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MC LC

Phng php nghin cu khoa hc ................................................................................................. 1


Mc tiu: ..................................................................................................................................... 1
Nghin cu khoa hc l g: ......................................................................................................... 1
Cc c im ca mt nghin cu khoa hc tt ......................................................................... 1
i cng v thng k v thng k m t ....................................................................................... 3
Mt s nh ngha ........................................................................................................................ 3
Bin s v cc loi bin s .......................................................................................................... 3
Phng php m t tm tt v trnh by s liu .......................................................................... 3
Cc s thng k m t ................................................................................................................. 4
Phng php trnh by s liu ..................................................................................................... 6
i cng v phn tch s liu ...................................................................................................... 14
Suy lun thng k ...................................................................................................................... 15
Xc nh v chn u tin nghin cu ............................................................................................ 28
Mc tiu .................................................................................................................................... 28
Xc nh vn ......................................................................................................................... 28
Tiu chun chn u tin cho vn nghin cu ....................................................................... 28
Thang im nh gi cc ch nghin cu ............................................................................ 29
Bng im ................................................................................................................................. 30
Phng php phn tch v khng nh vn nghin cu ............................................................ 31
Mc tiu .................................................................................................................................... 31
Phn tch vn ........................................................................................................................ 31
Cc bc phn tch vn ................................................................................................... 31
Xc nh phm vi v trng tm ca nghin cu ........................................................................ 34
Xy dng phn t vn ......................................................................................................... 35
Cc thng tin cn thit trong phn t vn ........................................................................... 35
Tng quan y vn ............................................................................................................................ 36
Mc tiu ................................................................................................................................... 36
Ti sao cn phi tham kho y vn khi chun b cng nghin cu ...................................... 36
Nhng ngun thng tin c th tham kho ................................................................................. 36
Cch vit phn tng quan .......................................................................................................... 37
Sai lch c th ........................................................................................................................... 37
Mc tiu nghin cu ...................................................................................................................... 39
Mc tiu hc tp: ....................................................................................................................... 39
Mc tiu nghin cu l g: ........................................................................................................ 39
Ti sao phi xy dng mc tiu nghin cu .............................................................................. 39
Yu cu ca mc tiu nghin cu ............................................................................................. 39
Gi thuyt nghin cu ............................................................................................................... 40
Tn ti nghin cu ................................................................................................................ 40
Tho lun nhm ......................................................................................................................... 40
Gii thiu v phng php nghin cu khoa hc y hc ................................................................ 41
i
Mc tiu .................................................................................................................................... 41
Gii thiu ................................................................................................................................... 41
Bin s ........................................................................................................................................... 43
Mc tiu .................................................................................................................................... 43
Bin s ....................................................................................................................................... 43
Bin s nh tnh v bin s nh lng .................................................................................... 43
nh ngha c th ...................................................................................................................... 44
Bin s c lp - ph thuc - gy nhiu .................................................................................... 45
Kim sot yu t gy nhiu ....................................................................................................... 45
Bin s nn (background variables) .......................................................................................... 46
Cc loi nghin cu ....................................................................................................................... 50
Mc tiu .................................................................................................................................... 50
M u ...................................................................................................................................... 50
Mt s loi nghin cu .............................................................................................................. 50
Nghin cu khng can thip ..................................................................................................... 50
Nghin cu can thip ................................................................................................................ 54
Tnh gi tr v tnh tin cy ca kt qu nghin cu ................................................................... 55
Cc s o dch t hc .................................................................................................................... 56
I. M u: .................................................................................................................................. 56
II. S o tuyt i v s o tng i ....................................................................................... 56
III. T s, t l, t sut ................................................................................................................. 56
IV. S o dch t ....................................................................................................................... 57
S o hu qu v s o tc ng ................................................................................................... 59
I. Nhc li v s o s xut hin ca bnh: t sut, nguy c v s chnh ................................. 59
II. S o s kt hp - s o hu qu .......................................................................................... 59
III. S o t s ............................................................................................................................ 59
IV. S o hiu s ....................................................................................................................... 61
V. Bin lun thm v t s nguy c v hiu s nguy c ............................................................ 62
VI. S o tc ng ..................................................................................................................... 63
VII. Bn lun thm v phn s nguy c quy trch dn s ......................................................... 65
Phng php thu thp s liu ........................................................................................................ 66
S dng thng tin sn c ........................................................................................................... 66
Quan st ..................................................................................................................................... 66
Phng vn mt i mt v b cu hi t in ........................................................................... 67
Thit k b cu hi .................................................................................................................... 67
Ly mu iu tra ............................................................................................................................ 71
Mc tiu: ................................................................................................................................... 71
i cng v phng php ly mu: ........................................................................................ 71
Cc phng php ly mu xc sut: .......................................................................................... 72
Cch tnh c mu ........................................................................................................................... 79
Mc tiu .................................................................................................................................... 79
Gii thiu ................................................................................................................................... 79
ii
Hai cch tip cn trong tnh c mu .......................................................................................... 79
Cc im cn lu trong tnh c mu ...................................................................................... 81
Tnh c mu bng phn mm Epi Info: ..................................................................................... 81
Th d ........................................................................................................................................ 83
Chin lc phn tch s liu .......................................................................................................... 84
Ci t chng trnh Stata 8.0 v s liu mu .............................................................................. 90
Khi ng v kt thc Stata ......................................................................................................... 93
M t ngn gn v Stata ................................................................................................................ 97
Lnh more ..................................................................................................................................... 99
Thng bo li v m phn hi ..................................................................................................... 100
Phm break .................................................................................................................................. 102
S dng bn phm trong Stata ..................................................................................................... 103
Khi ng Stata .......................................................................................................................... 105
1. Khi ng Stata ................................................................................................................... 105
2. M t giao din ca chng trnh Stata .............................................................................. 105
3. Cch cch thc hin lnh trong chng trnh Stata ........................................................ 106
4. Lu li kt qu phn tch .................................................................................................... 106
M t s liu vi Stata 8.0 for Windows ..................................................................................... 109
Thng k phn tch bin s nh lng vi Stata ....................................................................... 143
Thc hnh ................................................................................................................................ 145
iii
Phng php nghin cu khoa hc
Mc tiu:
- M t c cc c tnh ca mt nghin cu khoa hc
- Trnh by c cc c tnh ca mt nghin cu khoa hc tt
Nghin cu khoa hc l g:
Nghin cu l cng vic tm kim mt cch c h thng cc kin thc mi, da trn s t m v
nhu cu c cm nhn.
1
Nh vy c im ca nghin cu l tm ra kin thc mi. C hai phng php chnh tm
kim kin thc: hoc l xem xt cc ti liu, kin thc sn c tm ra cc kin thc mi
(scholarship) hay da vo thc t khch quan pht hin cc kin thc v hiu bit mi
(scientific research). Phng php da vo thc t khch quan tm ti cc kin thc mi c
gi l nghin cu khoa hc.
2
Nghin cu khoa hc l vic thu thp, phn tch v l gii s liu gii quyt mt vn hay
tr li mt cu hi (Theo Varkevisser v cng s, 1991).
Ni cch khc, nghin cu khoa hc phi bao gm cc bc thu thp s liu trn thc a (hay
t cc ca bnh trong bnh vin hay phng th nghim), phn tch s liu c thng tin v
v trnh by cc thng tin ny trong phn kt qu v trong phn bn lun v kin ngh, l
gii cc thng tin tr li cho cu hi nghin cu hay xut cc bin php gii quyt
vn .
S liu: Kt qu ca vic thu thp c h thng cc i lng v c tnh ca cc i tng
Thng tin: S liu c phn tch
Kin thc: thng tin c l gii v c s dng tr li cu hi hay gii quyt mt vn
no
Nhng qu trnh thu thp, phn tch v l gii s liu din ra tt p v gii quyt c vn
nghin cu, trc nh nghin cu phi phn tch t vn , xem nhng kin thc g bit v
cn cha bit v vn . Qu trnh ny c gi l t vn , tng quan y vn. Sau nh
nghin cu phi xc nh hi c c kin thc cn cha bit , cn nhng thng tin g v
c nhng thng tin ny cn thu thp nhng i lng v tnh cht no ca i tng. y l
ni dung ca phn phng php nghin cu trong cng nghin cu hay bo co khoa hc.
Sau khi thu thp c s liu (i lng hay tnh cht ca cc i tng nghin cu), kt qu
ca phn tch s liu (thng tin) c trnh by trong phn kt qu nghin cu. phn bn lun,
tc gi s nh gi xem cc thng tin c tr li c cu hi nghin cu hay khng v cu tr li
ca cu hi nghin cu chnh nhm gip gii quyt vn nghin cu l kin thc mi c to
ra.
Nh vy, mt bo co khoa hc s gm cc phn chnh: 1) t vn v mc tiu nghin cu 2)
Tng quan ti liu 3) Phng php v i tng 4) Kt qu nghin cu 5) Bn lun v 6) Kt
lun.
Cc c im ca mt nghin cu khoa hc tt
Mt nghin cu khoa hc tt c cc c im sau:
1
Last JM. A dictionary of Epidemiology. NewYork: International epidemiology association
1997; 146
2
Varkevisser C, Pathmanathan I, Brownlee A. Designing and conductiong health system
research projects. IDRC, Ottawa 1991
1
- Phi tp trung vo cc vn u tin trong chm sc y t
- Phi c tnh nh hng vo hnh ng v ra cc gii php
- Phi c tnh thi s: kt qu phi c kp thi a ra cc quyt nh ng n.
- Thit k nghin cu n gin v thc hin trong thi gian ngn
- Nn c tnh cht chi ph - hiu qu. Tt nht nu nghin cu c tin hnh vi chi ph
thp v do cc nhn vin, cn b y t thc hin cng vi cng vic hng ngy.
- Kt qu phi c trnh by theo hnh thc hu dng cho cc nh qun l, nh hoch
nh chnh sch v cng ng: Cn c tm tt nhng kt qu ch yu ca nghin cu v
nu bt nhng im l th cho i tng ca bn bo co. Da theo kt qu c th trnh
by gii php gii quyt mt vn v so snh u khuyt im ca vic tin hnh gii
php v khng tin hnh gii php.
- Nghin cu cn phi c nh gi khng ch da vo s cc bi bo c xut bn m
cn phi xem xt s nh hng ca n n chnh sch y t hay thay i cung cch phc
v v cui cng l tc ng ln sc kho ngi dn.
i vi nghin cu y t cng cng cn phi t them hai c im sau:
- S tt hn nu c s tham gia ca nhiu ngnh, nhiu khoa
- Nghin cu cn c tnh cht tham gia ca mi thnh vin c lin quan trong tt c cc
bc ca qu trnh tin hnh nghin cu
2
i cng v thng k v thng k m t
Mt s nh ngha
Thng k l phng php khoa hc dng thu thp, tm tt, trnh by v phn tch s liu.
S liu: Kt qu c c do vic quan st hay thu thp mt bin s cc i tng khc nhau
hay thi gian khc nhau.
Th d: Khi ti quan st gii tnh ca cc hc vin trong lp, ti c s liu l:
Nam, nam, n, n, n, nam, n, v.v
Th d: Mt nh nghin cu o nng hemoglobin ca 70 thai ph c kt qu nh sau:
10.2 13.7 10.4 14.9 11.5 12.0 11.0
13.3 12.9 12.1 9.4 13.2 10.8 11.7
10.6 10.5 13.7 11.8 14.1 10.3 13.6
12.1 12.9 11.4 12.7 10.6 11.4 11.9
9.3 13.5 14.6 11.2 11.7 10.9 10.4
12.0 12.9 11.1 8.8 10.2 11.6 12.5
13.4 12.1 10.9 11.3 14.7 10.8 13.3
11.9 11.4 12.5 13.0 11.6 13.1 9.7
11.2 15.1 10.7 12.9 13.4 12.3 11.0
14.6 11.1 13.5 10.9 13.1 11.8 12.2
v nhng con s ny c gi l s liu.
Cn lu s liu phi lin kt vi mt bin s nht nh. Nu ti quan st gii tnh ngi ny,
tui ca ngi khc, qun o ca mt ngi khc na th kt qu quan st c khng phi l s
liu.
Bin s v cc loi bin s
Bin s l nhng i lng hay nhng c tnh c th thay i t ngi ny sang ngi khc
hay t thi im ny sang thi im khc.
Nh vy bin s c th th hin i lng hay c tnh.
- Nu bin s th hin mt i lng n c gi l bin s nh lng (quantitative
variable). Bin s nh lng c th cn c chia thnh bin s t s - ratio variable(c gi tr
khng tuyt i) v bin s khong interval variable (khng c gi tr khng tuyt )
- Nu bin s nhm th hin mt c tnh, bin s c gi l bin s nh tnh. Bin s
nh tnh cn c chia lm 3 loi:
- Bin s nh gi binary variable (khi ch c 2 gi tr)
- Bin s danh nh nominal variable (khi c 3 hay nhiu hn cc gi tr v cc
bn thn cc gi tr khng c tnh cht th t)
- Bin s th t - ordinal variable (khi c 3 hay nhiu hn cc gi tr v cc bn
thn cc gi tr c tnh cht th t
- Ngoi ra c khi bin c khng ch c quan tm v phng din n c xy ra hay
cha xy ra m cn c quan tm v phng din bin c xy ra vo lc no. Th d sau khi
iu tr bnh nhn ung th chng ta khng ch quan tm bnh nhn c t vong hay khng m
cn quan tm bnh nhn bnh nhn t vong bao nhiu lu sau khi iu tr v nu bnh nhn cha
t vong, bnh nhn sng c bao lu.
Phng php m t tm tt v trnh by s liu
3
-T l cho tng gi tr nu
l bin th t hay danh
nh
- T l cho gi tr tiu biu
nu l bin nh gi
-T l cho tng gi tr nu
l bin th t hay danh
nh
- T l cho gi tr tiu biu
nu l bin nh gi
Cc s thng k m t
C hai loi thng k m t: thng k m t khuynh hng tp trung v thng k m t tnh phn
tn.
Thng k m t khuynh hng tp trung
Thng k m t khuynh hng tp trung c th l trung bnh (mean), trung v (median) v yu v
(mode). Nhng thng k ny cho bit gi tr tiu biu cho s liu.
Th d: c hai loi thuc h p A v B. Gi s c 5 i tng sau khi s dng thuc h p A s c huyt p
110 - 115 -120 - 125 -130 v 5 i tng khc sau khi s dng thuc h p B s c huyt p 120 - 125 -
130 - 135 - 140. Con s tiu biu nht cho bit tc dng ca thuc A l huyt p trung bnh sau khi s
dng thuc A v l 120. Con s huyt p trung bnh ny thp hn huyt p trung bnh sau khi s dng
thuc B cho bit thuc A c tc dng mnh hn.
Trung bnh ca s liu, c k hiu l (x (c l x gch) l tng cc gi tr ca s liu chia cho
s ln quan st (N).
N
x
x
i

Th d: S liu v huyt p tm thu ca 5 i tng l 120, 125, 130, 135, 150. Huyt p tm thu
trung bnh s l 132
132
5
150 125 130 125 120

