non-medical students had some differences in drinking cold drink habits,having a breakfast habits,menstruation diet and regular eating( P < 0. 01). Senior and junior students had some differences in getting regular meals and having sports during menstruation. Conclusion: Students with primary dysmenorrhea should avoid drinking herbal tea,increase exercise,live a regular,better nutrition,reduce psychological burden and these measures can effectively reduce or alleviate dysmenorrhea. We should strengthen health education for college students on adolescent health of female university students in schools.

目的 研究改进《消毒技术规范》中消毒效果监测法,以提高检出率.方法 通过增加取样液体积,以提高检测准确率.结果 当菌悬液细菌浓度约为1.5 cfu/ml时,分别取2ml与取1ml倾注培养细菌检出率之间有统计学意义(P＜0.001).结论 洗脱液中菌液的浓度≤1.5 cfu/ml时,改进方法的检出限明显高于现有方法.

OBJECTIVE To use the poisson distribution to investigate the detection limit of examination of the efficiency of disinfection and sterilization and to perform the experiment to verify.METHODS Two types of standard bacteria,ATCC25922 and ATCC29213,were suspended in different concentrations and were under the experimental conditions to mimic the process of examination of sterilization and disinfection.At each concentration,1 mL bacteria suspension was cultured for 100 times.The number of plates containing bacteria was counted and compared with the number calculated from the equation through Chi-square test to see whether there was a difference between two groups.RESULTS For the two strands,the differences between their calculated values and their experimental values were both statistically insignificant.On pour-plate cultures using 1mL-aliquot of each bacterial suspension,the corresponding required suspension concentration for achieving a detection rate of 99.00%,95.00%,90.00%,60.00% and 50.00% was 4.61,3.00,2.30,0.92 and 0.69 CFU/mL,respectively.CONCLUSION In the examination of the efficiency of disinfection,for partially plating the sample suspension,the detection limit under different positive rate can be calculated according to poisson distribution equation P(0)=e-λ.However,for testing the sterilization when the number of bacteria is small,this method remains to be improved.

Objective:To understand the main causes of maternal death and the years of life lost of the women of childbearing age by analyzing the status of maternal death in Dawen River basin in Taian city. Methods:Specific death rate and potential years of life lost(PYLL) were used to analyze the causes of death among the women of childbearing age in the main basin of Dawen River from 2002 to 2004. Results:The maternal mortalities were 1.09‰ in study area and 0.89‰ in control area,there was significant difference in standardized mortality rate between study area and control area(Z=2.83,P<0.01).Tumor,injury and poisoning,circulatory diseases,respiratory system diseases,urinary system diseases,and infectious diseases were the main causes of maternal death.The top six causes of maternal death of PYLL and PYLL rate were in accord with those of proportion of causes of maternal death,but the sequence was different.Except respiratory system diseases,infectious diseases,and parasitic diseases,there was significant difference in standardized PYLL rates of the other main causes of maternal death between study area and control area(P<0.01). Conclusion:Tumor,injury and poisoning,circulatory diseases,respiratory system diseases,urinary system diseases,and infectious diseases are the main causes of early death of the women of childbearing age.

Objective: To study the patient delay and influence factors in the young and old pulmonary tuberculosis patients for evidence in preventing and controlling tuberculosis.Methods:A cross-sectional descriptive survey was conducted in the young and old inpatients of pulmonary tuberculosis.The data were analyzed with SPSS13.0 and logistic regression.Results:The median of patient delay was 16 days and the rate of patient delay was 55.3% in the young patients.The median of patient delay was 27.5 days and the rate of patient delay was 70.2% in the old patients.Logistic regression showed that the factors associated with patient delay were the determination of patients after discomfort and the knowedge of tuberculosis prevention and cure organization in the young patients,hemoptysis and financial difficulties in the old patients.Conclusion:The patient delay in the old pulmonary tuberculosis patients is more severe than that in the young patients.To improve the early detection rate,it is very important to know tuberculosis prevention and cure organization for the old and young people,and put emphasis on free policy for the old people.The emphasis should be on the old from 60 to 64 years,and on the young in middle school students.

