Phương Pháp Nghiên Cứu Y học

Health Research Methodology

Phạm Văn Hậu

Ho Chi Minh City, 23/03/2023

No. Nội dung Số tiết
1 Tổng quan về phương pháp NCKH 5
2 Quy trình về nghiên cứu khoa học 5
3 Thiết kế nghiên cứu trong ngành KH sức khoẻ 10
4 Tổng quan tài liệu và cơ sở lý thuyết 2
5 Xây dựng đề cương nghiên cứu 3
6 Báo cáo kết quả và bài báo khoa học 5
1. Hiểu được khái niệm và ý nghĩa “báo cáo nghiên cứu”
2. Hiểu được khái niệm và ý nghĩa “bài báo khoa học”
3. Viết bản thảo để xuất bản bài báo trên tạp chí
4. Nắm được quy trình xuất bản bài báo

3
4
1. Một ấn phẩm báo cáo về kết quả của một dự án nghiên
cứu hoặc các quan sát khoa học về hoặc về một chủ đề
2. Báo cáo nghiên cứu được thực hiện bởi nhiều lĩnh vực
bao gồm công nghiệp, giáo dục
3. Có thể phổ biến trong nội bộ hoặc công khai (xuất bản,
thường không có sẵn từ các nhà bán sách hoặc thông qua
các kênh xuất bản thương mại tiêu chuẩn.
4. Phát hành bởi các tổ chức chính phủ, phi chính phủ và
quốc tế
5
1. Khóa luận tốt nghiệp đại học, luận văn cao học, luận án
tiến sĩ
2. Báo cáo tóm tắt nghiên cứu khoa học (hội nghị KH)
3. Báo cáo kết quả đề tài nghiên cứu khoa học
4. Theo mẫu / quy định của cơ quan quản lý – nhà tài trợ

6
8
9
1
• Chia sẻ kiến thức: Xây dựng hệ thống kiến thức nhân loại
• Cơ hội để hiểu hơn kinh nghiệm của mình. Ví dụ:
- Phân tích số liệu
- Bình duyệt
• Phát triển nghề nghiệp

1
• Scientific paper, paper, journal articles
• Nội dung khoa học
• Xuất bản trên trên tạp san khoa học

1
https://naturemicrobiologycommunity.nature.com/posts/43103-dear-editor 1
 Journal Editor Reviewers
Author submits screens manuscript and provide
manuscript sends to comments on
peer reviewers manuscript

1, 2, 3
Author addresses
Copy editing reviewer
comments

Author addresses
Copy Editor’s Layout Proof reading
comments

Publish

1
• Bài báo nguyên gốc (original papers)
• Bài báo nghiên cứu ngắn (short communications)
• Báo cáo trường hợp/loạt trường hợp (Case/case series reports)
• Bài tổng quan (Reviews)
• Bài xã luận (Editorials)
• Thư tòa soạn (Letters to the editor)
• Báo cáo tóm tăt (Abstracts)

1
• Dữ liệu của nghiên cứu chưa công bố trước đây
• Nghiên cứu đề ra ý tưởng mới hay cách diễn giải mới
• Nghiên cứu đề ra phương pháp mới để tiếp cận chủ đề cũ
• Quy trình bình duyệt chặt chẽ

1
1
• Short paper / short letter
• Số lượng từ ít, tùy vào tạp chí (~ 1000 từ)
• Nội dung tập trung vào 1 vấn đề hẹp hay phát hiện nhỏ
• Vẫn theo quy trình bình duyệt như original paper

1
1
• Nội dung xoay quanh 1 hay 1 số trường hợp đặt biệt
• Vẫn theo quy trình bình duyệt như original paper nhưng
nhẹ hơn

2
• Perspective paper
• Có thể là những tác giả uy tín được mời
• Tập trung vào chủ đề hẹp và đề ra hướng nghiên cứu cho
chuyên ngành
• Không hay có bình duyệt nhưng không chặt chẽ

2
• Bài bình luận một nội dung khoa học nào đó
• Không qua bình duyệt mà chỉ góp ý từ ban biên tập

2
• Phản hồi / phê bình cho bài báo được đăng trên tạp chí
• ~ 500 words, tùy từng tạp chí

2
• Bản tóm lượt (abstract) ~ 250 words
• Bài báo ngắn (proceeding paper)
• Không hay bình duyệt không chặt chẽ

2
2
2
• Tờ báo xuất bản định kỳ
• Mang thông tin khoa học đến đến giới khoa học
• Danh mục của index medicus:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC197854/pdf/mlab00192-0054.pdf

2
• I : Introduction
• M : Methods
• R : Results
• A : and
• D : Discussion

2
• Cơ sở nghiên cứu được tiến hành
• Lý do người đọc phải quan tâm đến nghiên cứu
1. Vấn đề chung là gì? Tình hình hiện nay ra sao?
2. Vấn đề cụ thể là gì ? Tình hình hiện nay ra sao và khoảng trống
trong y văn?
3. Công trình này đóng góp gì?