+ + + +

N
x
x
i
Do khng th thc hin cc php ton s hc trn cc bin s nh tnh (danh nh v th t)
chng ta ch c th tnh trung bnh cho s liu ca bin s nh lng.
Nu chng ta sp xp s liu theo th t, gi tr ng gia c gi l trung v. Nu c hai gi
tr cng ng gia, trung bnh cng ca hai gi tr ny l trung v.
4
Th d: S liu v huyt p tm thu (mmHg) ca 5 i tng l 120, 125, 130, 135, 150. Trung v
ca huyt p tm thu l gi tr ng gia v bng 130
S liu v chiu cao (cm) ca 6 ngi l 153, 155, 160, 162, 165, 161. tnh trung v, trc tin
chng ta phi sp xp s liu ny: 153, 155, 160, 161, 162, 165. Do c hai gi tr 160 v 161 cng
gia, trung v s l (160+161)/2 = 160,5 cm
Do bn cht ca bin s danh nh khng th sp c theo th t, chng ta ch c th tnh
trung v ca s liu nh lng v s liu ca bin s th t.
Ngoi ra yu v (mode) cng c s dng lm con s thng k tiu biu. Yu v l gi tr xut
hin ph bin nht (c tn sut cao nht).
Th d: S liu v huyt p tm thu (mmHg) ca 5 i tng l 120, 125, 130, 135, 150. Trong
trng hp ny khng c yu v.
im s ca 5 hc sinh l 5, 5, 6, 7, 9. Yu v ca im s l 5.
Trong mt p c 361 gia nh ngi Kinh, 120 gia nh ngi Khmer v 27 gia nh ngi Hoa.
Yu v ca bin s dn tc l dn tc Kinh.
Trong mt s liu c th, c th khng c yu v, c th c mt yu v hoc hai hay nhiu yu v.
y l khuyt im chnh ca s thng k ny. Do vy ngi ta thng ch dng yu v cho bin
s danh nh hay trong cc trng hp c bit
C th s dng trung bnh, trung v hay yu v cho bin s nh lng. Khi bin s nh lng
c phn phi bnh thng (hnh chung) th ba con s ny xp x bng nhau v khi ngi ta
thng tnh trung bnh bi v trung bnh c nhng c tnh ton hc mnh. Tuy nhin nu s liu
b lch th con s trung v phn nh gi tr tiu biu mt cch chnh xc hn.
Th d: Bnh nhn b lot d dy - t trng c iu tr theo mt phc dit vi khun
Helicobacter. Sau iu tr, bnh nhn c theo di v ghi nhn thi gian k t khi s dng thuc
n lc bt u ci thin triu chng au. 10 bnh nhn thi gian ny (ngy ) l nh sau: 1, 2, 2,
2, 2, 2, 3, 3, 3, 30. Bnh nhn c thi gian t lc iu tr n lc gim triu chng l 30 ngy trn
thc cht l bnh nhn khng p ng vi iu tr. Trung v v trung bnh ca s liu l 2 v 5
ngy. Con s trung v phn nh chn thc hn bi v vi t cch l mt bc s lm sng t s liu
trn c th nhn xt rng mt bnh nhn tiu biu s gim au sau 2 ngy dng thuc. Con ss 30
trong th d trn c gi l s ngoi lai (outlier) v lm s liu b lch. Nhn chung, khi s liu b
lch th con s trung bnh s b nh hng rt nhiu v khng phn nh gi tr tiu biu nh con
s trung v.
Thng k m t tnh phn tn:
C 3 thng k m t tnh phn tn: lch chun, khong t phn v v phm vi ca s liu.
Vic la chn thng k m t tnh phn tn c trnh by trong bng 2.
Thng k m t tnh phn tn c tm quan trng th hai sau con s m t khuynh hng tp
trung.
Th d: Thuc h p A c s dng trn 5 bnh nhn v huyt p tm thu sau khi dng thuc l 110, 115,
120, 125 v 130. Thuc h p B c s dng trn 5 bnh nhn v c huyt p sau s dng thuc l 100,
110, 120, 130, 140. Nh vy hai thuc h p ny c hiu qu h p l tng ng (bi v trung bnh ca
hai s liu l bng nhau) nhng kt qu ca thuc B phn tn hn v iu ny lm thuc B tr nn km an
ton.
lch chun (standard deviation - vit tt l SD hay s) l con s nh gi mc phn tn v
c tnh theo cng thc:
Nh vy lch chun phn nh khong cch trung bnh ca s liu so vi
gi tr tiu biu. Khi nim lch chun ch c th p dng cho bin s nh lng bi v
chng ta c th thc hin cc php ton s hc trn cc i lng nhng khng th thc hin
trn cc gi tr ca bin s nh tnh l cc c tnh.
Th d: S liu v huyt p tm thu (mmHg) ca 5 i tng l 120, 125, 130, 135, 150. Trung bnh ca
huyt p l 132 v lch chun bng

n
i
i
N
x x
s
1
2
1
) (
5
5 , 11 5 , 132
4
530
4
324 9 4 49 144
1 5
) 132 150 ( ) 132 135 ( ) 130 132 ( ) 132 125 ( ) 132 120 (
1
) (
2 2 2 2 2
1
2

+ + + +

+ + + +

n
i
i
N
x x
s
Phng sai v mt t nguyn l bnh phng ca lch chun. Phng sai (variance) c th
c k hiu v Var hay s
2
v c tnh theo cng thc sau:

n
i
i
N
x x
s
1
2
2
1
) (
Phm vi ca s liu l tt c cc gi tr ca s liu t gi tr nh nht n gi tr ln nht.
Th d: S liu v huyt p tm thu (mmHg) ca 5 i tng l 120, 125, 130, 135, 150. Phm vi ca bin
s huyt p l 120 n 150.
Th d: Thuc h p A c s dng trn 5 bnh nhn v huyt p tm thu sau khi dng thuc l 110, 115,
120, 125 v 130. Thuc h p B c s dng trn 5 bnh nhn v c huyt p sau s dng thuc l 100,
110, 120, 130, 140. S liu ca thuc B c tnh phn tn cao hn do phm vi thay i t 100-140 trong khi
phm v ca s liu thuc A ch t 110-130.
Khong t phn v (inter-quartile): Nu chng ta chia s liu sp theo th t lm 2 phn u
nhau, khong t phn v l khong cch ca trung v phn trn v trung v phn di.
Th d: S liu v huyt p tm thu (mmHg) ca 5 i tng l 120, 125, 130, 135, 150. S liu ny c
chia lm 2 phn: phn 1 gm 120, 125, 130 v phn 2 gm 130, 135, v 150. Trung v ca phn trn l 125
- trung v ca phn di l 135, do phm t phn v l 125-135.
Do bn cht ca khong t phn v l trung v ca phn s liu trn v phn s liu di, cng
ging nh trung v, khong t phn v khng b nh hng bi cc gi tr ngoi lai nh trong
trng hp ca lch chun. Cng nh trung v, khong t phn v ch c th p dng cho bin
s nh lng hay th t.
Cu hi: Phn tch trn my tnh v bin s hemoglobin cho kt qu sau. Hy th c v l gii
kt qu:
Variable | Obs Mean Std. Dev. Min Max
-----------+-----------------------------------------------------
hemoglobin | 70 11.98429 1.416122 8.8 15.1
Phng php trnh by s liu
S liu c th c trnh by thnh bng hoc cc th.
Trnh by bng:
Phn phi tn sut ca bin s nh tnh
S liu ca bin s ri rc c th c trnh by di dng mt phn phi tn sut. Phn phi
tn sut l mt bng ch ra tn sut xut hin ca tng gi tr ri rc ca bin s (Bng 1). Nh
vy bng phn phi tn sut gm 2 ct, mt ct lit k cc gi tr ca bin s v mt ct trnh
by tn sut tng ng ca cc gi tr .
Table 1. Phn phi gii tnh ca 69 hc sinh lp cm thng trng mm non 23 thng 11, Huyn
Hc mn
Gii S tr Phn trm
6
Nam 45 65%
N 24 35%
Tng s 69 100%
Bng trn l bn phn phi tn sut ca gii tnh. Bi v gii tnh c 2 gi tr nam v n nn ta
lit k 2 gi tr ny mt ct. ct th nh ta ghi tn sut tng ng ca cc gi tr ny. i khi
bng phn phi tn sut c thm ct phn trm nh trong th d trn. Bng 2 l mt th d
khc v bng phn phi tn sut.
Table 2. Phng php ca 600 tr trong bnh vin
Phng php

S sinh Phn trm


Sinh thng 478 79,7
Sinh forceps 65 10,8
Sinh m 57 9,5
Tng s 600 100,0
Phn phi tn sut ca bin s nh lng
Nu bin s l bin s lin tc chng ta khng th lit k tt c cc gi tr ca bin s. Trong
trng hp ny chng ta c th nhm (lm trn) gi tr ca bin s li.
C th cc bc xy dng bng phn phi tn sut cho bin s nh lng nh sau:
1- Tm phm vi (gi tr cc tiu v gi tr cc i) ca s liu. Trong th d v hemoglobin ca
70 ph n phm vi l 8,8 n 15,1
2. Chia phm vi s liu ra lm n khong vi rng ca mi khong l d. Cn lu rng
mi khong d nn l i lng chn nh 1, 2, 5, 10 hay 0,5, 0,2 v s cc khong n nn t 5-12
(trung bnh l 7-8). Trong th d trn ta c th chia phm vi ra lm 8khong vi chiu rng
khong bng 1 n v. Khi cc khong l: 8-8,9; 9-9,9; 10-10,9; 11-11,9; 12-12,9; 13-13,9;
14-14,9; 15-15,9.
3. m cc gi tr thch hp vo khong nh trc
Hemoglobin
(g/100ml)
m
8-8,9 1
9-9,9 111
10-10,9 1111 1111 1111
11-11,9 1111 1111 1111 1111
12-12,9 1111 1111 1111
13-13,9 1111 1111 111
14-14,9 1111
15-15,9 1
4. Xy dng bng phn phi tn sut vi bin s v cc khong gi tr ca bin s v tn sut
7
tng ng vi cc khong gi tr . Chng ta cng c th thm vo ct phn trm v ct phn
trm tch ly (nu thch hp)
Table 3. Hemoglobin ca 70 ph n
Hemoglobin Tn sut Phn trm Phn trm tch ly
8-8,9 1 1.43 1.43
9-9,9 3 4.29 5.71
10-10,9 14 20.00 25.71
11-11,9 19 27.14 52.86
12-12,9 14 20.00 72.86
13-13,9 13 18.57 91.43
14-14,9 5 7.14 98.57
15-15,9 1 1.43 100.00
Th d nh nu bin s l chu vi vng cnh tay ca tr chng ta c th lm trn chu vi vng cnh
tay n 1 cm. Khi ta c th xem thang o ca bin s l ri rc v trnh by bng phn phi
tn sut ca bin s (bng 2).
Table 4. Phn phi s o vng cnh tay ca 69 tr lp cm thng nh tr 23 thng 11, Hc mn.
Vng cnh tay Tn sut Phn trm Phn trm tch ly
13- <14 2 2.78 2.78
14- <15 31 43.06 45.83
15- <16 27 37.50 83.33
16- <17 9 12.50 95.83
17- <18 0 12.50 95.83
18- <19 2 2.78 98.61
19- <20 1 1.39 100.00
Biu v th
S liu cng c th c trnh by di dng th hoc biu . Mc d khng c ranh gii
tuyt i hon ton r rt, ni chung th (graph) c tnh cht ton hc nhiu hn, trong c
trc honh v trc tung cn biu (chart) l hnh nh mang tnh cht tng trng.
Nu bin s l bin ri rc, c th trnh by di dng biu hnh thanh (bar chart - hnh 1)
hoc biu hnh bnh (pie chart). Nu bin s l bin lin tc, th phn phi ca bin s c th
trnh by di dng t chc (histogram - hnh 2) hoc a gic tn sut.
Hnh thc ca bng
-C ta ngn gn v r rng
-t tn cho cc hng v ct
-Trnh by tng s ca hng v ct
-nh ngha cc k hiu v ch vit tt di bng
8
-Ghi ngun s liu di bng
Biu hnh thanh
Biu hnh thang l biu nhm m t s phn b ca bin s ri rc. Biu hnh thanh
gm c trc honh trn xc nh nhng gi tr ca bin s. ng vi tng gi tr ca bin s
ngi ta v cc thanh c chiu cao t l vi tn sut ca gi tr . Cn lu lun lun c
khong trng gia cc thanh.
45
24
0
10
20
30
40
50
Nam N
Hnh 1. Biu hnh thanh (bar chart) m t phn b gii tnh ca nhng hc sinh trong trng
mm non 23/11, Hc mn
Chng ta cng c th xy dng cc thanh theo chiu ngang nh trong v d sau
478
65
57
0 100 200 300 400 500
Sinh thng
Sinh forceps
Sinh mo
Hnh 2. Phng php sinh ca 600 tr sanh ti bnh vin X trong nm 1998
i vi bin s th t, iu cn lu l cc gi tr ca bin s phi c sp xp th t theo
trc honh.
9
T
a
n

s
u
a
t
e d u m a t
m u c h c a p 1 c a p 2 - 3 a i h o
0
1 0 0 0
2 0 0 0
Hnh 3. Trnh hc vn ca cc b m trong nghin cu
4,3%
19,5%
0,8%
3,9%
0%
5%
10%
15%
20%
25%
Dung ZDV Khong dung ZDV
ng am ao
Molay thai
Hnh 4. T sut ly truyn t m sang con nhng ngi m b nhim HIV theo iu tr
ha d phng v phng php sinh (Ngun: The European Mode of Delivery
Collaboration, Lancet, 27/3/1999)
Biu hnh bnh
Biu hnh bnh cng c dng m t s phn b ca bin s ri rc. Biu hnh bnh
l mt vng trn c chia lm nhiu cung tng ng vi cc gi tr ca bin s. ln ca
cung t l vi tn sut ca gi tr bin s.
10
N
35%
Nam
65%
Hnh 5. Biu hnh bnh (pie chart) m t phn b gii tnh ca nhng hc sinh trong trng
mm non 23/11, Hc mn
Sinh
thng
Sinh mo
Sinh
forceps
Hnh 6. Biu hnh bnh th hin phng php sinh ca 600 a tr sinh ti bnh vin X
T chc v a gic tn sut
T chc (histogram) v a gic tn sut (polyline) c dng trong m t phn b ca bin
s lin tc. v t chc , ngi ta chia bin ca gi tr lm nhiu khong gi tr v tnh
tn sut ca nhng khong gi tr . Nhng khong gi tr ny c biu th trn trc honh.
ng vi mi khong gi tr ngi ta v nhng hnh ch nht c din tch t l vi tn sut ca
khong gi tr . Bi v cc khong gi tr ny nm st nhau trn trc honh, cc hnh ch nht
ca t chc cng thng nm st nhau.
11

F
r
e
q
u
e
n
c
y
h e m o g l o b i n
8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6
0
5
1 0
1 5
2 0
Hnh 7. T chc mc hemoglobin ca 70 ph n.

F
r
e
q
u
e
n
c
y
h e m o g l o b i n
8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6
0
5
1 0
1 5
2 0
Hnh 8. a gic tn sut ca hemoglobin ca 70 ph n.
v a gic tn sut, ngi ta thng v t chc v ni cc trung im ca cc cnh trn
ca cc hnh ch nht. a gic tn sut thng khng p nh cc t chc nhng n c u
im l c th v nhiu a gic tn sut trn cng mt th d so snh cc phn phi ca
chng.
12

h e m o g l o b i n
8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6
0
5
1 0
1 5
Hnh 9. a gic tn sut hemoglobin ca 28 ph n ngho (ng ) so v 42 ph n trung bnh
v kh (ng xanh)
13
i cng v phn tch s liu
Php c lng
Dn s v mu
Thng thng chng ta khng th nghin cu ton b dn s m chng ta quan tm. Chng ta
thng ch c th nghin cu ch mt phn dn s , phn ny c gi l mu (sample) v t
c on v nhng c tnh ca dn s.
Trong nghin cu khoa hc, chng ta i t c trng ca c th (bin s - variable) c c
c trng ca mu (c gi l thng k - statistics) v t c trng ca mu chng ta s dng
phng php suy lun thng k v l gii c c c trng ca dn s (c gi l tham s -
parameter)
Mt loi mu thng c gp trong nghin cu l mu ngu nhin n. Khi ly mu ngu
nhin n, chng ta c th tnh c gi tr trung bnh v lch chun ca mu. R rng l
gi tr trung bnh v lch chun s khc nhau vi nhng mu khc nhau. Tuy vy cc nh
thng k chng minh rng gi tr trung bnh ca mu s c phn phi bnh thng v cc gi
tr trung bnh ny s tp trung ti trung bnh ca dn s. Do nu chng ta tnh trung bnh ca
mu th chng ta hi vng trung bnh ca dn s s nm ngay ti hay ln cn trung bnh ca
mu. phn tn ca trung bnh mu xung quanh chung bnh dn s c gi l sai s chun
(standard error) v s gim i khi c mu cng ln:

n
s
n
s
e s
2
. .
lch chun v sai s chun l hai i lng th hin s phn tn nhng lch chun th
hin s phn tn ca c th chung quanh gi trnh trung bnh dn s cn sai s chun l i
lng th hin s phn tn ca con s thng k (trung bnh mu hay t l ca mu) chung quanh
gi tr ca tham s (trung bnh dn s hay t l ca dn s).
c lng khong tin cy ca trung bnh
Nh chng ta trnh by, trung bnh ca mu s dao ng nhng tp trung ti gi tr trung
bnh ca dn s, nn chng ta c th c lng trung bnh dn s bng cch tnh trung bnh ca
mu.
Nhng do trung bnh mu c dao ng, chng ta khng chc l trung bnh mu s chnh xc
bng trung bnh ca dn s m ch c th tin l trung bnh dn s nm v tr u chung
quanh trung bnh ca dn s. Cc nh thng k cho rng 95% cc trng hp trung bnh dn s
khng nm xa qu 1,96 x SE so vi trung bnh mu: phm vi ny c gi l khong tin cy
95%. Nh vy khong tin cy 95% ca trung bnh ca bin s nh lng
Khong tin cy 95% (95% CI) : x t 1,96s/n
Trong trng hp c mu nh (n < 30), chng ta khng th s dng gi tr 1,96 nh trong cng
thc trn m cn phi s dng cc gi tr hi ln hn (v cng ln nu c mu cng nh), gi tr
ny c gi l gi tr ca phn phi t vi (c mu 1) t do.
Khong tin cy 95% (95% CI) : x t t
(1- /2)
s/n
Bi tp:
1. Mt nghin cu ghi nhn trn c mu 1235 tr s sinh tnh ng Thp cho thy trng lng
trung bnh ca tr s sinh l 3121 gram v lch chun l 435 gram. Hy c lng khong tin
cy 95% ca trng lng trung bnh ca tr s sinh tnh ng Thp.
14
S dng cng thc trn ta tnh c:
95%CI=3096.74 - 3145.26 gram.
2. Chiu cao ca 10 thanh nin l 160; 162; 165; 166; 169; 170; 172; 172; 176; 176. Hy c
lng khong tin cy 95% ca chiu cao trung bnh.
Trc tin chng ta phi xc nh trung bnh ca chiu cao l 168,8 cm v lch chun ca
chiu cao l 5,493. Do c mu l 10 chng ta phi d bng phn phi t 9 t do ta c gi
tr t (tng ng vi khong tin cy 95%) l 2,26. T chng ta tnh c khong tin cy 95%
95%CI=164.87 - 164.87.
c lng khong tin cy ca t l
c lng khong tin cy ca mt t l, chng ta cn xc nh t l p sau da vo p c
lng khong tin cy 95% ca p

n
) - (1 p p
p 96 , 1 n
n
) - (1 p p
p + 96 , 1
Bi tp
iu tra trn 127 thanh nin c 45 thanh nin ht thuc l. Hy tnh t l thanh nin ht thuc l
v khong tin cy 95% ca t l ht thuc l.
Chng ta tnh c t l ht thuc l thanh nin l 0.354 (35.4%). Da vo cng thc trn
chng ta tnh c khong tin cy 95% ca t l ht thuc l l 0,271 n 0,438
Suy lun thng k
Kim nh ngha
Phng php kim nh ngha c Fisher xut v da trn cn bn ca php phn chng.
Php phn chng trong logic hc s dng bng mnh : Nu A ko theo B th khng B s ko
theo khng A.
A B BA
Mt th d ca php phn chng l khi chng ta gp mt bnh nhn nghi ng tc rut v chng
ta hi bnh s xem bnh nhn c b trung tin hay khng. Gi s bnh nhn khng b trung tin
th chng ta s bc c chn on tc rut vi suy lun sau: Nu bnh nhn b tc rut s b trung
tin th bnh nhn s b trung tin, do bnh nhn khng b trung tin nn bnh nhn khng b tc
rut.
Mt cch tng quan hn, khi chng ta a ra gi thuyt chn on (th d nh chn on tc
rut), chng ta thng s xem xt cc h qu ph bin gi thuyt ny (Bnh nhn tc rut
thng b au bng,nn i, b trung tin v chng bng). Vic khng c mt trong cc hu qu
ph bin ca gi thuyt ny (th d nh bnh nhn khng c au bng, khng c nn i, khng
b b trung tin hay khng c chng bng) th chng ta c th bc b chn on. Cc bin c
nm ngoi cc h qu ph bin ca gi thuyt (bin c khng c au bng, khng c nn i,
khng b b trung tin hay khng c chng bng) c gi l min bc b ca chn on.
Trong kim nh thng k ngi ta cng s dng cc lp lun tng t. kim nh mt gi
thuyt thng k (c gi l gi thuyt Ho) cn phi xc nh min xy ra ph bin ca cc con
s thng k (nh trung bnh, t l, thng k t, thng k z, thng k chi bnh phng, v.v.) v nu
con s thng k ny nm ngoi min xy ra ph bin th chng ta s bc b gi thuyt Ho. Min
nm ngoi min xy ra ph bin ca s thng k c gi min bc b.
15
Hnh 1. Nguyn tc kim nh ngha theo Fisher. ng cong phn phi hnh chung th hin
phn phi ca thng k ca z khi =0 (gi thuyt Ho). Vng din tch di ng cong mu trng
th hin min cc thng k z thng xy ra nu gi thuyt Ho l ng. Vng din tch di ng
cong mu sm l min bc b gi thuyt Ho v c din tch l xc sut sai lm loi 1 (5%).
Khi s dng kim nh ngha chng ta cn lu cc im sau:
- Kim nh da trn nguyn tc phn chng ngha l chng ta ch c th bc b ch
khng th chng minh c gi thuyt Ho. V vy nu chng ta mun chng minh ht
thuc l l yu t nguy c ca ung th phi th phi t ra gi th.uyt thng k Ho l ht
thuc l khng phi l yu t nguy c ca ung th phi v s dng phng php kim
nh bc b iu ny.
- Gi thuyt Ho phi th hin bng ng thc (th d nh gi thuyt Ho: RR=1 hay Ho:
im trung bnh v bnh ly truyn qua ng tnh dc nam thanh nin = im trung
bnh v bnh ly truyn qua ng tnh dc n thanh nin ) th mi c th tnh c
phn phi ca thng k. Gi thuyt Ho khng th th hin bng bt ng thc (Ho: RR>1
l sai)
- Do din tch min bc b l mt con s c nh (thng l 0,05), xc nh con s
thng k T c nm trong min bc b hay khng ngi ta tnh xc sut xy ra thng k
cc oan hn gi tr T nu gi thuyt Ho l ng (c th hin bng cng thc: P (>T |
Ho) ). Xc sut ny c gi l gi tr p. V nu gi tr p nh hn ngng bc b ngha
l thng k T nm trong vng bc b v chng ta c th bc b gi thuyt Ho.
Gi tr p c k hiu khc nhau trn cc phn mm thng k. Th d phn mm Epi-Info, gi
tr p c k hiu l p-value, phn mm SPSS, gi tr p c k hiu l Sig. phn mm
Stata, cc gi tr p thng c k hiu khc nhau ty theo thng k c s dng l thng k g.
C th, trong phn mm Stata, gi tr p c k hiu nh sau:
P > |T| (nu kim nh t)
P > |z| (nu kim nh z)
Prob > chi2 (kim nh chi bnh phng)
Prob > F (Kim nh F; Kim nh ANOVA)
16
Kim nh gi thuyt
Khuyt im ca phng php kim nh ngha khi khng bc b c gi thuyt H
0
chng ta
khng bit c xc sut H
0
ng l bao nhiu. Mt nh thng k hc khc tn l Neyman
ra phng php kim nh gi thuyt trong c xt n sai lm loi 2.
P h a t b i e n H
0
; H
a
T n h s o t h o n g k e
( z ; t ; c h i
2
; F )
X a c s u a t s a i
l a m l o a i 1
N h o
B a c b o g i a t h u y e t
X a c s u a t s a i
l a m l o a i 2
K h o n g n h o
N h o
C h a p n h a n g i a
t h u y e t
T h c h i e n n g h i e n
c u v i c m a u
l n h n
K h o n g n h o
t r a b a n g t n h p
Sai lm loi mt v sai lm loi hai
Sai lm loi mt: bc b gi thuyt H
0
trong khi gi thuyt H
0
l ng.
Sai lm loi hai: Khng bc b gi thuyt H
0
trong khi gi thuyt H
0
sai.
Trong nghin cu thng k ngi ta khng bao gi c th chc chn. Do vy, khi nh nghin
cu i n kt lun bc b gi thuyt H
0
, ngi nghin cu c th b sai lm (sai lm loi mt -
vi mt xc sut no ). Khi nh nghin cu khng bc b gi thuyt H
0
, nh nghin cu cng
c th b sai lm (sai lm loi hai - cng vi mt xc sut no ). Mt iu nn nh l bng
kim nh thng k ngi ta c th xc nh c xc sut sai lm loi mt nhng khng th
tnh c xc sut sai lm loi hai m ch c th tnh c da vo i thuyt Ha v c mu ca
nghin cu.
i khi ngi ta cn s dng khi nim nng lc (power) ca kim nh thng k. Nng lc ca
kim nh thng k = 1 - xc sut sai lm loi 2. Khi nim nng lc ca thng k hay c
dng trong tnh c mu.
Bng 1. Tm tt v sai lm loi 1, sai lm loi 2 v gi tr ngng ca n
Chn l l Ho ng
(Khng c s khc bit)
Chn l l Ha ng
(Khng c s khc bit)
Bc b gi thuyt H
0
Sai lm loi 1
(Xc sut = )
Kt lun ng
(Xc sut = 1- =
Power ca nghin cu)
Khng bc b gi thuyt H
0
Kt lun ng
(Xc sut = 1- )
Sai lm loi II
(Xc sut = )
Chn la kim nh ph hp
Nh vy nguyn l ca kim nh ngha (hay kim nh gi thuyt l nh nhau). Cc kim nh
ch khc nhau vic la chn thng k xut pht t gi thuyt H
0.
Vic la chn ny ph thuc
vo bin s ca vn quan tm v thit k ca nghin cu.
17
Bng 10. Chn la kim nh ph hp theo thit k nghin cu
Loi thit k nghin cu
Thang o ca bin s
ph thuc
Hai nhm
iu tr
gm cc c
nhn khc
nhau
Ba (hay
nhi)
nhm iu
tr gm cc
c nhn
khc nhau
Trc v
sau mt
iu tr
(hoc 2
iu tr)
trn cng
cc i
tng
Nhiu iu
tr trn cng
cc i
tng
Lin h
gia hai
bin s
nh lng (mu rt t
mt dn s c phn phi
bnh thng v phng
sai hai nhm ng nht
t-test khng
bt cp
Phn tch
phng sai
t-test bt
cp
Phn tch
phng sai
o lng
lp li
Hi quy
tuyn tnh
v tng
quan
pearson
nh tnh - Danh nh

2
bng 2
x n

2
bng 3
x n
test
McNemar
Cochrance
Q
H s ca
bng n x m
(phi, OR,
RR)
nh tnh -Th t
(hay bin nh lng
khng bnh thng)
Kim nh
tng sp
hng
Mann-
Whitney
Kruskal-
Wallis
Kim nh
sp hng c
du
Wilcoxon
Friedman h s tng
quan
Spearman
Bng 11. Chn la kim nh ph hp tm s lin h gia bin c lp v bin ph
thuc
Bin ph thuc Bin c lp
Nh gi Danh nh (hoc th
t)
nh lng, a bin
(hoc th t)
nh lng phn phi bnh
thng
T-test ANOVA Hi quy tuyn tnh
Bin nh lng phn phi khng
bnh thng Bin th t
Mann-Whitney Kruskal-Wallis TQ Spearman
Nh gi Chi bnh phng Chi bnh phng Hi quy logistic
Sng cn Wilcoxon tng qut
Logrank
Wilcoxon tng qut
Logrank
Hi quy Cox
Php kim t bt cp
Tin lng ca bnh nhn suy h hp mn tnh tng carbonic thng km (t l t vong trong 3
nm thay i t 30% n 100%) v hin ti cha c phng php iu tr hu hiu. Tilapur v
Mir (Am J Med 1984; 77:987) cho rng ch n gim carbonhydrate c th ci thin tnh
18
trng h hp. Cc nh nghin cu ny tin hnh thc nghim trn 8 ngi suy h hp mn tnh
(c du hiu ca tim ln, gan ln, ph v tng p phi) vi ch iu tr bng ch n 600
Kcal v ghi nhn PaO2 (phn p oxy ng mch) v PaCO2 (phn p carbon dioxide ng
mch) trc v sau iu tr. Kt qu nghin cu c trnh by trong Bng 1. Hy so snh trung
bnh ca phn p oxy ng mch trc v sau khi iu tr.
19
Bng 1. Phn p Oxy ng mch v phn p CO2 ng mch trn 8 i tng trc v
sau ch iu tr vi ch n gim carbonhydrate
i tng Pa02 trc Pa02 sau Hiu s PaC02 trc PaC02 sau Hiu s
1 70 82 12 49 45 -4
2 59 66 7 68 54 -14
3 53 65 12 65 60 -5
4 54 62 8 57 60 3
5 44 74 30 76 59 -17
6 58 77 19 62 54 -8
7 64 68 4 49 47 -2
8 43 59 16 53 50 -3
Thc hnh:
Bc 1: Xy dng gi thuyt Ho:
Ho: Phn p oxy ng mch trc v sau iu tr khng thay i
Bc 2: Chn kim nh ph hp
Kim nh ph hp l kim nh t bt cp vi 7 t do
Bc 3: Tnh thng k t
Tnh trung bnh v lch chun ca bin s d (hiu s ca phn p oxy ng mch trc v
sau iu tr) tnh thng k t
66 , 4
/
; 2 , 8 ; 5 , 13
n s
d
t s d
d
Bc 4: tnh xc sut ca gi tr thng k t
tnh xc sut ca gi tr thng k t ta s dng hm tdist(gi tr t, t do, 2). C th tnh p
tng ng vi gi tr t = 4.63 7 t do chng ta nh cng thc "=tdist(4.63, 7, 2) vo mt .
Kt qu ta c gi tr p= 0.002397687.
Bc 5: Kt lun
V gi tr p= 0.002397687 nh hn 0.05 nn chng ta bc b gi thuyt Ho ngha l phn p oxy
ng mch c ci thin sau khi iu tr.
Php kim t (khng bt cp)
Nhm tm hiu vai tr ca catecholamine trong tng huyt p v cn, de Champlain (Circ Res
1976; 38:109) nghin cu 22 bnh nhn tng huyt p v cn (gm 13 ngi c nng
catecholamine cao v 9 bnh thng), ghi nhn nhp tim, huyt p tm thu, huyt p tm trng.
Kt qu ca nghin cu c trnh by trong bng 2. Hy so snh nhp tim hai nhm, nhm c
tng catecholamine v nhm khng tng catecholamine.
Bng 1. Trung bnh v lch chun ca Lung catecholamine huyt thanh, nhp tim, huyt p
tm thu v huyt p tm trung 13 bnh nhn tng huyt p tng catecholamine v 9 bnh nhn
tng huyt p khng tng catecholamine
Tng catecholamine Khng tng
S bnh nhn 13 9
catecholamine huyt thanh (ug/mL) x=0.484 s=0.133 x=0.206 s=0.060
20
Nhp tim x=90.7 s=11.5 x=77.8 s=13.2
Huyt p tm thu x=171.3 s=13.7 x=147.4 s=9.9
Huyt p tm trng x=103.0 s=8.3 x=95.6 s=12.9
Thc hnh:
Bc 1: Xy dng gi thuyt Ho:
Ho: Trung bnh nhp tim nhm bnh nhn c tng catecholamine = nhp tim trung bnh
nhm bnh nhn khng tng catecholamine
Bc 2: Chn kim nh ph hp
Kim nh ph hp l kim nh t vi (n
1
+n
2
-2) = 20 t do
Bc 3: Tnh thng k t
Trc tin chng ta phi tnh lch chun gp
21 . 12
) 1 ( ) 1 (
) 1 ( ) 1 (
2 1
2
2 2
2
1 1

+
+

n n
s n s n
s
p
( d nh cng thc tnh lch chun gp chng ta cn lu phng sai gp l trung bnh
ca phng sai ca mi nhm vi trng s l t do ca phng sai )
Sau chng ta tnh thng k t
44 . 2
/ 1 / 1
) (
2 1
2 1

n n s
x x
t
Bc 4: tnh xc sut ca gi tr thng k t
S dng my vi tnh chng ta tnh c gi tr p= 0,024123071 (nu s dng bng s thng k
chng ta s tm c p <0,05)
Bc 5: Kt lun
V gi tr p= 0,024123071 nh hn 0,05 nn chng ta bc b gi thuyt Ho ngha l gia hai
nhm bnh nhn c s kh bit v nhp tim trung bnh.
Phn tch phng sai
Anionwo et al. (1981, BMJ; 282:283) mun tm hiu xem mc hemoglobin trong 3 nhm bnh
hng cu lim c khc nhau hay khng bng cch ghi nhn mc hemoglobin 3 nhm bnh
nhn.
Bng 7. Phn tch phng sai mt chiu: s khc bit trong nng hemoglobin gia cc bnh
nhn b cc loi bnh hng cu lim khc nhau. S liu t Anionwo et al. (1981) British Medical
Journal, 282, 283-6
(a) S liu
Loi bnh hng cu
lim
S bnh
nhn
(n
i
)
Trung bnh
(x
i
)
s.d.
(s
i
)
Gi tr ca cc c th
hemoglobin g%
(x)
Hb SS 16 8,712 0,844 7,2; 7,7; 8,0; 8,1; 8,3; 8,4;
8,4; 8,5; 8,6; 8,7; 9,1; 9,1;
9,1; 9,8; 10,1; 10,3
21
Hb S/b-
thalassaemia
10 10,630 1,284 8,1; 9,2; 10,0; 10,4; 10,6;
10,9; 11,1; 11,9; 12,0; 12,1
Hb SC 15 13,300 0,942 10,7; 11,3; 11,5; 11,6; 11,7;
11,8; 12,0; 12,1; 12,3; 12,6;
12,6; 13,3; 13,8; 13,8; 13,9
Hy s dng kim nh thng k ph hp so snh nng Hemoglobin trung bnh 3 nhm
bnh nhn b hng cu lim.
Thc hnh:
Bc 1: Xy dng gi thuyt Ho:
Ho: Trung bnh Nng hemoglobin 3 nhm bnh HC lim bng nhau
Bc 2: Chn kim nh ph hp
Kim nh ph hp l phng php phn tch phng sai (ANOVA) vi thng k F vi (s
nhm, s quan st - s nhm) = (2,38) t do ; F ti hn= 3,32
Bc 3: Lp bng ANOVA v Tnh thng k F
Chng ta lp thnh bng phn tch phng sai nh sau:
Ngun bin thin SS d.f. MS=SS/d.f. MS gia cc nhm
F= ----------------------------
MS bn trong nhm
Gia cc nhm 99,92 2 49,96 50.03 , P<0,001
Trong cc nhm 37,95 38 1,00
Tng cng 137,85 40
Cc gi tr trn c th tnh theo cng thc sau:
Gia cc nhm
SS
b
= n
i
(x
i
-x)
2
= n
i
x
i
2
-( x)
2
/N
= 16 8,7125
2
+10 10,6300
2
+15 12,300
2