Objective: To test the paired-sample data of circular distribution with angles.Methods: The parametric procedure and nonparametric Moore test were applied.Results: Analysis of the paired-sample data with angles was conducted by two methods.Conclusion: The procedures can be used for the circurlar paired-sample data with angles,which is significant in medical research.

目的:通过对泰安市大汶河流域育龄妇女居民死亡状况的分析,了解育龄妇女的主要死因及其导致的寿命损失年数.方法:应用死亡专率和潜在减寿年数(PYLL)对大汶河主干流域育龄妇女2002～2004年人口死因进行分析.结果:研究区育龄妇女死亡率为1.09‰,对照区为0.89‰,其标化死亡率两区比较,差异有统计学意义(Z=2.83,P＜0.01).肿瘤、损伤与中毒、循环系统疾病、呼吸系统疾病、泌尿系统疾病、传染病是育龄妇女的主要死因.PYLL及PYLL率前6位死因与死亡构成前6位死因一致,但顺位不同.除呼吸系统疾病、传染病和寄生虫病外,其余主要死因研究区与对照区潜在寿命损失年数标化率(SPYLL率)差异有统计学意义(P＜0.01).结论:肿瘤、损伤与中毒、循环系统疾病、呼吸系统疾病、泌尿系统疾病、传染病是导致育龄妇女“早死”的主要死因.

目的了解社区为老服务的现状,并据此提出完善社区为老服务的对策与建议。方法采用自行设计的问卷收集有效数据594例,对涉及社区为老服务的8项指标进行统计学分析。结果社区为老服务现状与老年人对社区为老服务的需求差距比较大,特别是农村。"医护人员上门看病送药"差值最大为74.58%,排在第1位;农村比城市更需要改善社区为老服务中的医疗卫生服务。"日常起居照料"差值为61.28%排在第2位,城市老人高于农村老人,老人希望社区为他们提供起居照料服务。结论不论城市还是农村,为老年人提供身心健康服务是未来社区为老服务发展的重中之重,政府应整合人财物等资源完善社区为老服务工作。

With the purpose of improving research abilities of clinical medical undergraduates,the reform of medical statistics teaching has been carried out in some local colleges.In the course of teaching medical statistics to clinical medical undergraduates,the following methods have been performed: increasing teaching hours,cultivating relevant teachers,strengthening practice of research design and data analysis,compiling new textbooks,and combining commonly-used statistics methods in future clinical researches according to variant research styles.With the previous attempted reform,the clinical students not only have better grasped the theoretical knowledge,but also improved their research abilities abundantly.

Objective: To investigate whether quantitative apparent diffusion coefficient(ADC) measurements can be employed to predict the prognosis of infarction in acute ischemic stroke without intravenous contrast material.Methods: Thirty-three patients having acute stroke symptoms with verified infarction in magnetic resonance imaging(MRI) were included in this study.Their MRI studies were performed between 6 and 12 h after the onset of their symptoms and were repeated.The infarction volumes were calculated by using DWI and the patients were divided into two groups as the ones having an expansion in the infarction area(group I,n=22) and the others having no expansion in the infarction area(group II,n=11).The groups were compared in terms of the ADC values and areas obtained from DWI,referring to three points: the core of the infarction,ischemic penumbra and the contralateral nonischemic parenchymal tissue.Quantitative ADC values and the infarction area were estimated.P 0.05 were accepted to be statistically significant.Results: The internal mean infarction area during the times between 6 and 12 h and in the fourth day was calculated by DWI.A significant statistical result was demonstrated on the DWI between the two groups(P0.001) and there was no difference between the core of the infarction and parenchymal tissue(P0.05).The ADC values of ischemic penumbra between the groups were found to be highly significant(P0.001).Conclusion: We believe that ADC results obtained from the core and the penumbra of the infarction area without intravenous contrast material will be a feasible and practical in the estimation of the infarction prognosis and in the planning of a treatment protocol.