2
• Chi tiết phương pháp của nghiên cứu
• Cân đối giữa súc tích và đầy đủ
• Súc tích: kỹ thuật với chi tiết
• Đầy đủ: đọc và hiểu rõ phương pháp

3
• Ngắn gọn
• Đi thẳng vào phần mà Introduction đã dẫn nhập
• Phát hiện kết quả gì và trả lời câu hỏi đã nêu trong giới thiệu?
• Kết quả chính / phụ
• Trình bày bằng biểu đồ / bảng số liệu

3
Trình bày số liệu thống kê

Thống kê
Statistics
giống như
are like
bikini
bikinis. What.
Những gì để
they reveal is
lộ ra là gợi
suggestive
cảm, những , Prof. Aaron Levenstein
but what they
gì che giấu là
conceal
điều quan is
vital
trọng
32
• Không có cấu trúc cố định
• Giải thích số liệu phần kết quả và phát hiện chính là gì?
• Ý nghĩa của phát hiện này và bàn luận ý nghĩa này
• Ưu / khuyết của nghiên cứu
• So sánh với các nghiên cứu khác
• Cuối phần bàn luận là kết luận

3
3
1. Results
2. Methods
3. Discussion
4. Introduction
5. Abstract

3
• Nhận góp ý đồng nghiệp nội bộ trước khi gửi đăng
• Bình duyệt chung
• Bình duyệt chuyên môn

3
• Xác định tạp chí
- Chọn tạp chí với độc giả mà bạn muốn chia sẻ thông tin
- Theo các hướng dẫn của tạp chí dành cho tác giả
- https://jane.biosemantics.org/
• STROBE checklist (Báo cáo các nghiên cứu quan sát)

3
jane.biosemantics.org/
4
• Ít từ nhất và mô tả đầy đủ nội dung / mục đích bài báo

• Tiêu đề tốt:
1. Dự đoán nội dung của bài nghiên cứu
2. Gây hứng thú cho người đọc
3. Phản ánh phương pháp nghiên cứu
4. Chứa các từ khóa để giúp tìm kiếm bài báo

https://www.enago.com/academy/write-irresistible-research-paper-title/ 4
4
• Theo quy định của tạp chí

• Thông tin cần thiết để đọc giả quyết định đọc toàn văn

• Thông tin đủ để tiến hành nghiên cứu tương tự không

• Không có y đức

https://libguides.usc.edu/writingguide/abstract 4
• Sử dụng kiểu văn đơn giản và súc tích
- Tránh từ phức tạp
- Sử dụng câu ngắn
• Sử dụng các headings hay subheadings
- Phương pháp
- Kết quả

4
• Đoạn văn thường 3-7 câu
• Câu giới thiệu
• Các câu tiếp theo
• Câu kết của đoạn văn trước thường liên kết và bắt đầu ở
đoạn văn tiếp theo

4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040376/pdf/BLT.10.077982.pdf 4
• Độc giả là quốc gia / quốc tế
• Sử dụng ngôn ngữ phổ thông / quốc tế
• Trường hợp không có từ tương đương thì phải giải thích
từ địa phương khi dùng
- Phân cấp hành chính ở Malaysia: Country – states – district
(district ~ province)
- Aimag ở Mogolia tương đương với cấp tỉnh
4
• Biểu đồ, hình, bản đồ
• Thông tin trực quan và theo cách dễ hiểu hơn
• Thể hiện mô hình, xu hướng và so sánh dữ liệu
• Hình ảnh phải có tiêu đề và nhãn rõ ràng, được đánh số và
tham chiếu trong văn bản

4
• Công cụ hữu ích để trình bày dữ liệu và kết quả phân tích một
cách rõ ràng, có tổ chức và dễ hiểu
• Thay cho danh sách nhiều con số trong văn bản  người đọc
sẽ khó theo dõi
• Thông tin trình bày rõ ràng: Tiêu đề bảng, hàng, cột, đơn vị
• Hai hay 3 bảng tốt hơn bảng nhiều số liệu

5
• Tiêu đề của bảng: rõ ràng, ngắn gọn, miêu tả được số liệu gì,
ở đâu, khi nào, thông thường phải đánh số cho bảng
• Ghi chú hàng và cột: rõ ràng, ngắn gọn, đơn vị đo lường (năm,
tỷ lệ mắc/100.000 dân, tiền)
• Giải thích những chữ viết tắt, mã hóa, biểu tượng ở cuối bảng
• Ghi chú nguồn số liệu ở cuối bảng

5
• 3 - 4 số: Chữ
• Trên 4 số: Bảng số liệu

5
53
54
• Chỉ ra mô hình hoặc xu hướng của bệnh theo thời gian.
• Thông thường sử dụng đồ thị hình dây để biểu thị dãy số
liệu dài và so sánh một số dãy
350

300 305.79

250

200
Mắc/100.000

150 142.13
95.86 81.65
100
54.98
46.99 61.59
50 68.45
32.55 39.6
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Tỷ lệ mắc sốt xuất huyết ở Việt Nam, 1997-2006

