Since 2016, Binzhou Medical University began to carry out the blended learning reform in the organ-systems based curriculum (OSBC) of the experimental class of clinical medicine. Based on the traditional face-to-face teaching method, the blended learning mode of the integrated course of endocrine system under OSBC has been carried out by using the small private online course (SPOC) of MOOC platform of China universities. Many teaching methods have been adopted and formed, including case-based learning (CBL), problem-based learning (PBL), professional bilingual teaching, scientific research teaching and virtual simulation experiment teaching. The evaluation system for the combination of formative and summary assessment has been also adopted in the whole process to assess the students' academic achievement, and the teaching effect as well. The blended learning mode of the integrated course of the endocrine system under OSBC is still in the exploratory stage. There are some limitations, such as too high requirements for teachers' quality, long preparation time for teaching, and great difficulty in supervising online learning. However, the practice of teaching reform that has been carried out shows that it is effective, feasible, and worth popularizing.

Objective:To investigate the necessity and practical significance of fundus examination by three-mirror lens by analyzing the fundus examination results of students with suspected fundus lesions in physical examination of civil aviation recruitment.Methods:Data of fundus examination detected by three-mirror lens of students with suspected fundus lesions were collected among 1 808 students in physical examination of civil aviation recruitment from November 2017 to December 2019. Descriptive analysis were used to present the frequency and proportion of various fundus lesions, and the consistency between the results of direct ophthalmoscope and three-mirror lens was tested and the Kappa value was calculated. Chi-square test or Fisher exact probability method were used to analyze the characteristics of fundus lesions distributed across eye types, diopters and lesion locations (divided into upper temporal, lower temporal, upper nasal, and lower nasal by quadrants, or posterior polar, equatorial and peripheral parts by concentric circle).Results:A total of 449 students (898 eyes) with suspected fundus lesions detected by direct ophthalmoscope, of which 434 students were diagnosed with any kind of fundus lesions. The diagnosis rate was 96.66% (434/449); the detection rate of suspected fundus lesions was 24.83% (449/1 808); the detection rate of fundus lesions was 24.00% (434/1 808). Among 898 eyes of 449 suspected students, those with frost-like degeneration (233 eyes, 25.95%), cystic degeneration (170 eyes, 18.93%) and paving stone degeneration (234 eyes, 26.06%) were common. There were 70 eyes and 13 eyes detected with retinal holes and retinal detachment, accounting for 7.80% and 1.45% of the total eyes, respectively. Congenital hypertrophy of retinal pigmented epithelium ophthalmoscope and three-mirror examination showed poor consistency in the detection results of congenital hypertrophy of retinal pigment epithelium, retinal detachment, and retinal hole (Kappa values were 0.164, 0.349 and 0.535, respectively), and direct ophthalmoscope was inclined to miss diagnosis. The detection rate of fundus lesions in the right eye was higher than that in the left eye, with a high incidence in the upper temporal, followed by the lower temporal, and most fundus lesions tend to occur in the peripheral site.Conclusions:Fundus examination by three-mirror lens could supplement the deficiency of direct ophthalmoscope in screening fundus lesions, especially in detecting retinal detachment and retinal hole. It is worth to be widely promoted and incorporated into the operating standards of ophthalmic physical examination in aviation physical examination. It is suggested to use direct ophthalmoscope for initial examination to predispose the fundus lesions according to the distribution characteristics and the site of the lesions. In case of the type and site of fundus lesions cannot be accurately judged, the confirmation, classification and follow-up should be determined by the result of three-mirror lens examination.