- 430,2
2
/41=99,92
df
b
= k-1 = 2
MS
b
= SS/d.f.
Trong cc nhm
SS
w
= (n
i
-1)s
i
2
=15 x 0,84452 + 9 x 1,28412 + 14 x 0,9419 = 37,96
df
w
= N - k = 41-3 = 38
MS
w
= SS/d.f.
V gi tr thng k F
F = MS
b
/MS
w
Bc 4: tnh xc sut ca gi tr thng k F
Da vo my tnh chng ta tnh c gi tr p= 2.26 x 10
-11
. Chng ta cng c th da vo bng
thng k F tm c p <0,001
Bc 5: Kt lun
V gi tr rt nh nn chng ta bc b gi thuyt Ho ngha l ba nhm bnh nhn bnh hng cu
lim c gi tr hemoglobin trung bnh khc nhau c ngha thng k.
22
Php kim chi bnh phng
C 240 ngi c tim vaccine phng bnh cm v 220 ngi c tim placebo. Trong
nhm tim vaccine c 20 ngi b cm v trong nhm tim placebo c 80 ngi b cm. Hy so
snh t l mc cm gia 2 nhm: nhm tim vaccine v nhm tim placebo? Hy cho bit mc
lin h gia vaccine cm v bnh cm?
Thc hnh
Bc 1: Xy dng gi thuyt Ho:
Ho: T l mc cm nhm tim vaccine = t l mc cm nhm khng tim vaccine
Bc 2: Chn kim nh ph hp
Kim nh ph hp l kim nh chi bnh phng vi 1 t do
Bc 3: Lp bng 2 x 2 v Tnh thng k chi bnh phng
Lp bng 2 x 2 nh sau
Kt qu Mc bnh cm Khng mc Tng
Tim chng C 20 a
(8,3%)
220 b 240 a+b
Placebo 80 c
(36,4%)
140 d 220 c+d
Tng 100 a+c 360 b+d 460 N
tnh thng k chi bnh phng c hai cch:
Phng php chnh thc:
- Tnh cc gi tr k vng (E) cc , gi tr k vng ca mt bng tch cc bin chia
cho tng s chung (th d gi tr k vng ca a E
a
= (a+b) (a+c) /N, gi tr k vng ca c E
c
= (a+b) (c+d) /N)
- Tnh gi tr chi bnh phng theo cng thc
1) - cot (so 1) - hang so

( . . ,
) (
2
2
f d
E
E O

Trong th d ny
09 , 53 02 , 6 52 , 5 69 , 21 86 , 19
2 , 172
) 2 , 172 140 (
8 , 187
) 8 , 187 220 (
8 , 47
) 8 , 47 80 (
2 , 52
) 2 , 52 20 (
2 2 2 2
2
+ + +


Cng thc tnh tt cho bng 2 2
) )( )( )( (
) (
2
2
d b d c c a b a
N bc ad
+ + + +


Bc 4: tnh xc sut ca gi tr thng k
2
S dng my vi tnh chng ta c gi tr p= 3,31 x 10
-13
ngha l gi tr ca p rt nh. S dng
bng s chng ta bit c p < 0,001.
Bc 5: Kt lun
V gi tr rt nh nn chng ta bc b gi thuyt Ho. Chng ta c th kt lun t l mc cm
nhm tim vaccine thp hn c ngha thng k so vi nhm tim placebo.
S tng quan ca hai bin s nh tnh
Mc lin h gia tim chng vaccine v mc bnh cm
23
Mc lin h gia hai bin s nh tnh c c lng bng cch s dng RR (hoc OR nu
trong nghin cu bnh chng). Gi s s liu ca bng 2 x2 nm vng C2:D3 chng ta c th
tnh RR bng cch nhp cng thc "=MHRR(C2:D3)" ta c RR=0,23 vi khong tin cy 95%
ca RR t 0,15 n 0,36
So snh t l ca bin s nh gi : Kim nh chi-bnh phng
Khi hai bin s l bin s nh gi ngi ta s dng gi tr RR hay OR o lng mc lin
h (xem li phn cc s o dch t).
Kt qu Mc bnh Khng mc
bnh
Tng
Bin s phi
nhim
Phi nhim
a
1
b
1
N
1
Khng phi
nhim
a
o
b
0
N
0
Tng
a
1+
a
0
b
1+
b
0
N=N
1
+N
0
T s nguy c (RR) l t s ca nguy c ca nhm phi nhim trn nguy c ca nhm khng
phi nhim:
RR = (a
1
/N
1
)/(a
0
/N
0
)
Khong tin cy 95% ca t s nguy c:
0 0 1 1
1 1 1 1
96 , 1
N a N a
e RR
+

hay
2
96 , 1
1

t
RR
(test-based CI)
T s s chnh (OR) l t s ca s chnh mc bnh ca nhm phi nhim trn s chnh mc
bnh nhm khng phi nhim. Trong trng hp nghin cu bnh chng t s s chnh l t s
ca s chnh phi nhim ca nhm bnh trn s chnh phi nhim nhm khng chng.
RR = (a
1
/b
1
)/(a
0
/b
0
)
Khong tin cy 95% ca t s s chnh:
0 0 1 1
1 1 1 1
96 , 1
b a b a
e OR
+ + +

Bi tp
Mt nghin cu bnh chng nhm tm mi lin h gia s n tht v vim rut hoi t tm
c 61 trng hp vim rut hoi t v 57 trng hp chng. Trong nhm b vim rut hoi t
c 50 trng hp c tin cn n tht (gn y) v trong nhm chng c 16 trng hp c tin
cn n tht. Hy tm c lng s o lin h gia n tht v vim rut hoi t.
Table 5. S lin h gia n tht trong thi gian gn u v vim rut hoi t Papua New Guinea
(OR=11,6)
n tht trong thi gian gn y Khng n tht trong thi gian
gn y
Tng s
Nhm bnh 50 a
1
11 b
1
61
Nhm chng 16 a
0
41 b
0
57
Tng s 66 52 118
24
Nu t l n tht nhm bnh (50/61) cao hn t l n tht trong nhm chng (16/57) c ngha
thng k th chng ta c th kt lun rng c s lin quan gia n tht v vim rut hoi t. y
l bi ton so snh t l ca mt bin s nh tnh hai nhm v c gii quyt bng kim nh
chi bnh phng.
Tuy nhin bng vic kim nh gi thuyt chng ta ch xc nh c mi lin h m khng bit
ln ca s lin h. Bi v y l nghin cu bnh chng chng ta khng tnh c RR m phi
s dng OR o lng sc mnh lin h. S dng cng thc tnh OR v khong tin cy ca
OR ta c:
OR = (a
1
/b
1
)/(a
0
/b
0
) = (a
1
b
0
)/(a
0
b
1
) = 11.65 v
khong tin cy 95% ca OR = 4.87 n 27.85
Bi tp
C 240 ngi c tim vaccine phng bnh cm v 220 ngi c tim placebo. Trong
nhm tim vaccine c 20 ngi b cm v trong nhm tim placebo c 80 ngi b cm. Hy so
snh t l mc cm gia 2 nhm: nhm tim vaccine v nhm tim placebo? Hy cho bit mc
lin h gia vaccine cm v bnh cm?
Kt qu Mc bnh cm Khng mc Tng
Tim chng C 20 a
1
(8,3%)
220 b
1
240 N
1
Placebo 80 a
0
(36,4%)
140 d
220 N
0
Tng 100 360 460 N
Ta tnh c RR = (a
1
/N
1
)/(a
0
/N
0
) = (20/240)/(80/220) = 0.23
Khong tin cy 95% ca t s nguy c:
0 0 1 1
1 1 1 1
96 , 1
N a N a
e RR
+

= 0.15 n 0.36
Quan h gia hai bin s nh lng
Tng quan
Tng quan l s o mc hai bin s nh lng cng thay i vi nhau. C nhiu loi h s
tng quan, nhng chng u c gi tr t -1 n 1. Nu chng c gi tr bng zero c ngha l
hai bin s c lp v khng quan h g vi nhau. Nu chng c gi tr dng c ngha l hai
bin s ng bin vi nhau, nu chng c gi tr m ngha l hai bin s nghch bin. Gi tr
tuyt i ca h s tng quan cng gn mt ngha l hai bin s c lin h cht vi nhau v vai
tr ca sai s ngu nhin s t hn. Khi tr tuyt i ca h s tng quan bng mt c ngha l
hon ton khng c sai s ngu nhin.
Loi h s tng quan c s dng ph bin nht l h s tng quan Pearson r:
1
/ ) (
) ( ) (
) )( (
2 2

n
n y x n xy
y y x x
y y x x
r
y x
i i
i i

L gii ngha ca h s tng quan Pearson
- H s tng quan lun lun nm trong on [-1,1]
- H s tng quan r dng chng t hai bin s l ng bin; h s tng quan r m chng t
hai bin s l nghch bin.
- Tr s tuyt i ca h s tng quan r ni ln mc lin quan gia hai bin s. Nu tr tuyt
25
i ca r bng 1 (r=1 hay r=-1), quan h hon ton tuyn tnh ngha l tt c cc im nm trn
ng hi quy (Hnh 9.2 d v 9.2f). Nu tr tuyt i ca r nh hn 1 s c cc im s liu
phn tn chung quanh ng hi quy (hnh 9.2 c v 9.2e).
- Bnh phng ca h s tng quan (r
2
) th hin t l bin thin ca bin s ph thuc c gii
thch bng s bin thin ca bin s c lp (nu mi lin h ny l nhn qu)
- Nu r=0, khng c mi lin h tuyn tnh gia hai bin s. iu ny c ngha l (1) khng c
mi lin h g gia hai bin s hoc (hnh 9.2a) (2) mi lin h gia hai bin s khng phi l
tuyn tnh (hnh 9.2b)
- Theo quy c, quan h vi r t 0,1 n 0,3 l quan h yu, t 0,3 n 0,5 quan h trung bnh
v trn 0,5 l quan h mnh.
Hi quy
Hi quy l mt m hnh ton hc m t s bin i ca mt bin s ny theo nhng bin s
khc.
Mt phng trnh hi quy c th c dng nh sau:
cn nng (kg) = 6,85 + 0,18 thng tui
(phng trnh hi quy tnh cn nng ca tr t 9 n 40 thng tui theo thng tui)
theo phng trnh ny ngi ta gi:
cn nng: bin s ph thuc
thng tui: bin s c lp
6,85: h s ca hng s, hay cn gi l im chn (intercept)
0,18: h s ca bin s thng tui.
Mt cch tng qut phng trnh hi quy s c dng:
Y = b
0
+ b
1
x
1
+ b
2
x
2
+ b
3
x
3
Vi y l bin s ph thuc
x
1
, x
2
, x
3
l cc bin s c lp
b
0
: im chn ca phng trnh
b
1
, b
2
, b
3
: h s ca cc bin s c lp
H s ca bin s c lp ni ln nu bin s c lp tng mt n v th bin s ph thuc y s
thay i bao nhiu. C th hn nu bin s x
2
thay i mt n v th bin s y s tng gi tr l
b
2
(bin s y s gim nu gi tr b
2
m).
Bi tp
1. Mt nh nghin cu ghi nhn lng mui n v huyt p tm thu ca 5 i tng trong bng
4.
i tng Lng mui Huyt p
1 5 110
2 10 120
3 12 110
4 18 120
5 20 140
Hy tm mi lin h gia huyt p tm thu v lng mui s dng.
Thc hnh
26
tm s lin h gia hai bin s nh lng chng ta s dng h s tng quan. Da vo cng
thc ta tnh c
r = 0,771829.
Nh vy c mi lin quan thun gia lng mui n v huyt p tm thu. Mi lin quan ny l
mnh v lng mui n gii thch cho n 60% (0.77 0.77) s thay i ca huyt p tm thu.
Chng ta cng tm c phng trnh ca huyt p theo lng mui tiu th s l:
Huyt p tm thu = 99,8 mmHg + 1,55 x Lng mui.
Gi tr 99,8 c gi l im chn ca phng trnh hi quy v 1,55 l h s gc ca bin s
lng mui tiu th. iu ny c ngha l nu lng mui n tng thm 1 gram/ngy th huyt
p tm thu s tng trung bnh 1,55 mmHg.
2. L gii ngha ca phn tn sau
Figure 8. Trng lng s sinh theo tui thai (tun) ca 641 tr sinh do th thai trong ng nghim
Anh quc
t
r
o
n
g