• Chỉ ra mô hình hoặc xu hướng của bệnh theo thời gian.
• Thông thường sử dụng đồ thị hình dây để biểu thị dãy số
liệu dài và so sánh một số dãy
400
2011 2005-2010
300

200

100

0
Tuần 1 Tuần 2 Tuần 3 Tuần 4
• Dùng để so sánh số liệu với những biến số riêng rẽ
• Đồ thị hình cột đơn: được sử dụng để biểu thị số liệu từ
bảng 1 biến số 3
2.67

2.5

Mắcc/100.000 dân
1.5
1.28
1.2
0.97
1

0.5

Hà Nội Hải phòng Hải Dương Hà Tây

Tỷ lệ mắc viêm não vi rút theo tỉnh, 2006

• Trình bày số liệu từ bảng 2 hoặc nhiều biến số
• So sánh mức độ mắc bệnh của các loại khác nhau của 2
hoặc nhiều dãy số liệu
3500

Mắc/100.000 dân 3000

2500

2000 Miền Bắc

Miền Nam
1500

1000

500

0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Năm

Tỷ lệ mắc hội chứng cúm, miền Bắc và miền Nam, 1997-2006

So sánh tổng số và minh họa từng phân loại so với tổng số
h×nh 4: Sè m¾c Quai bÞ theo khu vùc, 1997-2006
Sè m¾c
45000

40000

35000

30000

25000

20000

15000

10000

5000

0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

MiÒn B¾c MiÒn Trung MiÒn Nam T©y Nguyªn

Số mắc quai bị theo khu vực, 1997-2006

• Biểu thị từng thành phần của 1 nhóm hoặc 1 biến số.
• Thường dùng tỷ lệ %.
• Độ lớn của mỗi phần tỷ lệ thuận với từng thành phần.
Tây Nguyên
Miền Bắc
0.5%
16.0%
Miền Trung
11.5%

Miền Nam
72.0%

Tỷ lệ mắc thương hàn theo khu vực. 2006

• Trình bày nơi xảy ra bệnh.
• Loại bản đồ:
‒ Bản đồ điểm
‒ Bản đồ màu phân bậc
Bản đồ mật độ điểm BN sởi khẳng định
phòng thí nghiệm, 2013

Chú thích:

1 BN
Bản đồ phân bậc
Tay chân miệng - 2011
Tỷ lệ tử vong / 1.000.000

http://www.biomedcentral.c
om/1471-2334/14/341
Xin trân trọng cảm ơn

Information for action

Thank You
and
Good Luck!

65
 Tips for tables
• Indicate when data are missing from the table either
by adding a row or column with the number of
missing values or explaining in a footnote to the table
• Include row and or column totals to help the reader
understand the table
• Check and recheck all numbers in tables
• Proof-read carefully for transcription errors
• Arithmetic errors may cast doubt on your results so
– Carefully check all arithmetic in table
– Check that rows and columns add up correctly
– Check that percentages correctly calculated
 Typical tables
• Some typical tables in epidemiological analysis include:
– Description of study population (e.g. frequency distribution of key
variables)
– Cross tabulations
– Results of multivariate analysis
 Exercise 1: How can this table be improved?

Table 1: Disease A, B and C by age

Age Disease A Disease B Disease C

0-5 427 49 222

6-11 1063 63 345

12-23 2347 245 863

24-35 1239 543 963

38-59 658 679 1235

 Exercise 1: Some suggestions for improvement

Table 1: Disease A, B and C by age

Title should specify exactly what is being reported (such as incidence or prevalence),
and provide information on time and place data (when, what and where)

Age Disease A Disease B Disease C

0-5 427 49 222

6-11 1063 63 345

12-23 2347 245 863

24-35 1239 543 963

38-59 658 679 1235

Total column would be useful

Might want to also include columns with percentages for each disease
 Exercise 2: How can this table be improved?
Reasons why people with severe illness did not seek medical care

Reason %

Too expensive (had no money) 29%

Too far away (no transport) 11%

Poor services 17%

Long wait 18%

Medical staff unfriendly and rude 19%

 Exercise 2: Some suggestions for improvement
Table 2: Reasons why people with severe illness did not seek medical care

Reason %

Too expensive (had no money) 29%

Too far away (no transport) 11%

Poor services 47%

Long wait 18%

Medical staff unfriendly and rude 19%

% Column adds up to more than 100%. Correct error or indicate why colum
does not sum to 100%
Include the total number of cases in the title
 Exercise 3: How can this table be improved?
Table 2: Demographic characteristics of study population
Variable N

Age <1 40
1-5 40
5-15 100
15+ 100
Sex Male 150
Female 149
Economic status of family Hi 30
Middle 80
Low 100
 Exercise 3: Suggestions for improvement?
Table 2: Demographic characteristics of study population
Include total number of cases in title