Objective:To investigate the necessity and practical significance of fundus examination by three-mirror lens by analyzing the fundus examination results of students with suspected fundus lesions in physical examination of civil aviation recruitment.Methods:Data of fundus examination detected by three-mirror lens of students with suspected fundus lesions were collected among 1 808 students in physical examination of civil aviation recruitment from November 2017 to December 2019. Descriptive analysis were used to present the frequency and proportion of various fundus lesions, and the consistency between the results of direct ophthalmoscope and three-mirror lens was tested and the Kappa value was calculated. Chi-square test or Fisher exact probability method were used to analyze the characteristics of fundus lesions distributed across eye types, diopters and lesion locations (divided into upper temporal, lower temporal, upper nasal, and lower nasal by quadrants, or posterior polar, equatorial and peripheral parts by concentric circle).Results:A total of 449 students (898 eyes) with suspected fundus lesions detected by direct ophthalmoscope, of which 434 students were diagnosed with any kind of fundus lesions. The diagnosis rate was 96.66% (434/449); the detection rate of suspected fundus lesions was 24.83% (449/1 808); the detection rate of fundus lesions was 24.00% (434/1 808). Among 898 eyes of 449 suspected students, those with frost-like degeneration (233 eyes, 25.95%), cystic degeneration (170 eyes, 18.93%) and paving stone degeneration (234 eyes, 26.06%) were common. There were 70 eyes and 13 eyes detected with retinal holes and retinal detachment, accounting for 7.80% and 1.45% of the total eyes, respectively. Congenital hypertrophy of retinal pigmented epithelium ophthalmoscope and three-mirror examination showed poor consistency in the detection results of congenital hypertrophy of retinal pigment epithelium, retinal detachment, and retinal hole (Kappa values were 0.164, 0.349 and 0.535, respectively), and direct ophthalmoscope was inclined to miss diagnosis. The detection rate of fundus lesions in the right eye was higher than that in the left eye, with a high incidence in the upper temporal, followed by the lower temporal, and most fundus lesions tend to occur in the peripheral site.Conclusions:Fundus examination by three-mirror lens could supplement the deficiency of direct ophthalmoscope in screening fundus lesions, especially in detecting retinal detachment and retinal hole. It is worth to be widely promoted and incorporated into the operating standards of ophthalmic physical examination in aviation physical examination. It is suggested to use direct ophthalmoscope for initial examination to predispose the fundus lesions according to the distribution characteristics and the site of the lesions. In case of the type and site of fundus lesions cannot be accurately judged, the confirmation, classification and follow-up should be determined by the result of three-mirror lens examination.

Objective: To understand the health literacy and relevant factors of cancer prevention consciousness in Chinese urban residents from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of demographic characteristics and cancer prevention consciousness focusing on nine common risk factors, including smoking, alcohol, fiber food, food in hot temperature or pickled food, chewing betel nut, helicobacter pylori, moldy food, hepatitis B infection, estrogen, and exercise. The logistic regression model was adopted to identify the influencing factors. Results: The overall health literacy of the cancer prevention consciousness was 77.4% (24 980 participants), with 77.4% (12 018 participants), 79.9% (6 406 participants), 77.2% (1 766 participants) and 74.5% (4 709 participants) in each group (P<0.001). The correct response rates for nine risk factors ranged from 55.2% to 93.0%. The multivariate logistic regression analysis showed that compared with community residents, people with primary school level education or below, and the number of people living together in the family <3, the cancer risk assessment/screening intervention population, cancer patients, those with junior high school level educationor above and the number of people living in the family ≥3 had better health literacy of the cancer prevention consciousness (all P values <0.05). Compared with females, 39 years old and below, government-affiliated institutions or civil servants, from the eastern region, males, older than 40 years, company or enterprise employees, and from the middle or western region had worse health literacy of the cancer prevention consciousness (all P values <0.05). Conclusion The health literacy of the cancer prevention consciousness in Chinese urban residents should be improved. The cancer screening intervention, gender, age, education, occupation, the number of people co-living in the family, and residential region were associated with the health literacy of the cancer prevention consciousness.