l
u
o
n
g

t
r
e
t u o i t h a i
2 0 2 4 2 8 3 2 3 6 4 0 4 4
0
1 0 0 0
2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
27
Xc nh v chn u tin nghin cu
Mc tiu
Sau bui tho lun cc hi tho vin c th:
- Xc nh cc tiu chun chn la cc vn y t u tin nghin cu
- Lm vic theo nhm nh, dng cc tiu chun chn xc lp u tin nghin cu
- S dng cc phng php ng thun nhm chn mt ch thch hp thc hin
cng nghin cu v cng ny s c s dng trong sut kho o to
Xc nh vn
Vn l mt thiu st hay khong cch gia hin ti v iu mong i. Th d nu t l tim
chng 6 loi vaccine ca cc bnh Lao, Bch hu, Ho g, Un vn, Bi lit, Si tr em 12
thng tui ti mt a phng l 60% trong khi chng ta mong mun t l tim chng y l
90% th t l tim chng thp l mt vn .
Nu t l tim chng vaccine vim gan virus B trong dn s l 30% trong khi chng ta khng
t ra ch tiu tim chng ca loi vaccine ny th t l tim chng vaccine vim gan virus B
30% khng phi l vn .
Vn c th xy ra do thiu ht trang thit b, do c cu t chc th vn c gi l vn
qun l. Th d vic iu tr cho bnh nhn st rt khng tt do trm y t khng c thuc st
rt iu tr st rt cho bnh nhn th vn ny c gi l vn qun l v cn c gii
quyt bng cch lm vic vi chng trnh st rt cung cp thm thuc. i khi vn xy ra
do chng ta khng c kin thc v vn . Th d, nu chng ta khng th iu tr tt bnh
nhn st rt do chng ta khng bit c k sinh trng st rt khng vi loi thuc no v cn
nhy cm vi thuc chng st rt no. nghin cu Khi vn ny l vn nghin cu v
cu hi m chng ta cn phi tr li gii quyt vn nghin cu c gi l cu hi nghin
cu.
Cc cu hi nghin cu c th c phn thnh ba loi tu theo loi kin thc cn tm:
1- M t vn y t nhm xy dng k hoch can thip: m t c th bao gm cc thng tin
v ln v phn b ca nhu cu sc kho hoc thng tin v ngun lc nhm xy dng k
hoch can thip.
2. Kin thc nh gi mt chng trnh can thip hay mt phc iu tr v cc phng
din: bo ph ca nhu cu sc kho, bao ph ca dn s mc tiu, cht lng, hiu qu,
chi ph, v.v
3. Kin thc xc nh cc vn y t hay phn tch nguyn nhn ca vn tm gii php.
Mt vn cn c nghin cu ph thuc v ba iu kin:
1. Phi c s bt cp, khong cch gia iu ang tn ti v iu chng ta mong mun
2. L do ca vn (khong cch) l cha r
3. Phi c nhiu hn mt cu tr li cho vn nghin cu
Tiu chun chn u tin cho vn nghin cu
C 7 tiu chun c s dng hng dn chn u tin cho cc vn nghin cu:
1. Tnh xc hp: Tnh xc hp ca vn nghin cu ph thuc vo quy m v mc trm
trng ca vn . Cn lu tnh xc hp ca vn ph thuc vo quan im ca cc bn.
2. Trnh trng lp: Cn phi kim tra xem nghin cu c thc hin ti a phng hay
khng hay ti mt a phng c iu kin tng t hay khng
3. Tnh kh thi: Cn xem xt mc phc tp ca ti v ngun lc cn thit tin hnh
28
nghin cu: nhn s, thi gian, trang thit b v tin bc. Nu vn l quan trng m ngun lc
khng c th xem xt vic xin ti tr t cc ngun bn ngoi.
4. Tnh c chp nhn t cc nh qun l: Ni chung mt nghin cu cn c s quan tm v
ng h ca cc cp c thm quyn. Khi nghin cu c tin hnh mt cch thun li hn v
kt qu c th c ng dng a vo thc tin. Nu mt nghin cu c tin hnh nhm
thay i mt chnh sch th cn phi tranh th s ng h v s tham gia ca cc nh hoch nh
chnh sch.
5. Tnh ng dng ca kt qu v cc kin ngh Cc kin ngh c th c p dng hay khng?
iu ny khng ch ph thuc vo s quan tm ca cc cp lnh o m cn ph thuc vo
ngun lc hin c ti a phng.
6. Tnh cp thit ca ti: Kt qu ca nghin cu c cn thit ra mt quyt nh khn cp
hay khng? Nghin cu no cn phi lm trc v nghin cu no c th thc hin sau.
7. Tnh chp nhn v o c: Bao gm s chp nhn ca cng ng k c v mt li ch v vn
ho. Nghin cu ny c s dng th mi chp nhn tham gia nghin cu hay khng? Nu kt
qu pht hin bnh tt ngi dn c cung cp iu tr cho h hay khng?
Thang im nh gi cc ch nghin cu
Tnh xc hp:
1. Khng xc hp: bnh t gp v khng trm trng
2. Xc hp: bnh ph bin nhng t trm trng
3. Rt xc hp: ph bin c hu qu xu
Trnh trng lp
1. thng tin v vn nghin cu
2. C thng tin v vn nghin cu nhng cha bao ph vn chnh
3. Khng c thng tin gii quyt vn
Tnh kh thi
1. Nghin cu khng kh thi vi ti nguyn sn c
2. Nghin cu kh thi vi ngun lc sn c
3. Nghin cu rt kh thi vi ngun lc sn c
Tnh chp nhn ca cp lnh o
1. Ch khng chp nhn c vi lnh o
2. Ch t nhiu kh chp nhn
3. Ch c chp nhn hon ton
Tnh ng dng
1. Khuyn co t c hi c thc hin
2. Khuyn co c t nhiu c hi c thc hin
3. Khuyn co c nhiu c hi c thc hin
Tnh cp thit
1. Thng tin khng cp thit cn thit
2. Thng tin cn thit ngay nhng c th tr hon
3. Thng tin rt cn thit ra quyt nh
29
Tnh chp nhn v o c
1. C vn quan trng v o c
2. C mt t tr ngi v o c
3. Khng c vn o c
Bng im
Vn 1 Vn 2 Vn 3 Vn 4
1. Tnh xc hp
2. Trnh trng lp
3. Kh thi
4. c lnh o
chp nhn
5. Tnh ng dng
6. Tnh cp thit
7. Y c
Tng s
30
Phng php phn tch v khng nh vn nghin cu
Mc tiu
Sau khi hon tt bui tp hun cc hi tho vin c th:
1. Phn tch mt vn v cc yu t nh hng n n
2. Vit phn t vn cho cng nghin cu m mnh s phi xy dng
Phn tch vn
Phn tch vn l cng vic xc nh vn ct li t vn nghin cu v xc nh cc yu
t nh hng n vn ct li .
Th d: mt bc s hi sc cp cu nhn xt t l t vong nhng bnh nhn hn m do i tho
ng l rt cao do khng xc nh c phc iu tr ph hp cho cc bnh nhn ny. Vn
ny c th do nhiu vn nh khc nhau nh: tng p lc thm thu, nhim toan chuyn
ha, do mt nc, do nhim trng tim n, do bnh nn, v.v. Gi s ngi bc s xc nh
nhim toan chuyn ha l nguyn nhn ch yu ca t vong cc bnh nhn hn m i tho
ng v ng ta lit k cc cc yu t nh hng n toan chuyn ha th y l vic phn tch
vn
Bc ny c th n gin hay phc tp ty theo mc hiu bit v vn nghin cu ca nh
nghin cu. Vic phn tch vn nhm cc mc ch:
1. Cho php cc thnh vin nghin cu chia x kin thc v vn nghin cu
2. Lm r vn nghin cu v cc yu t nh hng n n
3. Lm thun li hn vic quyt nh v phm vi v trng tm ca nghin cu
Cc bc phn tch vn
Bc 1: Lm r cc quan im ca cc nh qun l, nhn vin y t v nh nghin cu c
lin quan n vn . iu ny l cn thit bi v i khi quan im ca nh qun l
khng th hin mt cch r rng m ch c th l "Vn chm c bnh nhn tiu ng
cn phi xem li". Do vy n cn c lm r
Bc 2: Chuyn bit v m t vn ct li, bao gm bn cht ca vn , phn b ca
vn v quy m v mc trm trng ca vn ct li
Bc 3: Phn tch vn : cc yu t gp phn vo vn v cn lm sng t mi quan
h gia vn v yu t gp phn. Bc ny c chia lm 4 bc nh:
- Vit ra vn ct li gia t giy
- ng no tm ra cc yu t c nh hng n vn
- Xc nh thm cc yu t gp phn vo vn
- Phn cc yu t c lin quan thnh cc nhm: kinh t x hi, dch v y t v cc yu t
bnh tt.
Bc 1: Lm r quan im ca nh nghin cu, nhn vin y t v nh lnh o
- i khi quan im ca nh lnh o c pht biu cha r rng th d nh : Cn xem xt li
vic chm sc bnh nhn tiu ng; Cn nghin cu vn b tuyn, Kho st vn iu
tr DOTS. Khi chng ta cn tho lun v khng nh di dng vn l khong cch gia
hin ti v iu mong mun
- khi vn di dng trnh by r rng, vn tr thnh nhiu vn nh:
T l cha khi bnh nhn iu tr bng DOTS thp
Nhn vin y t khng m bo ng chc nng gim st
31
Bnh nhn khng tun th lch iu tr
Bnh nhn tiu ng v thn nhn khng c nhn thc v tiu ng v t chm sc
trong tiu ng
Bnh nhn tiu ng c bin chng cao
Bnh nhn tiu ng t dung np vi iu tr
T l ti nhp vin cao trong nhng bnh nhn tiu ng
Bc 2:
- chn vn ct li t cc vn nh
Bnh nhn tiu ng c bin chng cao
T l ti nhp vin cao trong nhng bnh nhn tiu ng
- M t vn ct li theo:
Bn cht: s khc bit v hin ti v mong mun
Phn b ca vn : Con ngi, thi gian, ni chn
Tm c v trm trng ca vn : quy m ca vn , trm trng ca vn , hu
qu vn
Bc 3:
- Xc nh yu t gp phn to ra vn v mi quan h gia vn v vn gp phn
S dng s cy vn , trong vn c t gia v cc yu t nh hng v gp phn
c t chung quanh v hng mi tn th hin s tc ng. Vn thng c v vi 2
ng vin phn bit vi cc yu t nh hng.
Y e u t o
Y e u t o
V a n e
\
Qu trnh ny bao gm cc bc sau:
Bc 3.1: Vit vn ct li gia
Bc 3.2: tm ra cc yu t nh hng
B e n h n h a n
k h o n g d u n g
n a p i e u t r
K h o n g c o
i e u t r t a i
c s
T l e t a i n h a p
v i e n d o b e n h t i e u
n g c a o
T l e b i e n
c h n g c a o
T l e b i e n
c h n g c a o
Bc 3.3: Tip tc tm ra cc yu t nh hng v gp phn sao cho cc yu t ny l
yu t c th thay i. di l mt s cy vn ca vn lao phi v tng huyt p.
32
N h n g y e u t o
d c h v u k h a c
T l e b o t r
b e n h n h a n l a o
p h o i c a o
B N k h o n g
h i e u s c a n
t h i e t
N h n g y e u
t o c a n h a n
v a x a h o i
K h o n g u
n h a n v i e n
K h o n g t
v a n c h o B N
N h a n v i e n
k h o n g h u a n
l u y e n
K h o n g u
t a i l i e u e
G D S K L a o
T h i e u h i e u b i e t
v e c a m n h a n
c u a B N L a o v e
l a o p h o i
C h a t l n g
d c h v u k e m
o n a n g
c u a b e n h
T l e b o t r
b e n h n h a n l a o
p h o i c a o B N k h o n g h i e u
s c a n t h i e t
p h a i i e u t r
T h a m v a n
k h o n g u
T h i e u s h o
t r t g i a
n h
a p n g
v i i e u t r
i e u t r
t h u o c n a m
K i e n t h c k e m
v e n g u y e n
n h a n v a h a u
q u a b e n h
T u o i ; G i i ;
G i a o d u c
T h i e u s h o
t r c h u l a o
o n g
C a u t r u c
g i a n h
N g h e
n g h i e p
P h o n g
k h a m x a
T n h p h u c v u :
- G i m c a
- i l a u
- K h o n g u n h a n v i e n
- K h o n g u h u a n l u y e n
- T h i e u h i e u b i e t v e b e n h n h a n
l a o
- K h o n g u t a i l i e u
- T h i e u g i a m s a t
- P h a c o k h o n g t h c h h p
- H n g d a n k h o n g t h c h h p
33
T a i b i e n
m a c h m a u
n a o
D d a n g
m a c h
B e n h t i m
T a n g h u y e t
a p
V a n o n g
h a n g n g a y
L n g m u o i
t i e u t h u
B e o p h
C h e o a n
K h o n g h i e u
b i e t v e C H A
K h o n g t u a n
t h u i e u t r
K h o n g c o
g i a o d u c s c
k h o e
D c h v u y t e
c h a t o t
B e n h n h a n
k h o n g b i e t
s o o H A
T a n g h u y e t
a p
H u t t h u o c l a
U o n g r u
R o i l o a n l i p i d
m a u
R o i l o a n
n g h u y e t
Bc 3.4: Sp xp cc yu t thnh cc nhm ln v xy dng s :
Yu t kinh t x hi: Gm tui, gii, hc vn, ngh nghip, kin thc cng ng, cc loi hnh
iu tr cng ng, thi vi cc loi hnh iu tr
Yu t dch v y t: tnh c c v tip cn c ca dch v, qun l dch v y t, cht lng
c s y t
Yu t y sinh: trm trng ca bnh tt, p ng vi iu tr, hin tng khng thuc, c lc
vi khun
Ch :
- Nu bn cht nghin cu l m t, s phn tch khng tm kim nguyn nhn ca vn
- Th d nu chng ta mun nghin cu kin thc, thi , hnh vi ca hc sinh v giun sn
xy dng ti liu gio dc sc kho trng hc. C 2 s :
Nhng yu t KAP gy nn bnh giun sn
Nhng yu t gp phn vo s pht trin KAP thanh thiu nin
Xc nh phm vi v trng tm ca nghin cu
Sau khi phn tch vn , cn phi xem xt li trng tm v phm vi ca ti. Vic xc nh
phm vi v trng tm ca ti ph thuc vo
1. Tnh hu dng thng tin (thng tin v cc yu t gp phn): Thng tin no khi c
thu thp gii quyt vn s gip gii quyt vn y t v ci thin chm sc y t?
Thng tin ny cn thit cho ai? Thng tin s gii quyt n cc yu t no ca vn ?
2. Tnh kh thi: C th thu thp c nhng thng tin no trong thi gian d nh dnh
thc hin nghin cu?
3. tnh lp li: C thng tin no lin quan n cc yu t trong s c ri? vn
no ca thng tin cn c nghin cu thm.
34
Lu :
- Cn tham kho ti liu hoc hi kin chuyn gia xc nh trng tm v phm vi ca
nghin cu
- Nu cha r s lin h v tm quan trng ca cc yu t gp phn, khi xc nh phm vi
nghin cu d c nguy c b qua nhng yu t gp phn quan trng nht.
- r mi lin h v tm quan trng ca cc yu t gp phn, s dng nghin cu thm d
nhm pht hin ti a nhng yu t c lin quan bng cch nghin cu mt s t i tng.
Xy dng phn t vn
Phn u tin trong mt cng nghin cu l phn t vn . Phn ny ht sc quan trng
bi v n t nn tng cho s xy dng tip theo ca cng nghin cu, gip tm kim thng
tin v bo co t cc nghin cu khc c th tham kho v cho php ch ra mt cch c h
thng ti sao vn ny c nghin cu v chng ta c th gt hi g t kt qu nghin cu.
iu ny l rt quan trng khi chng ta trnh by nghin cu ca chng ta cho cc thnh vin
ca cng ng v cc nhn vin, cn b v lnh o ngnh y t.
Cc thng tin cn thit trong phn t vn
1. M t ngn gn v c im kinh t x hi, vn ho , tnh trng sc kho v y t ca a
phng c lin quan n vn nghin cu.
2. M t v bn cht ca vn (s khc bit gia thc tin v iu mong mun) nu vn cn
cha r.
3. Phn tch cc yu t chnh nh hng n vn
4. M t cc gii php c s dng trc y hoc kt qu cc nghin cu trc v nu r l
do ti sao cn gii php mi hay cn mt nghin cu mi
5. M t loi thng tin hi vng s c c t nghin cu v thng tin ny s gip gii quyt vn
ny nh th no hay gip tr li cu hi nghin cu nh th no?
6. Nu cn thit cn nu ra nh ngha ca nhng khi nim quan trng ca nghin cu.
35
Tng quan y vn
Mc tiu
Sau khi nghin cu phn ny, hc vin c kh nng
1. Trnh by nhng l do tham kho cc y vn c sn v cc thng tin khc trong khi
chun b cng nghin cu
2. Trnh by cc ngun ti liu c th tham kho
3. Chun b tng quan y vn v nhng thng tin khc c lin quan n cng nghin
cu, nhng thng tin ny trnh by cc s liu nn tng v nhng thng tin h tr cho
ch ch nghin cu.
Ti sao cn phi tham kho y vn khi chun b cng nghin cu
Vic tham kho y vn s gip chng ta trnh vic lp li cc cng trnh lm t trc
Tham kho y vn s gip bn tm hiu cc nh nghin cu khc pht hin v bo co
nhng g v vn bn mun nghin cu. iu ny gip bn hon thin phn t vn
Tham kho y vn gp bn quen thuc hn vi nhng loi thit k nghin cu c s
dng trong ch nghin cu ny
Tham kho y vn cho bn nhng l l thuyt phc ti sao ti nghin cu ca bn l cn
thit.
Nhng ngun thng tin c th tham kho
Chng ta c th tham kho cc ngun thng tin khc nhau. Cc ngun thng tin ny c th l cc
c nhn, cc nhm ngi hay cc t chc. Ngun thng tin cng c th l t nhng ti liu
xut bn nh sch v, tp ch, bi bo, cc th mc hoc nhng ti liu cha xut bn nh
cng nghin cu, bo co, h s, c s d liu trong my tnh. Hin nay cc website trn
internet l mt ngun thng tin quan trng c c cc kin ca c nhn, ca cc nhm, cc
t chc, cc ti liu xut bn hoc ti liu cha xut bn.
Cc ngun thng tin c th c nhiu cp khc nhau, cp a phng, cp quc gia hay
cp
Cp Th d v ngun thng tin
a phng - S liu ca bnh vin hay phng khm t cc thng k nh k
- kin, nim tin ca cc nhn vt ch cht
- Quan st lm sng, bo co cc tai bin
- iu tra hay bo co hng nm
- Nin gim thng k ca a phng
- Sch, bi bo khoa hc, bo ch, v.v
Quc gia - Bi bo t cc tp ch khoa hc quc gia, sch v tm kim c trong
th vin ca trng i hc, th vin ca WHO, UNICEF
- Vn bn, bo co, s liu th t
- B y t
- Tng cc thng k
- Cc t chc phi chnh ph
Quc t - Cc tp ch khoa hc, tp ch chuyn ngnh
- Cc n bn ca WHO, UNICEF, UNFPA, v.v
36
- Cc sch, ti liu khoa hc kinh in
Cch vit phn tng quan
C mt s bc phi thc hin chun b cho vic tng quan y vn v cc thng tin
1. u tin phi t chc cc th th mc theo nhm ca cc ch tu theo n c lin
quan n kha cnh no ca vn
2. Sau , quyt nh trnh t trnh by cc ch . Nu pht hin rng bn khng
tm c y vn cho thng tin v mt kha cnh ca vn ca bn m bn cm thy rng
n quan trng, cn phi n lc tm kim y vn .
3. Cui cng, trnh by tng theo ngn t mt cch mch lc trong vng t mt n
hai trang nhng cn phi c ti liu tham kho.C hai cch trch dn ti liu tham kho:
- Bn c th nh s th t trn vn bn tham chiu n cc ti liu tham kho. Sau
lit k cc ti liu tham kho theo th t v s dng cc thng tin c m t trong
th th mc v phn lit k cc ti liu tham kho ny phi c a vo sau cng
lm ph lc (cch trch dn ny thng c gi l trch dn theo h thng
Vancouver).
- Mt cch khc l bn c th vit h ca tc gi nc ngoi (ton b tn v h nu l tc
gi trong nc), nm xut bn v s trang c trch dn tham chiu n ti liu tham
kho. Trong trng hp ny lit k cc ti liu tham kho theo th t bng ch ci v
phn lit k cng c a vo sau cng lm ph lc (cch trnh dn ny c
gi l trch dn theo h thng Havard)
4. Quy tc lit k ti liu tham kho:
Tp ch:
Altman Cho DG. Statistics in medical journals. Stat Med 1983;1:59-71.
[H - tn tt].[Tn bi bo].[Tn t bo] [nm XB];[s]:[trg u]-[trg cui]
Sch:
Andersen B. Methodological errors in medical research. An incomplete catalogue.
Oxford: Blackwell, 1990.
[H - tn tt].[Nhan sch].[Ni xut bn]:[nh xut bn],[nm XB]
Mt chng sch:
Bailar JC. Communicating with a scientific audience. In: Bailar JC, Mosteller F, eds.
Medical uses of statistics. Waltham, MA:NEJM Books, 1986:325-37.
[H - tn tt].[Tn chng sch]. In: [H - tn tt].[Nhan sch].[Ni xut bn]:[nh
xut bn],[nm XB]:[trg u]-[trg cui]
Mt Website
National Board of Health and Welfare, Sweden. Hospital discharge register.
http://www.sos.se/epc/par/pareng.htm (accessed 20 July 2001).
[Tn c quan ch qun website]. [tn bo co].[a ch website (ngy truy cp)]
Sai lch c th
Sai lch trong y vn hay trong tng quan y vn l s bin dng ca nhng thng tin khin cho
kt lun t y vn hay tng quan y vn khng phn nh tnh hnh thc tin. Chng ta cn phi
cnh gic vi nhng loi sai lch ny v cn phi ht sc nghim tc vi ccy vn hin c. Nu