Variable N

Age <1 40
1-5 40
5-15 100
15+ 100
Sex Male 150
Female 149
Economic status of family Hi 30
Middle 80
Low 100
Insert rows with missing values
Graphs, charts, figures and maps
 Good design of graphs, figures, charts and maps*
• Show data clearly
• Induce reader to think about what the graphic is about rather than
how it is designed
• Avoid distorting the data
• If possible, show several levels of detail – this makes the graph
more interesting
• Keep unnecessary lines and information to a minimum
– Grids should be muted or suppressed so they do not compete with data
– Erase extraneous information and lines

*Adapted from The Visual Display of Quantitative Information by Edward Tufte

Exercise 1: What is wrong with this chart? How can it be
improved?
Exercise 1: Some suggestions for improvement

Delete 3rd dimension

Eliminate excessive design
Improved chart: Option 1
Improved chart: Option 2
Interpretation of results
 What do results mean?
• What did study find in answer to research questions?
• How good is evidence provided by the study?
– Variability and confidence intervals for estimates
– Strength and significance of association
– Consistency of findings
– Limitations and sources of error
• How do findings fit in with facts and findings from other studies?
• Does your study bring up issues for further investigation or new hypotheses?
• What are the public health policy implications?
 Consistency of findings
• Have findings been consistently observed?
– In different time periods?
– In different geographical areas?
– In different population sub-groups?
Example: More males than females found among adult reported dengue
cases in 6 Asian countries, every year over a period of 2-10 years, and
in almost all sub-regions. The fact that the results were so consistent
adds to the strength of study results
Note: An equally important finding was that male/female differences in
reported dengue cases aged 1-14 were small or non-existent in almost
all countries, making the findings more striking for the adult age
groups
 Bradford-Hill criteria
• Strength of relationship
• Consistency
• Coherence with other known facts
• Specificity (is outcome specific to subgroups studied?)
• Temporality (cause before outcome)
• Biological gradient (dose-response relationship)
• Biological plausibility
• Experiment (occasionally can do an experiment)
• Analogy (eg since we know that rubella is severe during
pregnancy, we might be more easily convinced that another
virus might be severe during pregnancy)

Bradford-Hill A, The environment and disease: Association or causation, Proceedings of the

Royal Society of Medicine 58(1965).
 Limitations and sources of error
• Are there any alternative explanations for your findings?

• Be skeptical – think of all possible study limitations and sources

of error besides random error (which is taken into
consideration by statistical tests)
 Selection Bias
• Study sample may not represent population of
interest
– Reported cases from health care providers may be biased
in favor of the rich or men compared to the poor or
women due to unequal access
– Case fatality rates based on health service facilities may be
biased towards severe cases since severe cases are most
likely to be reported
– Non response may bias sample, especially if responders
have different characteristics from non-responders
 Selection bias example
Antenatal clinic patients are often used to estimate HIV levels in the general population

Antenatal clinic patients had lower infection levels than in pregnant women in the
immediate surrounding area in a study of 12 sub-communities in Zimbabwe 1998-
2000.

The authors suggested that reason was that women from nearby rural areas also used
the clinic and these women had much lower levels of HIV infection

Gregson S, Terceira N et al. Study of bias in antenatal clinic HIV 1 surveillance data in a high
contraceptive prevalence population in sub-Saharan Africa. AIDS 2002, Vol 16 No 4
 Class discussion
• In your studies was selection bias possible or likely?
• How might this affect your results?
 Confounding
• Co-occurrence of several different factors
– At a wedding diner in the UK, contaminated liver parfait was served
on the same plate as salad, so that those who ate liver were also
more likely to eat salad
– Over time, the amount of alcohol consumed rose in similar pattern to
increase in priests. But this does not imply that there was a direct
relationship between alcohol consumption and number of priests.
Both were related to population growth
 Class discussion
• In your studies are there possible or likely confounding factors?
• How might they affect your results?
 Information bias
• Typical systematic measurement errors in a variable used for
analysis
– Recall bias
– Poor calibration of weighing scale
– Contamination in laboratory
– Interviewer influences responses in a survey
 Class discussion
• In your studies is information bias possible or likely for any of
your variables?
• What steps have you taken to reduce information bias?
• How may possible or likely information bias errors affect your
results?
Coherence with known facts and previous findings
• How do your study results fit in with known facts and findings
from other studies?
• Are there known facts that help to explain your results?
• Do previous studies have evidence to support or to refute your
results?
 Further issues and new hypotheses

• Does your study bring up issues for further investigation or

new hypotheses?
 Implications for public health policy
• What are the implications of your study for public health
policy?
 Methods

What methods were used to get the results

 Methods
• Describe what you did in the study
• Link to Results section
– Only describe the methods for how you got the results in your Results section
• Can use subheadings
– Can be same subheadings as results section e.g.
• Epidemiological investigation
• Environmental investigation
• Microbiological investigation
 Methods
Outline
• Study design
• Study site
– Brief description of location
• Study participants
– Describe how study participants were identified
• Data
– Source
– Case definition
– Variables
– Data cleaning - missing/incomplete data
• Analysis
– Computer programs
– Statistics used
• Ethics
– Provide details of ethics approval if required
– If ethics approval was not required, provide a statement why
 Methods: Example
Study design