Objective To investigate the true incidence of lumbar spondylolysis with low back pain and lower extremity radicular symptoms population and the association with spondylolytic spondylolisthesis.Materials and Methods The MSCT data of 5301 subjects for reasons related to low back pain and lower extremity radicular symptoms were reviewed,spondylolysis,spondylolytic pondylolisthesis in the lumbosacral region were analyzed.Results Lumbar spondylolysis was found in 221 subjects of 5301 cases(4.17%),male 112(4.61%),female 109(3.80%) respectively,there were statistically significant difference(χ2=220,P0.001)between male and female.Among these 221 subjects,there were 236 vertebrae with spondylolysis.Unilateral spondylolysis was found in 22 subjects(9.95%) and 214 had bilateral spondylolysis.Of 236 vertebrae with spondylolysis.According to Meyerding grading system,116 were in grade I and 4 in gradeⅡ,and no grade Ⅲ,Ⅳ of spondylolisthesis was found.Spondylolisthesis was found in 55.14% of the subjects with bilateral spondylolysis,and in 9.09% of those with unilateral spondylolysis,which had statistically significant difference(χ2= 19.621,P0.001,rs=0.277).Conclusion The incidence of lumbar spondylolysis with low back pain and lower extremity radicular symptoms population is 4.17%(male 4.61%,female 3.80%).spondylolysis is little correlated with spondylolytic spondylolisthesis.

Objective: To investigate the distribution of Taian City primary school children's obesity,and analyze the risk factors of the children's obesity.Methods:With stratified cluster sampling survey and multivariate statistical methods,the possible risk factors of body mass index(BMI) for obesity of pupils were studied.Results:The pupils' BMI were positively skewed distribution.In Taian City,the total detection rate of primary obesity was 8.21%,men and women were detected in 13.14% and 5.22%,difference in the gender(χ2=33.323,P=0.000) was statistically significant in the detection rate.Logistic regression showed the factors that affected primary obesity were gender,physical exercise,irregular diet,vegetable intake,obesity of the father,obesity of the mother,and so on.Conclusion: The obesity of the primary pupils is mainly affected by gender,genetic and lifestyle.

Objective The purpose of this study was to correlate T2 signal intensity values in nucleus pulposus of lumbar discs with patient age,gender and stage of nucleus pulposus degeneration.Methods Lumbar imaging findings of 422 cases subjects were retrospectively reviewed through T2 signal intensity values of nucleus pulposus evaluated based on the signal intensity values of MR T2-weighted mid-sagittal images of the lumbar spine,the t2 signal intensity values at all five lumbar levels (from L5-S1 to L1-L2) between male and female were used independent sample t-test and the Spearman correlation analysis.The age and grade of nucleus pulposus of disc degeneration and T2 signal intensity values were estimated by calculating and Chi-square test and the Spearman correlation analysis.The t-test was used to correlate the different anatomic levels of disc degeneration;T2 signal intensity values among the five different anatomic levels using non-parametric correlation analysis.Results There were significantly differences in T2 signal intensity values of nucleus pulposus at the same grade and anatomic level between male and female.Advanced with age,T2 signal intensity values of nucleus pulposus decreased and stage of disc degeneration increased accordingly.T2 signal intensity values may represent the nucleus pulposus degeneration of interverterbral disc.L4-L5 was the highest incidence among the nucleus pulposus degeneration of intervertebral disc.Conclusions The T2 signal intensity values based approach may be a feasible and practical tool to determine nucleus pulposus degeneration.T2 signal intensity values of nucleus pulposus of lumbar intervertebral disc are correlated with grade of degeneration and patient age.

Objective: To test the two-sample dispersion.Methods: The Miller test of nonparametric procedures was applied.Results: The data of the two-sample dispersion were tested by Miller test procedure.Conclusion: It is one of the nonparametric statistics,and it has applicable significance in medical and biological research.

<正>医疗服务潜在需求是指未转化为需求的医疗需要,通常以应就诊而未就诊或应住院而未住院的比例来反映〔1〕。这些潜在医疗服务需求往往是居民健康的主要影响因素,而造成潜在医疗服务需求的原因常常与卫生资源不合理配置有

Objective: To test the degree of agreement of data in two-way design.Methods: The Kendall's coefficient of concordance W of nonparametric procedures was applied.Results: The Kendall's coeffecient of concordance W procedure was conducted by SPSS.Conclusion: The procedure may be applied to the data in two ways,which is of significance in medical research.

医学统计学是运用数理统计学的原理和方法研究医学资料的搜集、整理与分析,并根据分析结果做出决策的一门学科.医学统计学作为一门方法学可以应用到医学各个研究领域.可以包括基础医学、临床医学、预防医学及中医学等研究领域.