bn c nghi ngi v mt s ti liu tham kho hay bn c th pht hin nhng kin khc nhau
chng ta cn tho lun mt cch nghim tc v thng thn. Thi nghim tc ny s gip
37
chng ta trnh khi cc sai lch trong nghin cu ca chnh chng ta. Nhng sai lch thng
thy trong y vn bao gm:
1. Che du nhng im tranh lun hay s khc nhau trong kt qu nghin cu ca chnh
mnh
2. Ch tham kho ti liu ca nhng ngi ng h quan im ca tc gi.
3. Rt ra nhng kt lun ht sc mnh bo t kt qu nghin cu s b hay nghin cu
mng manh hay khi qut ho lan trn t mt nghin cu trng hp.
Vic mc phi cc loi sai lch trn s to nn cc nghi ng v tnh trung thc khoa hc
(scientific integrity) ca nh nghin cu. Hn na vic trnh by mt cch khng cn thn cc
kt qu s khin cho c gi ng dng kt qu nghin cu mt cch sai lc. iu ny khng ch
gy tn km thi gian, tin bc m cn c th gy hu qu xu cho sc kho ca ngi dn.
Vic o vn trnh by kt qu hay cng trnh ca cc nh khoa hc khc m khng trch dn
cng l mt hnh ng thiu o c m cc nh nghin cu cn phi trnh. Do nh nghin
cu cn phi tun th theo cc hng dn v trch dn ti liu tham kho trong khi vit cng
cng nh khi vit bo co khoa hc. mt s quc gia, hnh ng o vn c th b truy t.
38
Mc tiu nghin cu
Mc tiu hc tp:
Sau khi nghin cu phn ny, hc vin c kh nng:
- Khng nh cc l do vit mc tiu cho mt nghin cu
- Xc nh v m t s khc bit gia mc tiu tng qut v mc tiu c hiu
- Xc nh c tnh ca mc tiu nghin cu
- Xy dng mc tiu nghin cu cho nghin cu ca bn mt hnh thc ph hp.
Mc tiu nghin cu l g:
Mc tiu nghin cu nhm tm tt nhng g s t c sau khi hon thnh nghin cu. Thng
thng ngi ta chia mc tiu lm mc tiu tng qut v mc tiu c hiu. Mc tiu tng qut
l nhng iu t c mt cch chung nht, cn mc tiu c hiu bao gm cc phn nh hn
v c lin h vi nhau v vi mc tiu tng qut mt cch hp l. Trong mc tiu c hiun n
c th nhng iu s lm trong nghin cu, lm u v vi mc ch g.
Th d:
Nu chng ta c vn nghin cu l mc s dng dch v phng khm tr em thp ti
huyn CT. V sau khi phn tch vn nghin cu chng ta nhn thy gii quyt cc vn
trn cn phi tm hiu cc l do khin mc s dng dch v phng khm tr em thp ti huyn
CT ta s thit lp mc tiu tng qut nh sau:
- Xc nh cc l do ca mc s dng dch v phng khm tr em thp ti huyn CT
Nhm t c mc tiu tng qut k trn, chng ta phi hon thnh cc cng vic sau. Cc
cng vic ny c gi l mc tiu c hiu:
- Xc nh mc s dng dch v phng khm tr em huyn CT trong cc nm 2000 v 2001
so vi ch tiu t ra
- Xc nh c s lin h gia vic s dng dch v phng khm tr em vi ma trong nm, loi
hnh phng khm
- Xc nh cc yu t dch v ca phng khm nh hng n tnh hp n i vi b m
- Xc nh cc yu t vn ho v kinh t x hi nh hng n vic s dng dch v phng
khm tr em.
- Kin ngh cc gii php ci thin s dng dch v phng khm tr em.
- Xy dng k hoch thc hin v cc kin ngh phi hp vi cc ban ngnh.
Nh trnh by trn, trong cc nghin cu ng dng, nn c mc tiu xc nh quy m ca
vn v c cc mc tiu nhm xy dng k hoch ng dng kt qu ca nghin cu.
Ti sao phi xy dng mc tiu nghin cu
Khi tin hnh nghin cu cn phi xy dng mc tiu nghin cu nhm gip cho ch nghin
cu c tp trung v trnh vic thu thp cc thng tin khng cn thit gii quyt vn .
Ngoi ra vic xy dng mc tiu c th s gip cho vic thit k nghin cu bng cch t chc
mc tiu nghin cu thnh cc phn hay cc giai on xc nh.
Yu cu ca mc tiu nghin cu
Mc tiu nghin cu tt cn phi t c cc yu cu sau:
- Phi bao gm cc kha cnh khc nhau ca vn nghin cu theo mt trnh t hp l v mch
lc.
- c hnh vn r rng, c th ch r iu s lm, lm u, trong thi gian no v vi mc
39
ch g
- Mc tiu phi ph hp vi iu kin thc tin, kh thi.
- Mc tiu phi bt u bng cc t hnh ng c th v c th nh gi mc t c nh:
xc nh, so snh, kim chng, tnh ton, m t
Gi thuyt nghin cu
Gi thuyt nghin cu l mt mnh khng nh quan h gia mt hay nhiu yu t vi vn
nghin cu. Th d "s dng dch v phng khm tr em thp nht trong thi gian thu hoch" l
mt gi thuyt nghin cu bi v n khng nh rng trong thi gian thu hoch th mc s
dng dch v phng khm tr em s thp.
Vic kim nh gi thuyt nghin cu c th c xem l mt mc tiu nghin cu bi v n s
gip cho gii quyt vn nghin cu. Gi thuyt nghin cu thng c s dng kim tra
mt l gii c v thng c s dng trong cc nghin cu y sinh hc nhng thng khng
ph hp i vi nghin cu h thng y t.
Tn ti nghin cu
Cn phn bit tn ti nghin cu vi vn nghin cu: Vn nghin cu l s khc bit
gia hin ti v iu mong i trong khi tn ti nghin cu li tp trung v phng php gii
quyt vn v vy tn ti nghin cu thng lin quan cht ch vi mc tiu nghin cu.
Tuy nhin khc vi mc tiu nghin cu, thng bt u bng mt ng t hnh ng, tn ti
nghin cu thng l mt ng danh t (nn c gi l tn). Tn ti nghin cu nn ngn
gn, bi v n chim ch trong mc lc ca t bo hay trong MEDLINE, nhng phi cha nhiu
thng tin. Bi v hin nay do s ph bin ca vic tm kim bi bo trn Internet, tn ti nn
cha nhng t kho (keyword) ca bi bo. Phn t kho ca bi bo hin nay khng phi l
phn bt buc v vy vic xy dng tn ti nghin cu mt cch hp l l cc k quan trong.
Tho lun nhm
Chn mt ch to v mt th k
- Trnh by li phn t vn : tp trung vo
Lng ho v c th ho vn
Thm d cc yu t nh hng n vn
Cc hot ng nghin cu
- Xy dng mc tiu tng qut v c hiu
- Kim tra li cc yu cu ca mc tiu
- Trnh by trc lp mc tiu nghin cu.
40
Gii thiu v phng php nghin cu khoa hc y hc
Mc tiu
Sau phn ny, hc vin c kh nng:
1. Xc nh nhng cu hi thch hp cn phi t ra khi pht trin phng php cho cng
nghin cu
2. M t c cc thnh phn thch hp cn c gii quyt trong phn phng php ca
cng nghin cu.
Gii thiu
Cu hi Thnh phn trong thit k nghin cu
Lm th no thu thp s liu K hoch thu thp s liu
Lm th no c th thu thp nhng
s liu ny
Chn thit k nghin cu
Cng c no thu thp s liu Chn k thut thu thp s liu
Thu thp s liu u: Trn bao
nhiu i tng, chn nh th no?
Ly mu
Chng ta cn nhng s liu mi no? Chn bin s
Chng ta lm g vi s liu c
thng tin
K hoch phn tch
Chng ta c lm hi ai khi tin hnh
nghin cu?
Kha cnh o c ca nghin
cu
Lm sao bit c phng php thu
thp s liu?
Th nghim phng php
41
Gi s sau khi bn xc nh c:
- Chn ch nghin cu
- Chun b mt m t ngn gn v vn nghin cu v tm quan trng ca n
- Tng quan y vn v cc thng tin bit c v vn
- Pht trin cc mc tiu nu ln mt cch r rng mc ch ca nghin cu, ch i g kt qu
nghin cu v cch s dng cc kt qu nghin cu
t c mc tiu t ra, bn phn phi quyt nh bn s phi lm g: th d nhng s
liu no cn c thu thp, lm th no thu thp cc s liu , x l nh th no. Cc cu
hi trong lu trang sau ch ra nhng mc chnh cn phi xem xt khi pht trin thit k
nghin cu.
42
Bin s
Mc tiu
1. Xc nh bin s l g v ti sao vic chn la bin s l quan trng
2. Phn bit c bin s nh tnh (categorical) v bin s nh lng (numerical)
3. Phn bit c s khc bit gia bin s c lp v bin s ph thuc v chng c s dng
trong nghin cu nh th no
4. Xc nh c cc bin s c o lng trong d n nghin cu ang c thit k v cho
bit:
- Bin s no c th o lng trc tip
- Bin s no khng th o lng trc tip v phi s dng nh ngha c th(operation
definition)
- Bin s no khng th o lng c vo thi im hin ti.
Bin s
Do nghin cu khoa hc l vic thu thp, phn tch v l gii s liu gii quyt vn nghin
cu hay tr li mt cu hi nghin cu (Varkevisser et al., 1991) nn nghin c khoa hc cn
phi thu thp thng tin cc c tnh hay cc i lng ca i tng. Cc c tnh hay i lng
ny c gi l bin s. Ni cch khc:
Bin s l nhng i lng hay nhng c tnh c th thay i t ngi ny sang ngi khc
hay t thi im ny sang thi im khc.
Bin s nh tnh v bin s nh lng
Nh vy bin s c th th hin i lng hay c tnh. Nu n th hin mt i lng n c
gi l bin s nh lng. Nu n nhm th hin mt c tnh n c gi l bin s nh tnh.
Bin s nh tnh cn c chia lm 2 loi: bin s danh nh v bin s th t.
Bin s danh nh l bin s m gi tr ca n khng th biu th bng s m phi biu din bng
mt tn gi (danh: tn) v cc gi tr ny khng th sp t theo mt trt t t thp n cao.
Th d: Bin s dn tc vi cc gi tr: Kinh, Khmer, Hoa, Chm, l bin s nh tnh v chng ta khng
th sp xp cc gi tr ny t theo mt trt t t thp n cao hay ngc li.
Mt s th d khc ca bin s danh nh l tnh trng hn nhn (c 4 gi tr: c thn, c gia nh, li d,
ga) nhm mu (A, B, AB v O).
Trong phn tch thng k, tin vic nhp s liu hay l gii kt qu, ngi ta c th nh x
(mapping) cc gi tr ca bin danh nh vo cc con s. Vic ny c gi l m ha v cn
hiu rng vic m ha ny hon ton c tnh cht p t v cc con s c dng trong m ha
khng phn nh bn cht ca bin s danh nh.
Gii tnh l bin s danh nh v c hai gi tr l nam v n. Chng ta c th m ha gii tnh v quy c
Nam l 1 v N l 2. Tuy nhin vic m ha ny l p t v chng ta hon ton c th quy c Nam l 1
v N l 0. Vic m ha ch nhm gip vic nhp s liu v x l s liu tr nn d dng hn ch khng
nhm phn nh bn cht ca bin s (do hon ton v cn c nu cho rng m ha Nam=1 v N=0
l phn nh thi phong kin "Nht nam vit hu - Thp n vit v).
Bin s th t l bin s danh nh nhng c th sp xp th t c.
Th d: tnh trng kinh t x hi (giu, kh, trung bnh, ngho, rt ngho) l bin s th t bi v ngi
giu c iu kin kinh t tt hn ngi kh, ngi kh hn ngi trung bnh, trung bnh hn ngho, v.v
Nhng th d khc l hc lc ca hc sinh (gii, kh, trung bnh, km), tin lng (tt, kh, xu, t vong).
Theo phn loi tng huyt p ca T chc Y t Th gii c trnh by nh sau, th phn loi huyt p vi
cc gi tr huyt p bnh thng, huyt p cao nh, va v nng l bin s th t.
43
Huyt p bnh thng: HA tm thu (139 v HA tm trng ( 89
Tng huyt p nh: HA tm thu ( 179 hay HA tm trng ( 104
Tng huyt p va: HA tm thu ( 180 hay HA tm trng (114
Tng huyt p nng: HA tm thu (180 v HA tm trng ( 115 mmHg
Bin s nh lng nhm th hin mt i lng v do c gi tr l nhng con s.
Th d: tui l bin s lin tc bi v ta c th ni ngi ny 20 tui, ngi kia 32 tui, v.v.
Nhng th d khc l ng huyt, hemoglobin, hematocrite, chiu cao, cn nng, thu nhp, v.v
Khi chng ta quan tm n vic l gii nguyn nhn ca s vic chng ta chia bin s thnh bin
s c lp v bin s ph thuc.
Bin s dng m t hay o lng vn nghin cu c gi l bin s ph thuc.
Bin s dng m t hay o lng cc yu t c cho l gy nn (hay gy nh hng n)
vn nghin cu c gi l bin s c lp
Cn phn bit s khc bit gia bin s v gi tr ca bin s (cn gi l yu t): Gii tnh l
bin s nhng N khng phi l bin s m l mt gi tr ca bin s (hay cn gi l yu t).
Thi gian ch i c s dng dch v y t l bin s nhng thi gian ch i lu l gi tr
ca bin s. Kin thc v cc cy con thuc l bin s nhng t hiu bit v cc cy con thuc l
yu t. Ta c th ni bin s mc ht thuc l c lin quan n nguy c ung th phi nhng
phi ni ht thuc l nng l yu t nguy c ca ung th phi.
Bin s (i lng hay c tnh c quan tm) c chia lm 3 loi:
- Bin s c th o lng trc tip - chiu cao, cn nng, tui, tnh trng hn nhn.v.v
- Bin s khng th o lng trc tip c nh tnh trng dinh dng, mc c kh, mc
hi lng ca bnh nhn, kin thc ca b m v thc hnh chm sc tr.
- Bin s khng o lng c trong nghin cu hin ti. Trn nguyn tc, mi bin s u c
th o lng c nhng trong mt nghin cu c th c th c mt s bin s khng o lng
c do hn ch ca iu kin k thut hay khng thng nht v nh ngha c th (th d nng
endorphine gia tng sau khi chm cu, mc hu dng ca nhng bnh nhn b tn tt, cht
lng dn s)
nh ngha c th
Thng thng, nh nghin cu bt u vi mt quan im tng i m h v cch o lng
cc bin s nghin cu. Th d, nu nh nghin cu mun o lng mc au th nh nghin
cu phi chuyn i khi nim au thnh mt mnh cht ch xc nh cch o lng bin s
ny. Ph thuc vo cch l gii tru tng ca khi nim au v yu cu c th ca nghin cu,
chng ta c th chn la mt phng php o lng mc au n.
nh ngha c th ca bin s l mt mnh v cch ngi nghin cu ca mt nghin cu no
chn cch o lng bin s . N phi khng c m h v ch c mt cch l gii duy
nht. Th d, mt nh nghin cu cho rng vic iu tr ca b ta c th gip ci thin vic "kim
sot vn ng", cu hi chng ta cn t ra ngay l "kim sot vn ng" c ngha nh th
no. Nh nghin cu c th tr li l b ta quan tm n vic kim sot vn ng c o lng
bi Plunkett Motor Dexterity Task Score. Mt nh nghin cu khc c th khng chp nhn
nh ngha ny v cho rng vic kim sot vn ng nn c t nh gi bi bnh nhn. C hai
nh ngha ny c gi l nh ngha c th.
Mt nh ngha c th tt l nh ngha cung cp thng tin cho php mt nh nghin cu
khc c th lp li k thut o lng, nu ngi mun. Trong m t nghin cu nh nghin
cu nn bao gm trong nh ngha c th nhng cng c o lng v quy trnh nghin cu
ngi c c th r rng v nhng vic lm.
44
Bin s c lp - ph thuc - gy nhiu
Vic xc nh bin s no l bin s c lp hay bin s ph thuc c xc nh trong phn t
vn v mc tiu ca nghin cu. Do trong khi thit k nghin cu cn phi xc nh r
rng bin s no l c lp v bin s no l ph thuc.
Th d nu nghin cu mi quan h gia ung th phi v ht thuc l th ht thuc l l bin s
c lp v ung th phi l bin s ph thuc
Nu nh nghin cu mun tm hiu ti sao thanh nin ht thuc th ht thuc l bin s ph
thuc v "p lc ca bn b" l bin s c lp.
Bin s gy nhiu (confounding variable) l bin s cung cp mt gii thch khc ca mi lin
h gia bin s c lp v bin s ph thuc. Mt bin s c nh gi l bin s gy nhiu khi
c 3 c tnh sau:
- C lin quan n bin s ph thuc (l yu t nguy c ca vn nghin cu)
- C lin quan n bin s c lp (phn b khng u gia cc gi tr ca bin c lp)
- Khng nm trong c ch tc ng ca bin c lp ln bin ph thuc
Th d:
C mi
lin h
gia s ln khm tin sn v sanh con nh hn 2500 gram. Tuy nhin thu nhp ca gia nh
cng c th nh hng n s ln khm tin sn v vic sanh con nh cn. Nh vy thu nhp ca
gia nh l yu t gy nhiu.
Kim sot yu t gy nhiu
khc phc yu t gy nhiu ngi ta c th s dng:
- Phng php hn ch: th d ch nghin cu nhng b m trong gia nh c thu nhp trung
bnh, khng nghin cu nhng b m trong gia nh ngho
- Phng php bt cp trong chn mu v phn tng trong phn tch mu:
- Phng php phn tng: gm tin hnh phn tch s liu ring bit cho nhm b m ngho, cho
nhm b m trung bnh v nhm b m giu ri tng hp kt qu li. Thc cht phng php
phn tng gm l s tng hp ca nhiu nghin cu hn ch (mi nghin cu c hn ch cho
mt gi tr ca bin s gy nhiu)
- Phng php m hnh ha s dng phng php hi quy a bin tch ring tc ng ca
tng bin s c lin quan trong m hnh. Khi h s ca cc bin s trong m hnh nh gi
tc ng ca bin s , khng b nh hng hay gy nhiu bi cc yu t khc (bi v trong
hi quy a bin, h s B
1
ca bin s X
1
nu ln s thay i ca bin ph thuc Y khi X
1
thay
i mt n v v cc bin s lin quan khc nh X
1
, X
2
, khng thay i).
- Phng php chia nhm ngu nhin: ch s dng c cho nghin cu thc nghim nhng y
l phng php kh yu t gy nhiu ton din nht v khng cn xc nh hay o lng ton
b cc yu t gy nhiu.
S ln khm thai
(Bin s c lp)
Cn nng con lc sinh
(Bin s ph thuc)
Thu nhp - Hc vn gia nh
(bin s gy nhiu)
45
Bin s nn (background variables)
Trong bt c nghin cu no, c nhng bin s nn tng th d nh tui, gii, trnh gio dc,
tnh trng kinh t, tnh trng hn nhn, tn gio, v.v. Nhng bin s ny thng c nh hng
n vn nghin cu (bin s ph thuc) v c tc ng nh bin s gy nhiu. Nu bin s
nn c nh hng quan trng n nghin cu cn phi thu thp thng tin v bin s nn. Nhng
khng nn thu thp qu nhiu bin s nn trnh lm tng kinh ph nghin cu mt cch v
ch.
46
Bi tp:
1. Gi s chng ta c khung nim (conceptual framework) v mi lin h gi km vn ng v
bnh mch vnh nh sau:
Trong cc yu t: Ht thuc l, Tng LDL-cholesterol, Xem ti vi nhiu, yu t no c xem l
yu t gy nhiu?
2. Mt nghin cu on h c tin hnh Anh quc, nhng ngi tham gia c ghi nhn
mc hot ng tnh dc cao u nghin cu (c nh gi bng tn sut c khoi cm) c
nguy c t vong trong 10 nm thp hn nhng ngi c ghi nhn c mc hot ng tnh
dc thp.
1
Gi s iu ny l ng, anh ch c li khuyn g v vic hot ng tnh dc gim
thiu nguy c t vong.
Mt s nh khoa hc cho rng kt lun ca nghin cu c th l khng ng. H gii thch rng
nhng ngi c quan h tnh dc thng xuyn l nhng ngi c sc kho tng qut tt hn,
do , c nguy c t vong thp hn. Theo cc anh ch, nhng nh khoa hc ny cho rng tnh
trng sc kho tng qut l yu t bin i hu qu hay yu t gy nhiu? Nu iu ny c
chng minh l ng th anh ch s c li khuyn g i vi mi ngi gim thiu nguy c t
vong.
Cc bc s lm sng c kinh nghim li a ra li gii thch khc. H cho rng nhng ngi
kho mnh, quan h tnh dc thng xuyn l c li cho sc kho v lm gim nguy c t vong
cn ngi tnh trng sc kho tng qut km vic quan h tnh dc thng xuyn li
khin i tng d b t vong hn. Theo cc anh ch, nu kinh nghim lm sng ny l ng th
tnh trng sc kho tng qut l yu t bin i hu qu hay yu t gy nhiu? Nu iu ny l
ng th anh ch s c li khuyn g i vi mi ngi gim thiu nguy c t vong.
1. Davey Smith G, Frankel S, Yarnell J. Sex and death: are they related? Findings from
the Caerphilly Cohort study. BMJ. 1997; 315: 1641-1644
2. Gn nh tt c cc nghin cu quan st cho thy s gim nguy c t vong bnh tim cc ph
n s dng oestrogen. Mt nghin cu gp (meta-analysis) ca 25 nghin cu xut bn tm
thy nguy c tng i chung l 0.70 i vi bnh mch tim cc ph n c s dng estrogen
(so vi nhm khng dng oestrogen); trong 7 nghin cu khc nh gi hiu qu ca vic s
dng oestrogen v progestogen, nguy c c lng l 0.66.
2