A descriptive epidemiological study was conducted using data

from the national notifiable disease register.
 Methods: Example
Study sites

Two study sites were chosen. One site was Baganuur District, a district of Ulaanbaatar,
the capital of Mongolia, located 130 km east of the city centre with a population of 25
875. The other study site was Selenghe Province, located 300 km north of Ulaanbaatar
at the border to the Russian Federation with a population of 21 460. Age distribution
nationwide and at the two study sites were compatible. Each site has one hospital and
four family group practices (outpatient clinics), and all the residents receive free
medical care.

Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response Journal, 2011(1). doi:10.5365/wpsar.2010.1.1.004
 Methods: Example
Study participants

All the patients with ILI who visited these health care facilities as
well as patients who were hospitalized with a diagnosis of SARI
were enrolled in this study.

Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response
Journal, 2011(1). doi:10.5365/wpsar.2010.1.1.004
 Methods: Example
Data

Information on demographic characteristics; medical history, including

underlying medical conditions; influenza immunization status; clinical
course and treatment with antiviral medications was collected from every
case by using a standardized questionnaire. The government census data
in 2008 were used for estimating population-based proportion.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response Journal, 2011(1).

doi:10.5365/wpsar.2010.1.1.004
 Methods: Example
Data
The proportion of ICU/SCU admissions among hospitalized patients with pandemic A(H1N1) 2009 infection was
calculated. Univariate association of various factors were evaluated using descriptive statistical techniques. The
association between ICU/SCU admission and patient characteristics (age, sex, indigenous status, underlying medical
conditions and whether antiviral treatment was received) was evaluated using univariate logistic regression
followed by multivariate forward stepwise logistic regression test.

To assess the predictive value of various factors, the area under the receiver-operating characteristic (ROC) curves
was calculated. The ROC curve evaluates the ability of the full logistic regression model to discriminate patients
admitted to ICU/SCU from those with no ICU/SCU admission. The SPSS package (Version 12) was used for all
analyses.

Phung H et al. Surveillance of hospitalizations with pandemic A(H1N1) 2009 influenza infection in Queensland, Australia. Western Pacific Surveillance and Response Journal.
2011, 2(2). doi: 10.5365/wpsar.2010.1.1.013
 Methods: Example
Ethics

1:
The study was conducted primarily as part of a national public health programme, with
supplemental data obtained from a community seroprevalence study which had been approved by
the National Environment Agency Bioethics Review Committee (IRB 005.2) in 2007.
Ler et al. Epidemiological characteristics of the 2005 and 2007 dengue epidemics in Singapore - similarities and distinctions. Western Pacific Surveillance and Response Journal. 2011, 2(2).doi:
10.5365/wpsar.2010.1.1.011

2:
Ethical clearance was not required for this analysis. This analysis was conducted as a clinical audit
(during a public health emergency event), required under the Health Services Act (1991).
Phung H et al. Surveillance of hospitalizations with pandemic A(H1N1) 2009 influenza infection in Queensland, Australia. Western Pacific Surveillance and Response Journal. 2011, 2(2). doi:
10.5365/wpsar.2010.1.1.013
 Methods: Exercise
Manuscript outline
For your study identify the follow:
• Study design
• Study site
– Brief description of location
• Study participants
– Describe how study participants were identified
• Data
– Source
– Case definition
– Variables
– Data cleaning - missing/incomplete data
• Analysis
– Computer programs
– Statistics used
• Ethics
– Provide details of ethics approval if required
– If ethics approval was not required, provide a statement why
 Discussion

Interpretation of results
 Discussion
• Interpretation of your results
• Relate results to literature
– How do your results compare to other studies?
• Opportunity to highlight the strengths of your study, e.g.
– E.g. new findings, first study in Mongolia
• 4-6 paragraphs
• Include references
 Discussion
Outline
• Main finding
– Describe main finding
– Relate to literature
– Should be closely linked to your objectives
• Minor findings
– Describe minor findings
– Relate to literature
• Limitations
– Describe limitations
– Explain the possible affect of these limitations on your results
• Conclusion
– Restate your major finding/message
– Link to public health implications
– Future directions
 Discussion
1. Major finding
• Main finding
– Describe main finding
– Relate to literature
– Should be closely linked to your objectives
• Minor findings
– Describe minor findings
– Relate to literature
• Limitations
– Describe limitations
– Explain the possible affect of these limitations on your results
• Conclusion
– Restate your major finding/message
– Link to public health implications
– Future directions
 Discussion: Example
1. Major finding