Objective: To understand the consciousness of the cancer early detection among urban residents and identify the influencing factors from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. Self-designed questionnaires were used to collect population, socioeconomic indicators, self-cancer risk assessment, regular participation in physical examination and other information. The multivariate logistic regression model was used to identify the factors of people who had not regularly participated in the regular physical examination in the past five years. Results: The self-assessment results of 32 357 residents showed that there were 27.54% (8 882) of total study population with self-reported cancer risk, 45.48% (14 671) without cancer risk and 26.98% (8 704) with unclear judgement on their own cancer risk. Among population with cancer risk, 79.84% (7 091) considered physical examination accounted. In the past five years, there were 21 105 (65.43%) residents participated in regular physical examination and 11 148 (34.56%) participated in non-scheduled one, respectively. The multivariate logistic regression analysis showed that compared with unmarried and western region residents, divorced, middle and eastern region residents had a stronger consciousness to participate in the regular physical examination (P<0.05). Compare with residents with annual household income less than 20 000 CNY in 2014, cancer risk assessment/screening intervention population, and self-assessment with cancer risk, residents with annual household income between 20 000 CNY and 59 000 CNY in 2014, occupational population, community residents, cancer patients, self-reported cancer-free risk, and self-assessment with unclear judgement of cancer risk were less likely to participate in the regular physical examination (all P values <0.05). Conclusion From 2015 to 2017, the Chinese urban residents had a acceptable consciousness of the cancer early detection. The marital status, annual household income, population group and self-assessment of cancer risk were related to the consciousness of the cancer early detection of people who had not participated in the regular physical examination in the past five years.

Objective: To understand the consciousness of the cancer early diagnosis among urban residents and identify the related factors from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The general demographic characteristics, the consciousness of the cancer early diagnosis (whether people would have a willingness or encourage their relatives/friends to confirm the abnormal results once which were detected from the physical examination) and other information were collected by using the self-designed questionnaire. The non-conditional logistic regression model was used to identify the relateol factors related to the consciousness of the cancer early diagnosis. Results: As for residents with abnormal result from the physical examination, 89.29% (28 802) of residents would choose to seek medical treatment for further diagnosis. If their relatives/friends had abnormal results from the physical examination, 89.55% (28 886) of residents would encourage their relatives/friends to confirm the diagnosis in time. The non-conditional logistic regression model analysis showed that compared with the public institution staff/civil servants, annual household income less than 20 000 CNY, the western region and the cancer risk assessment/screening intervention population, the company staff, annual household income about 40 000 CNY and more, and the residents from the middle and eastern region had a stronger consciousness to seek further diagnosis; while the unemployed residents and community residents were less likely to seek further diagnosis (P<0.05). Conclusions From 2015 to 2017, the Chinese urban residents had a good consciousness of the cancer early diagnosis. Occupation, annual household income, residential region and population group were related to the consciousness of the cancer early diagnosis.

Objective: To understand the consciousness of the cancer early treatment and its demographic and socioeconomic factors. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The questionnaire collected personal information, the consciousness of the cancer early treatment and relevant factors. The Chi square test was used to compare the difference between the consciousness of the cancer early treatment and relevant factors among the four groups. The logistic regression model was used to analyze the influencing factors related to the consciousness of the cancer early treatment. Results: With the assumption of being diagnosed as precancer or cancer, 89.97% of community residents, 91.84% of cancer risk assessment/screening population, 93.00% of cancer patients and 91.52% of occupational population would accept active treatments (P<0.001). If the immediate family members were diagnosed as precancer or cancer, people who would encourage their family members to receive early treatment in the four groups accounted for 91.96%, 91.94%, 92.44% and 91.55%, respectively (P<0.001). The company employees, annual household income with 40 000 yuan and more and other three groups had a relatively better consciousness of the cancer early treatment (P<0.05). Male, widowed, unemployed and from the central and western regions had a relatively worse consciousness of the cancer early treatment (P<0.05). Conclusion Residents in urban China participants had a good consciousness of the cancer early treatment. The marital status, occupation, annual household income and residential regions were major factors related to the consciousness of the cancer early treatment.

Objective: To understand the health literacy of the cancer prevention and treatment among urban residents of China, and explore the related factors. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The health literacy of the cancer prevention, early discovery, early diagnosis, early treatment and the demands of cancer prevention and treatment knowledge was analyzed. The level of health literacy among different groups were calculated and compared. The binary logistic regression model was used to analyze the influencing factors of the health literacy of the cancer prevention and treatment. Results: The level of health literacy of the cancer prevention and treatment was 56.97% among all study population; in each group it was 55.01% for community residents, 59.08% for cancer risk assessment/screening population, 61.99% for cancer patients and 57.31% for occupational population, respectively (P<0.001). The level of health literacy of the cancer prevention and treatment of residents aged 50 to 69 years old, other occupational groups, unmarried, the central and western region residents and the group with unclear self-assessment of cancer risk was significantly lower than that of residents younger than 40 years old, personnel of public institutions/civil servants, married, the eastern region residents and the group whose self-assessment without cancer risk (P<0.05) . The level of health literacy of cancer prevention and treatment of females, people who went to high school or over, cancer risk assessment/screening population, cancer patients and occupational population was significantly higher than that of males, people who had an education level of primary school or below and community residents (P<0.05) . Conclusion The health literacy of the cancer prevention and treatment of urban residents in China was relatively high, but there was still room for improvement. Gender, age, educational level, occupation, region, marital status, self-assessment of cancer risk, and type of respondents were the key influencing factors of the health literacy of the cancer prevention and treatment. Male, 50-69 years old, lower educational level, central and western regions, unclear cancer risk self-assessment, and without specific environmental exposure to cancer prevention and treatment knowledge or related risk factors were the characteristics of the key intervention group of the health literacy of the cancer prevention and treatment.