Tuy nhin, gn y, Hemminki

and McPherson tng kt 22 nghin cu th nghim ngu
nhin ca vic s dng tr liu oestrogen v thy rng cc bin c tim mch li l nguyn nhn
ch yu ca vic b cuc hay phn ng ngoi .
3
T s nguy c tm tt l (1.39) trong nhm s
dng estrogen so vi nhm khng s dng. iu ny cho thy estrogen khng c tc dng

c
li, nu khng phi l c hi, ln nguy c bnh tim mch.
Anh ch tin vo kt qu nghin cu ca loi nghin cu no hn? Anh ch cho rng iu tr
hormone thay th ph n mn kinh c li hay c hi cho sc khe tim mch? Ti sao anh ch
li tin nh vy?
Km vn ng Tng LDL-cholesterol
Gim HDL-cholesterol
Bnh mch vnh
Ht thuc l
Xem ti vi nhiu
47
1. Barrett-Connor E. Hormone Replacement Therapy. BMJ 1998;317:457-461 .
2. Barrett-Connor E, Grady D. Hormone replacement therapy, heart disease, and other
considerations. Annu Rev Public Health 1998; 19: 55-72.
3. Hemminki E, McPherson K. Impact of postmenopausal hormone therapy on
cardiovascular events and cancer: pooled data from clinical trials. BMJ 1997; 315: 149-
153
4. Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens
on heart disease risk factors in postmenopausal women. JAMA 1995; 273: 199-208
3. Mt nghin cu thc nghim trn kh chimpanzee cho thy lng estrogen gip kh
chimpanzee ci c bo v v c nguy c b st rt thp hn so vi kh c. Mt nh nghin
cu quan tm n ti ny v thc hin mt nghin cu bnh chng xc nh mi lin h
gia gii tnh v st rt. Nh nghin cu ny tm c 150 trng hp bnh (trong c 88
nam) v 150 chng (trong c 68 nam). T s s chnh th tnh c l 1,71.
Nh nghin cu ny cng bit cht t v dch t v cho rng nhng hot ng ngh nghip ngoi
nh l yu t gy nhiu v do , thu thp thng tin v ngh nghip hot ng ngoi nh cc
i tng, s dng phng php phn tng v ghi nhn c cc kt qu sau:
Nhm ngh nghip ngoi nh Nhm ngh nghip trong nh
Bnh Chng Tng
s
Bnh Chng Tng s
Nam 53 15 68 Nam 35 53 88
N 10 3 13 N 52 79 131
Tng
s
63 18 81 Tng
s
87 132 219
Theo cc anh ch, ngh nghip (ngoi nh v trong nh) c phi l yu t gy nhiu trong nghin
cu ny hay khng? ti sao?
Nh nghin cu ang vit bi bo co v d nh s cng b gi tr OR hiu chnh theo ngh
nghip. Tnh c c mt chuyn vin dch t ca T Chc Y t Th gii c c bn tho ca
nghin cu ny v cho kin phn bin. Theo ng, do ngh nghip l hu qu ca gii tnh nn
chui gii tnh - ngh nghip - st rt c th c xem nh l c ch tc ng ca gii tnh ln
nguy c mc bnh st rt. Do ngh nghip khng phi l yu t gy nhiu. ng ta khuyn
nn bo co gi tr OR th (khng hiu chnh cho ngh nghip). Theo anh ch, nh nghin cu
c nn nghe theo li khuyn ca chuyn gia dch t hay khng?
Bias in studies of use of oestrogen and heart disease
1