In this study, we estimated ILI incidence in the 2008–2009 and 2009–2010

seasons and also characterized SARI cases. The highest ILI incidence was
seen in children younger than five years of age and the same was seen
among the influenza A(H1N1) positive SARI cases. Similar findings were
observed in another influenza epidemiological study.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response Journal, 2011(1).
doi:10.5365/wpsar.2010.1.1.004
 Discussion
2. Minor finding
• Main finding
– Describe main finding
– Relate to literature
– Should be closely linked to your objectives
• Minor findings
– Describe minor findings
– Relate to literature
• Limitations
– Describe limitations
– Explain the possible affect of these limitations on your results
• Conclusion
– Restate your major finding/message
– Link to public health implications
– Future directions
 Discussion
2. Minor finding

Pregnancy has been associated with increased hospitalization and severity of illness
due to pandemic A(H1N1) 2009 infection. In our study, 7% of hospitalized patients with
confirmed pandemic A(H1N1) 2009 infection were pregnant compared to the 1%
prevalence of pregnancy in the general population. Although a slightly higher
proportion of pregnant patients were admitted to ICU or SCU, this did not reach
statistical significance.

Phung H et al. Surveillance of hospitalizations with pandemic A(H1N1) 2009 influenza infection in Queensland, Australia. Western Pacific Surveillance and Response Journal.

2011, 2(2). doi: 10.5365/wpsar.2010.1.1.013

 Discussion:
3. Limitations
• Main finding
– Describe main finding
– Relate to literature
– Should be closely linked to your objectives
• Minor findings
– Describe minor findings
– Relate to literature
• Limitations
– Describe limitations
– Explain the possible affect of these limitations on your results
• Conclusion
– Restate your major finding/message
– Link to public health implications
– Future directions
 Discussion: Exercise
3. Limitations

There are several limitations in our study. Because of limited

laboratory capacity, especially during the pandemic period, we
could not collect samples for certain weeks from all the ILI and
SARI cases, which potentially led to an underestimation in the
analysis. Because we defined the influenza epidemic periods
from limited laboratory results and defined a cut-off point at
20% of influenza-positive proportion, we might have shortened
the influenza epidemic periods and in turn underestimated the
ILI cases. In spite of these limitations, the proportion of
specimens positive for influenza in our study were 17% in
Baganuur and 18% in Selenghe, which is compatible with other
studies showing 10%–19%.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and
Response Journal, 2011(1). doi:10.5365/wpsar.2010.1.1.004
 Discussion: Exercise
3. Limitations

• In this example, identify the following:

– Limitations
– Effect on the results
– Credibility of results statement
 Discussion: Exercise
3. Limitations
• LIMITATION: Because of limited laboratory capacity, especially during the pandemic period, we could
not collect samples for certain weeks from all the ILI and SARI cases,
– EFFECT: which potentially led to an underestimation in the analysis.

• LIMITATION: Because we defined the influenza epidemic periods from limited laboratory results and
defined a cut-off point at 20% of influenza-positive proportion,
– EFFECT: we might have shortened the influenza epidemic periods and in turn underestimated the ILI cases.

• CREDIBILITY STATEMENT: In spite of these limitations, the proportion of specimens positive for
influenza in our study were 17% in Baganuur and 18% in Selenghe, which is compatible with other
studies showing 10%–19%.
 Discussion:
4. Concluding paragraph
• Main finding
– Describe main finding
– Relate to literature
– Should be closely linked to your objectives
• Minor findings
– Describe minor findings
– Relate to literature
• Limitations
– Describe limitations
– Explain the possible affect of these limitations on your results
• Conclusion
– Restate your major finding/message
– Future directions
– Public health implications
 Discussion:
4. Concluding paragraph

• Emphasise your major finding or message

• Future directions
– Identify existing information gaps and suggest
areas for further research (be specific)
• Public health significance
– Implications
– Recommendations
 Discussion: Example
4. Concluding paragraph

Finally, there is growing evidence that early treatment with antiviral

medication may reduce the likelihood of hospitalization and death due to
pandemic A(H1N1) 2009 infection. Our study supports these findings.
Patients admitted to an ICU or SCU, or who died, were less likely to have
received antiviral therapy within 48 hours of the onset of symptoms
compared to other hospitalized patients. Early antiviral treatment for
influenza cases may therefore have important public health implications for
example for reducing the severity of the impact of pandemic A(H1N1) 2009
infection.

Phung H et al. Surveillance of hospitalizations with pandemic A(H1N1) 2009 influenza infection in Queensland, Australia. Western
Pacific Surveillance and Response Journal. 2011, 2(2). doi: 10.5365/wpsar.2010.1.1.013
 Discussion: Exercise
4. Concluding paragraph

We observed the highest incidence of ILI among children, especially children under
five years of age; the highest proportion of SARI was also observed in this age group.
Other infections such as respiratory syncytial virus and rhinovirus can also cause ILI in
this age group, so it is necessary to examine other pathogens with influenza-negative
samples for more clear disease burden estimation. We believe our findings can lead to
awareness among parents who have young children with high potential to be affected
with influenza infection. This awareness will encourage individuals in Mongolia to
adopt non-pharmaceutical interventions (e.g. hand hygiene) during the influenza
epidemic period. However, to reveal a more accurate disease burden of influenza in
Mongolia and to develop intervention strategies such as a vaccination programme,
further studies in urban areas and with more severe patients are necessary to observe
the severity of influenza infection.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and
Response Journal, 2011(1). doi:10.5365/wpsar.2010.1.1.004
 Discussion: Exercise
4. Concluding paragraph

• In this example, identify the following:

– Main finding or message
– Public health significance
– Future directions
 Discussion: Exercise
4. Concluding paragraph
MAIN FINDING:
• We observed the highest incidence of ILI among children, especially children under five years
of age; the highest proportion of SARI was also observed in this age group.