Objective: To investigate the demand and access to the cancer prevention and treatment knowledge and related factors among urban residents in China from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of general demographic characteristics, the demand and access to cancer prevention and treatment knowledge, and the influencing factors of the attitude. The Chi-square test was used to analyze the difference of the demand of the cancer prevention knowledge among different groups and the corresponding factors of the cancer prevention and treatment knowledge were analyzed by using the logistic regression model. Results: The proportion of residents who need the cancer prevention and treatment knowledge was 79.5%. The demand rate of the inducement, symptom and diagnosis methods of cancer in the occupational population was highest, about 66.8%, 71.0% and 20.8%, respectively. The demand rate of treatment methods and cost in current cancer patients was the highest, about the 45.9% and 21.9%, respectively. The top three sources to acquire the cancer prevention and treatment knowledge were "broadcast or television" (69.5%), "books, newspapers, posters or brochures" (44.7%) and "family and friends" (33.8%). The multivariate analysis showed that compared with public institution personnel/civil servants, unmarried/cohabiting/divorced/widowed and others, annual household income less than 20 000 CNY, from the eastern region, people without cancer diagnosis and people with self-assessment of cancer risk, the demand rate of cancer prevention and treatment knowledge was higher in enterprise personnel/workers, married, annual household income between 60 000 CNY and 150 000 CNY, from the central region, people with cancer and people with unclear cancer risk (all P values <0.05). Conclusion There was a high demand for the cancer prevention and treatment knowledge among urban residents in China from 2015 to 2017. The main access to the knowledge is from the radio or television. The occupation, marital status, annual household income, residential region, health status and risk of disease were the main factors of the demand of the cancer prevention and treatment knowledge.

OBJECTIVE: To evaluate the effectiveness of using artificial tears and eye exercise for intervention of dry eye disease in aircrew members. METHODS: A accidental sampling method was used and 86 patients diagnosed with dry eye disease were selected as study subjects. Artificial tears or artificial tears plus eye exercise were used in patients. Symptoms of dry eye disease were investigated. RESULTS: of break up time( BUT) and schirmer I test( SIT) were recorded.RESULTS: The main symptoms of these 86 aviators diagnosed with dry eye disease were visual fatigue( 82. 6%),dry feeling( 60. 5%),and itchy eyes( 29. 1%). Among them,28 patients( 32. 6%) were treated with artificial tears only( artificial tears group) and 58 patients( 67. 4%) were treated with artificial tears plus eye exercise( combined treatment group). The duration of treatment of less than 4 weeks,4-weeks,and 6-9 weeks were 25,36 and 25 cases,respectively.After treatment,the symptoms improved in 71 patients( 82. 6%). All patients of these two groups showed improved SIT and BUT compared with the same group before treatment( P < 0. 01). There was no significant difference in the change of SIT and BUT between the artificial tears group and the combined treatment group after treatment( P > 0. 05). There was statistical significance in the change of SIT in the main effect of treatment time( P < 0. 01),but no significant difference in the main effect of treatment measures and the interaction effect( P > 0. 05). There was no statistical significance in the change of BUT in the main effect of treatment measures,treatment time and the interaction effect( P > 0. 05).CONCLUSION: The intervention using artificial tears or artificial tears combined with eye exercise improved the subjective symptoms of dry eye disease in aircrew members. The SIT and BUT also improved after intervention.