FUTURE DIRECTIONS:
• Other infections such as respiratory syncytial virus and rhinovirus can also cause ILI in this age
group, so it is necessary to examine other pathogens with influenza-negative samples for
more clear disease burden estimation.

PUBLIC HEALTH SIGNIFICANCE:

• We believe our findings can lead to awareness among parents who have young children with
high potential to be affected with influenza infection. This awareness will encourage
individuals in Mongolia to adopt non-pharmaceutical interventions (e.g. hand hygiene) during
the influenza epidemic period.

FUTURE DIRECTIONS:
• However, to reveal a more accurate disease burden of influenza in Mongolia and to develop
intervention strategies such as a vaccination programme, further studies in urban areas and
with more severe patients are necessary to observe the severity of influenza infection.
 Discussion: Exercise
Manuscript outline
• For your study identify the following:

• Main finding
– Describe main finding
– Relate to literature
– Should be closely linked to your study objective
• Minor findings
– Describe minor findings
– Relate to literature
• Limitations
– Describe limitations
– Explain the possible affect of these limitations on your results
• Conclusion
– Restate your major finding/message
– Future directions
– Public health implications
 Discussion: Group discussion
Manuscript outline

• Discuss the following for your study:

– Main finding
– Minor findings
– Limitations
– Public health significance
 Introduction

Context and need for your study

 Introduction
• Introduces the topic
• Provides justification for doing the study
• 2-4 paragraphs
 Introduction:
Outline
1. General situation
– Brief description of disease
– Brief description of relevant epidemiological characteristics of disease

2. Specific context
– Brief description of disease in the context of your study (e.g. Mongolia)

3. Gap in knowledge
– Briefly describe the gap in knowledge
– Why was it necessary to undertake the study

4. Objective of the study

– Include brief description of study
 Introduction: Example
1. General Situation: influenza

Influenza is a common vaccine-preventable viral

infection that is characterized by a sudden onset of
fever, headache, myalgia, malaise, non-productive
cough, sore throat and rhinitis. Influenza can cause
severe disease or death in the very young, the elderly
and people with underlying medical conditions.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and
Response Journal, 2011(1). doi:10.5365/wpsar.2010.1.1.004
 Introduction: Example
2. Specific context: influenza epidemiology and disease burden

In developed countries with temperate climates, annual seasonal

epidemics usually occur in winter or early spring and often result in
dramatic increases in cases, hospitalizations and deaths. The methods
used to estimate disease burden, especially mortality impact, have been
well established in developed countries and several such study results
have been published.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response Journal, 2011(1).
doi:10.5365/wpsar.2010.1.1.004
 Introduction: Example
3. Gap in knowledge

On the other hand, much less is known about the burden of influenza in
developing countries. Monitoring the incidence and clinical characteristics
of influenza and hospitalization due to influenza is critical in understanding
the influenza disease burden in the population and guiding prevention and
control strategies.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response Journal, 2011(1).
doi:10.5365/wpsar.2010.1.1.004
 Introduction: Example
4. Objective

We performed prospective data and sample collection from

patients who visited outpatient clinics with influenza-like illness
(ILI) and hospitalized patients with severe acute respiratory
infections (SARI) to define the epidemiology and disease burden
of influenza in Mongolia.
Nukiwa N et. al. Evaluating influenza disease burden during the 2008-2009 and 2009-2010 influenza seasons in Mongolia. Western Pacific Surveillance and Response
Journal, 2011(1). doi:10.5365/wpsar.2010.1.1.004
 Introduction: Exercise
Manuscript outline
For your study identify the following:

1. General situation
– Brief description of disease
– Brief description of relevant epidemiological characteristics of disease

2. Specific context
– Brief description of disease in the context of your study (e.g. Mongolia)

3. Gap in knowledge
– Briefly describe the gap in knowledge
– Why was it necessary to undertake the study

4. Objective of the study

– Include brief description of study
 Introduction: Group discussion
Manuscript outline

• Discuss the following for your study:

– General situation
– Specific context
– Gap in knowledge
– Objective
Preparing your manuscript for submission

Abstract, title, authorship, references, title page

 Abstract

You paper in a nutshell!

 Abstract
• Most important part of your paper!
– May be used by journal editors for screening
– Many readers decide if they want to read the entire article based on the abstract
– So it should be well written and interesting
• Concise summary of your paper
– Should accurately reflect your paper
– Do not include information not mentioned in your manuscript
• Focus on main results/message
• Write after you have finished the manuscript
 Abstract
• At minimum, you should include the following:
– Objective
– Study type
– Main result
– Conclusion
• Keep to the word limit (usually about 250 words)
Title
 Title: Examples
Descriptive

Epidemiological characteristics of the 2005 and 2007 dengue epidemics in

Singapore – similarities and distinctions
Ler et al. Epidemiological characteristics of the 2005 and 2007 dengue epidemics in Singapore - similarities and distinctions. Western Pacific Surveillance and Response
Journal. 2011, 2(2). doi: 10.5365/wpsar.2010.1.1.011

Malaria among patients and aid workers consulting a primary healthcare

centre in Leogane, Haiti, November 2010 to February 2011 – a prospective
observational study
Neuberger A, Zaulan O, Tenenboim S, Vernet S, Pex R, Held K, Urman M, Garpenfeldt K, Schwartz E. Malaria among patients and aid workers consulting a primary healthcare
centre in Leogane, Haiti, November 2010 to February 2011 – a prospective observational study. Euro Surveill. 2011;16(13):pii=19829. Available online:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19829
 Title: Examples
Main finding

Outbreak of hand, foot and mouth disease caused by Coxsackie A16 virus
in a childcare centre in Croatia, February to March 2011
Ljubin-Sternak S, Slavic-Vrzic V, Vilibić-Čavlek T, Aleraj B, Gjenero-Margan I. Outbreak of hand, foot and mouth disease caused by Coxsackie A16 virus in a childcare centre in
Croatia, February to March 2011 . Euro Surveill. 2011;16(21):pii=19875. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19875

Yersinia enterocolitica O:9 infections associated with bagged salad mix in

Norway, February to April 2011
MacDonald E, Heier BT, Stalheim T, Cudjoe KS, Skjerdal T, Wester A, Lindstedt BA, Vold L. Yersinia enterocolitica O:9 infections associated with bagged salad mix in Norway,
February to April 2011. Euro Surveill. 2011;16(19):pii=19866. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19866
Authorship
 Authorship
• Should be discussed at the beginning of the study
– Who should be an author?
– What order for the authors?
– Who should be the corresponding author?
• Responsible for corresponding with journal and after publication, responsible
for answering questions about the paper.
 Authorship
International Committee of Medical Journal Editors:
• Authorship credit should be based on
– 1) substantial contributions to conception and design, acquisition of data, or analysis and
interpretation of data;
– 2) drafting the article or revising it critically for important intellectual content; and
– 3) final approval of the version to be published.

• Authors should meet conditions 1, 2, and 3. Other contributors can be included in

the acknowledgements
References
 References
• Need to provide an in-text citation when referring to another
person’s work
• Provide full details of the reference in bibliography at the end
of the manuscript
• For examples see:
http://www.nlm.nih.gov/bsd/uniform_requirements.html
 References
Refer to instructions to authors for correct in-text citation
format. Examples include:
– This is consistent with a previous study (1).
– This is consistent with a previous study.1
– This is consistent with a previous study (Field et al, 2009).
 References
In text citations should be placed in the sentence where the
material is referenced e.g:
In the last decade, dengue transmission has extended its reach into
places as far north as Nepal,4 Ningbo in China5 and France,6 and as far
south as Bueno Aires in Argentina.7

Ng LC. Challenges in dengue surveillance and control. Western Pacific Surveillance and Response Journal. 2011, 2(2). doi:10.5365/wpsar.2011.2.2.001
 Title page
• Include a title page with your manuscript with the following:
– Title
– Authors and affiliations
– Contact information of corresponding author
– Funding for the study
– Running title
– Word counts (for abstract and for text)
– Number of figures and tables
– Conflicts of interest

http://www.icmje.org/manuscript_1prepare.html
 Proof reading
• Proof read your manuscript before submission
• Fix typographical and grammatical errors
• Figures and tables
– Ensure all numbers are correct
– Ensure the table/figure number matches the in text citation
• References
– Ensure in text citation matches the bibliography
 Peer review
• Peer reviewers will:
– Highlight errors
– Suggest changes to the manuscript
• E.g. additional analyses required
• E.g. additional discussion points required
• Document your responses to each reviewer comment
– Provide the detail of what changes you have made to the manuscript
– If you disagree with the reviewer and do not make a change, provide justification
 Peer review: Example
Reviewer comment:
– In the discussion you mention that there is a difference in the rate of
infection in urban and rural areas. Statistical tests should be carried
out to determine if the difference is significant.
Author reply:
– Statistical tests were carried out as indicated in paragraph 4 of the
methods and table 1 of the results.
 Advice for successful publication
• Read articles from your target journal
– Is your manuscript similar in format?
– Does your manuscript on a similar topic?

• Ensure your manuscript is within the scope of the journal your are
submitting to

• Follow the ‘Instructions to authors’ for your target journal

Thank You
and
Good Luck!

152
1