Bias in who is prescribed oestrogen:
More educated
Higher social class
Osteoporosis*
No diabetes, heart disease, or
hypertension
Healthier before treated
Bias in who takes oestrogen:
Compliant women
48
49
Cc loi nghin cu
Mc tiu
1. M t c nhng thit k thng c s dng trong nghin cu khoa hc y hc v hn ch
ca mi loi nghin cu
2. Trnh by c tng loi nghin cu c nh hng g n tnh gi tr v tnh tin cy ca kt
qu nghin cu
3. Xc nh c loi nghin cu thch hp cho cng nghin cu ca chnh hc vin
M u
Ph thuc vo chng ta bit g v vn nghin cu, c nhng cu hi khc nhau cn c
t ra v tng ng vi cc thit k nghin cu khc nhau. Vic chn la thit k nghin cu
ph thuc vo
- Vn thuc loi g?
- Kin thc bit c v vn
- Ngun lc c c dnh cho nghin cu
Th d trong nhng vn v qun l y t (th d nh vic qu ti ca bnh vin) ch cn m t
r rng vn v xc nh cc yu c gp phn cng cung cp nhng thng tin hnh
ng.
i vi mt s vn qun l y t v nhiu loi nghin cu khc, c th chng ta cn mun bit
mi lin h gia cc bin s (th d nh t n rau v ung th i trng). Trong trng hp ny
chng ta cn c nghin cu phn tch hay nghin cu thc nghim.
Mt s loi nghin cu
C nhiu cch phn loi nghin cu trong ngi ta thng chia lm 2 loi:
- Cc nghin cu khng can thip: trong nh nghin cu ch m t v phn tch tnh hnh
nhng khng can thip
- Cc nghin cu c can thip: nh nghin cu tc ng ln tnh hnh v o lng kt qu ca
vic tc ng (th d nh tin hnh chng trnh gio dc sc kho v xem n c tc ng g ln
t l tim chng).
Nghin cu khng can thip
Nghin cu khng can thip bao gm nghin cu thm d, nghin cu m t v nghin cu
phn tch
Nghin cu thm d
Nghin cu th m d l nghin cu trn quy m nh trong thi gian ngn khi chng ta cha r v
vn hay tnh hnh cn phi nghin cu
Th d: U ban quc gia phng chng AIDS mun xy dng dch v tham vn cho bnh nhn
AIDS v ngi nhim HIV nhng khng bit nhng nhu cu ca bnh nhn cn c h tr.
thm d nhng nhu cu ny, mt s cuc phng vn su c tin hnh vi nhiu nhm
bnh nhn v vi cc nhn vin y t lm trong lnh vc ny.
Trong nghin cu thm d ngi ta thng m t v so snh. Th d nh nghin cu c th m
t nhu cu ca tng nhm bnh nhn v so snh nhu cu v tham vn ca bnh nhn nam v
bnh nhn n. Nghin cu thm d s c gi tr tt hn nu nh nghin cu c gng tip cn vn
t nhiu hng khc nhau.
50
Nghin cu m t
Nghin cu m t bao gm vic thu thp v trnh by c h thng cc s liu nhm cung cp
mt bc tranh v mt tnh hung c th.
Nghin cu m t c th c tin hnh trn mt quy m ln hoc quy m nh. quy m nh
nghin cu m t bao gm vic m t su cc c tnh ca mt s bnh nhn hay cc trm y t
hoc cc d n. Loi hnh nghin cu ny c gi l nghin cu trng hp (case study) hay
bo co ca bnh (case report, case series). quy m ln hn v cc cuc iu tra ct ngang
nhm xc nh s phn b ca cc bin s nht nh mt thi im. Cc c tnh ny c th l
cc c tnh thc th, kinh t x hi hay hnh vi ca cng ng.
i khi nh nghin cu thng kt hp s m t dn s nghin cu vi s so snh cc nhm
trong dn s. Mc d nghin cu ny cng s dng phng php so snh tng t nh nghin
cu phn tch, khi ch so snh cc nhm dn s khc nhau, bn cht ca nghin cu ny vn l
nghin cu m t.
Khc vi cc nghin cu phn tch nhm tm mi lin h gia mt yu t phi nhim v tnh
trng bnh tt, cc nghin cu m t, Nghin cu m t nhm bo ng, tm hiu mt s c
im hay c lng quy m ca mt vn sc kho hay tm hiu kin thc, thi , hnh vi
ca ngi dn v vn xut cc gii php can thip.
Nhng nghin cu m t bao gm: nghin cu ca bnh, nghin cu lot ca bnh trong nghin
cu lm sng v nghin cu trng hp trong nghin cu sc kho cng cng. Cc nghin cu
kin thc, thi , hnh vi hay cc iu tra ct ngang cng l cc nghin cu m t quan trng.
Cc nghin cu m t tng i ph bin trong y vn v sau y l mt s th d
Mt bo co lot ca bnh (case series) da trn vic m t bnh s v bnh cnh lm sng ca 4
ngi n ng c nhp vin ti trung tmY khoa ca i hc California Los Angeles
(UCLA) v bnh vim phi do Pneumocystic carinii. 6 y l mt vn sc kho cn phi bo
ng v loi vim phi ny trc y ch xut hin nhng ngi b ri lon h thng min
dch. Nhng nh nghin cu tin hnh mt nghin cu xem y l mt vn sc kho mi
hay ch l cc trng hp tng t vi nhng ca bnh vim phi Pneumocystic carinii c pht
hin t trc? Vn sc kho ny c nhng c im g ?
Mt nghin cu trng hp c tin hnh da trn vic m t c im ca mt trm y t c
hot ng tng i tt nhm rt ra cc bi hc v qun l cho cc trm y t
7.
y l mt nghin
cu c ngha thc tin trong tnh hnh c nhiu trm y t cn hot ng km.
Anh quc nhm chm sc ban u (primary care groups) c a vo hot ng t nm
1999 v c mt ngn qu thng nht chi tr cho cc hot ng y t ca bnh nhn bao gm c
chi ph nhp vin. Tuy nhin ngi ta vn cha r cc thng tin nn (baseline) v sc kho, kinh
t x hi v t l nhp vin ca 66 nhm chm sc ban u nay thnh ph Lun n. V vy
mt nghin cu ct ngang m t c tin hnh v cho thy s khc bit ng k v kinh t x
hi, y t v thc hnh ca cc nhm v cc thng tin ny c s dng cho vic lp k hoch v
nh gi dch v y t
8
.
Nh vy cc nghin cu m t c mt gi tr thc tin ht sc to ln v hon ton khng km
nghin cu phn tch v gi tr khoa hc. Tuy nhin mt s nh nghin cu v khng nm r
mc tiu nghin cu ca mnh nn thay v thc hin mt nghin cu m t tt h tin hnh mt
nghin cu phn tch km. Th d trong mt nghin cu ct ngang nhm tm hiu m hnh bnh
tt ca mt cng ng (y l mt nghin cu rt c gi tr thit k chng trnh can thip y
t cho cng ng ) nh nghin cu khng tp trung vo vic m t cc vn sc kho m li
(th d nh) c gng tm mi lin h gia ung th v ht thuc l v nh vy lm long gi tr
ca ti nghin cu bng mt phn tch km cht lng v b sai lch.
Nghin cu so snh hay nghin cu phn tch
Dch t hc phn tch (hoc tm nguyn nhn) c ni dung tm nguyn nhn gy ra vn sc
51
khe trong dn chng.
Phng php p dng l phn tch cc yu t nh hng lm gia tng t l bnh trong mt dn
s. Nguyn l ca phng php ny l so snh t l mc bnh ca hai nhm dn s: mt dn s
c tip xc vi yu t nguy c v mt dn s khng tip xc vi yu t nguy c. Nu t l mc
bnh ny khc bit gia hai nhm (ngha l nguy c tng i khc 1) th ta kt lun c th c
mi lin h gia yu t tip xc v bnh tt. Mc du rt nhiu lnh vc khoa hc sinh hc tham
gia vo kho st nguyn nhn bnh tt con ngi nhng vai tr ca dch t hc l c o v
khng th thay th. Hn na phng php dch t hc thng i u tm ra cc nguyn nhn.
Cc ngnh khoa hc khc s i theo tm thm chng c ng h. Th d John Snow tm ra
c ch ly bnh ca dch t trc khi cc nh vi sinh hc tm ra phy khun t Doll v Hill tm
thy vai tr ca thuc l gy bnh ung th phi trc khi cc nh khoa hc tm thy ha cht
sinh ung trong khi thuc l.
c s liu c th, dch t hc phn tch c th dng cc phng php iu tra thu thp sau
y:
Kho st nguyn nhn trong cohort
C o t i e p
x u c
K h o n g
b e n h
C o
b e n h
K h o n g
b e n h
T h i g i a n t
1
t
0
K h o n g
t i e p
x u c
K h o n g
b e n h
C o
b e n h
K h o n g
b e n h
T h i g i a n t
1
t
0
Nghin cu on h l nghin cu nhm tm ra s lin h gia mt yu t phi nhim v mt
tnh trng sc kho (th d nh mt bnh tt) bng cch quan st v so snh nguy c mc bnh
gia hai nhm qun th c tnh trng phi nhim khc nhau. Mt th d kinh in ca nghin
cu on h l nghin cu cc bc s Anh quc (The British Doctor's study) c bt u tin
hnh vo nm 1951 trong 34.440 nam bc s c hi v tnh trng ht thuc l (c hay
khng) v c theo di v t vong do ung th phi trong vng 20 nm 3. Kt qu cho thy
nguy c t vong hng nm do ung th phi ngi khng ht thuc l l 10/100.000 trong khi
nguy c t vong hng nm do ung th phi ngi ht thuc l l 140/100.000. Nh vy ht
thuc l lm tng nguy c ung th phi ln 14 ln (nguy c tng i l 14) v nh vy ht
thuc l c gi l yu t nguy c (hay nguyn nhn) ca ung th phi.
Tin ca nghin cu on h l phi theo di y mt hin tng sc kho ca qun th
trong thi gian kh di (khng c mt theo di - loss from follow-up). y l khuyt im chnh
ca nghin cu on h v cc thit k nghin cu khc (bnh chng v ct ngang) c xut
khc phc. Nu c theo di y , nghin cu on h c u im l trc quan v t gy
ra sai lch do chn la v s c tnh thuyt phc cao.
52
Kho st nguyn nhn bnh chng:
C o
b e n h
C o t i e p
x u c
K h o n g
t i e p
x u c
T h i g i a n t
0
t
1
K h o n g
b e n h
C o t i e p
x u c
K h o n g
t i e p
x u c
T h i g i a n t
0
t
1
Gi s chng ta khng c iu kin theo di 34.440 bc s trong thi gian 20 nm nhng chng
ta c iu kin (a) bit chc chn mt ngi c phi l mt nam bc s hay khng (b) ghi nhn
c thng tin ca tt c cc trng hp ung th phi xy ra trn cc nam bc s v (c) chn
mt mu i din cho qun th nam bc s v phng din ht thuc l. Khi bng php tnh
s hc n gin c th chng minh:
OR
la thuoc hut khong ngi benh mac chenh so
la thuoc hut ngi benh mac chenh so
benh mac khong ngi la thuoc hut chenh so
benh mac ngi la thuoc hut chenh so
V nh vy chng ta c th c lng c nguy c tng i m khng cn phi quan st
trong thi gian di.
Nhm tm hiu s lin quan gia s dng Oestrogen tng hp (OCE) v ung th mi mc t
cung, mt nghin cu bnh chng c tin hnh trong c 183 ngi b ung th ni mc t
cung (nhm bnh) v 183 ngi khng b ung th ni mc t cung (nhm chng) c hi tin
cn s dng OCE4 . Kt qu cho thy trong nhm bnh c 55 ngi c tin cn s dng OCE
(s chnh s dng OCE trong nhm ny l 55/128=0,43) v trong nhm chng c 19 ngi c
tin cn s dng OCE (s chnh s dng OCE trong nhm chng l 19/164=0,12). T s ca hai
s chnh ny l 0,43/0,12= 3,6. Con s ny (3,6) cng chnh l s chnh mc ung th mi mc
t cung ca nhm s dng OCE so vi nhm khng s dng OCE hay l mc tng nguy c ung
th ni mc t cung nu s dng OCE.
Nghin cu bnh chng tt i hi phi tho mn 3 iu kin nu trn trong c iu
kin l phi c thng tin v tt c cc trng hp bnh v vy nghin cu ny thch hp cho cc
bnh nghim trng v tt c cc trng hp bnh u phi nhp vin. Bnh ung th l mt th d
kinh in ca loi bnh thch hp cho nghin cu bnh chng. Nu nghin cu bnh chng
khng tho mn c 3 iu kin trn s b sai lch (biased). Hn th na, khi tin hnh nghin
cu bnh chng, nh nghin cu phi chun b rt chu o v mt k thut v khng d dng
thuyt phc c cng ng khoa hc u ng rng nhm chng l thc s i din cho qun
th khng mc bnh. Tuy nhin nghin cu bnh chng c u im l tin hnh nhanh, t tn
km c bit trong nghin cu cc bnh him v c thi gian tim tng ko di.
53
Nghin cu ct ngang
Tr v th d nghin cu s lin h gia ht thuc l v ung th phi, chng ta c th khng cn
thi gian theo di trong sut thi gian t 1951 n 1971 m ch cn tin hnh mt cuc iu tra
thi im 1971, ghi nhn thng tin v ht thuc v ung th phi v c c kt lun tng t
nh nghin cu on h nu chng ta gi nh c rng (a) Tt c cc trng hp ung th phi
chn on trong giai on 1951 n 1971 u cn sng cho n nm 1971 (b) Vic mc ung th
phi khng lm thay i thi quen ht thuc l ca bc s mc bnh (ngha l nu h ht thuc l
ri b ung th phi th h vn tip tc ht thuc l v nu h khng ht thuc l th sau khi ung
th phi vn tip tc khng ht thuc l). Nh vy, nghin cu ct ngang thng t c s
dng cho cc bnh nghim trng nh ung th, bnh nhim trng, tai nn. Nhng bnh thch hp
cho nghin cu ct ngang bao gm ri lon c tnh cht nh lng v t gy t vong (bo ph,
suy dinh dng, bt dung np ng huyt, tng huyt p th nh hay trung bnh).
Mt nghin cu ct ngang c tin hnh Bavaria, cng ho lin bang c nhm nh gi tc
ng ca b sa m (trong thi k nh nhi) ln nguy c bo ph (vo cui tui nh tr) bng
cch s dng cc s liu chiu cao, cn nng v b cu hi v dinh dng ca 9357 tr t 5-6
tui c khm sc kho trc khi nhp hc 5. tr khng c b m, t l bo ph l 4,5%
trong khi tr c b m t l bo ph l 2,8%. Tc gi kt lun rng b sa m lm gim
nguy c bo ph cui tui nh tr. Mc d y l nghin cu ct ngang nhng c tnh gi tr
tt do tho mn c hai gi nh ca nghin cu ct ngang (a) a tr b bo ph khng b tng
nguy c t vong v (b) vic tr b bo ph khng nh hng g n vic b sa m giai on
nh nhi.
Tm li nghin cu ct ngang c u im l n gin v t tn km. Tuy nhin n ch c th p
dng c cho cc bnh tt c tnh cht nh lng, ph bin, t gy t vong v cc yu t nguy
c t bin ng.
Nghin cu can thip
Trong nghin cu can thip nh nghin cu tc ng ln tnh hnh v o lng kt qu ca vic
tc ng. Thng thng c hai nhm c so snh,nhm c can thip (th d nh c iu
tr vi mt loi thuc) v nhm khng c can thip (nhm s dng gi dc).
Nghin cu can thip c chia thnh nghin cu thc nghim v nghin cu bn thc nghim
Trong nghin cu thc nghim, cc c nhn c chia ngu nhin thnh (t nht) hai nhm. Mt
nhm c nhn can thip (nhm th nghim) v mt nhm khng c nhn can thip (nhm
chng). Kt cuc ca can thip c tnh t vic so snh kt qu hai nhm.
Nghin cu thc nghim c 3 c tnh:
- Thao tc
- C nhm chng
- Chia nhm ngu nhin: sc mnh ca nghin cu thc nghim chnh l vic chia nhm ngu
nhin gip loi b yu t gy nhiu.
Nghin cu bn thc nghim l nghin cu c s thao tc ca nh nghin cu nhng thiu mt
trong hai c tnh cn li ca nghin cu thc nghim (th d nh khng c nhm chng hay
khng c chia nhm ngu nhin.
Nghin cu thc nghim c th c chia lm 3 loi:
1- Th nghim lm sng: l nghin cu trn i tng bnh nhn. Loi nghin cu bao gm
vic th nghim mt iu tr mi hay mt bin php d phng cc di chng trn bnh
nhn nhm nh gi hiu qu ca vic iu tr hay d phng k trn.
2- Th nghim thc a l vic can thip trn ngi cha c bnh. Loi nghin cu ny ch yu
nh gi cc bin php d phng. nghin cu c tnh xc hp ngi ta thng ch s
dng th nghim thc a nh gi cc gii php can thip d phng cho cc bnh
54
bnh ph bin hay trm trng. Cc th nghim vaccine l mt loi th nghim thc a
ph bin nht.
3- Can thip cng ng tng t nh th nghim thc a nhng c c im l bin php can
thip c p dng cho c cng ng ch khng phi c mt c nhn n l. Can thip
cng ng p dng khi bin php can thip ny ch c th p dng cho quy m cng
ng th d nh vic nh gi hiu qu ca vic ci to v sinh mi trng trong vic
phng chng st rt.
Nghin cu can thip chnh thng c 3 c im quan trng: c vic can thip ch ng v c
hiu cho nghin cu, c nhm i chng v s dng vic phn nhm ngu nhin a cc i
tng vo nhm can thip v hay nhm i chng i chng. Nghin cu can thip khng c
3 c tnh trn c gi l nghin cu bn can thip (quasi experiment). Vic sai lch thng
tin trong nghin cu can thip c th c gim thiu nu vi phng php m n (c ngha l
lm sao cho i tng khng bit loi iu tr ca c nhn mnh) hoc m i (c i tng iu
tr v nh nghin cu u khng bit loi iu tr c thc hin trn tng c nhn). Tuy nhin
tnh cht m ca nghin cu can thip khng phi l yu cu tuyt i.
Do nghin cu thc nghim c chia lm 2 nhm can thip v nhm chng bng phng php
chia nhm ngu nhin, s phn b u yu t gy nhiu trong 2 nhm v hn ch vai tr ca yu
t gy nhiu, c bit kh c mu ln. l l do ti sao nhng bng chng t nghin cu
thc nghim c nh gi cao.
Tnh gi tr v tnh tin cy ca kt qu nghin cu
Tnh gi tr ngha l kt lun ca nghin cu l ng
Tnh tin cy l nu ai s dng cng phng php nghin cu trong cng mt hon cnh s c
kt lun tng t.
Gia tr va chnh xac Gia tr - khong tin cay
Khong gia tr - khong tin cay
55
Cc s o dch t hc
I. M u:
Bi v Dch t hc l khoa hc m t s phn b ca bnh tt v cc hin tng sc khe trong
dn s, cc loi s o s phn b bnh tt l nhng khi nim trung tm ca dch t hc.
II. S o tuyt i v s o tng i
S o tuyt i l s tuyt i ca cc hin tng sc khe v bnh tt:
Th d: trong nm 1997 ti thnh ph H Ch Minh c khong 600 ngi cht v b tai nn giao
thng ng b v 4 ngi cht do cc phng tin giao thng ng thy. y l cc
s o tuyt i. T cc con s ny chng ta c th cho rng giao thng ng b nguy
him hn giao thng ng thy. Nhn xt ny c th nhm ln bi v chng ta cha xt
n quy m ca dn s nguy c.
S o tng i l t s ca hin tng sc khe bnh tt so vi dn s c nguy c c hin tng
sc khe .
Th d: Ngi ta c tnh ti TP H Ch Minh vo nm 1997 c khong 700.000.000 lt vn
chuyn trn ng v 1.000.000 lt vn chuyn bng ng sng. Nguy c b t vong
trn mi lt vn chuyn ng b vo khong 0,87/1.000.000 v nguy c b t vong
trn mi lt vn chuyn l 2/1.000.000. T cc con s ny, chng ta thy vn chuyn
bng ng sng nguy him hn vn chuyn bng ng b
Cu hi: V phng din y t cng cng, c phi dng s o tng i thch hp hn s o
tuyt i. Ti sao?
III. T s, t l, t sut
Do dch t hc s dng cc s o tng i, cc s o thng l mt thng s gm t s v
mu s. Ty theo mi quan h gia t s v mu s cng nh ty theo ngha ca s o, cc
thng s ny c th l t s, t l hay t sut:
T s (ratio) l loi thng s n gin nht do mt t s chia cho mt mu s bt k
a/b
Trong t s, t s khng nht thit l mt phn ca mu s.
Th d: trong dn s ca mt x ngi ta th c khong 49 ngi nam trong dn s 100 ngi.
T s gii tnh = nam:n= 49:51.
T l (proportion) l mt thng s trong t s l mt b phn ca mu s.
Th d: trong dn s mt x gm 100 ngi c 49 ngi nam. T l nam gii trong dn s l
49%.
T sut (rate). t "sut" trong ting Vit cng nh t "rate" trong ting Anh thng ch mt
hin tng c lin quan n thi gian. Th d: li sut: tin li hng thng, sinh sut: s ln sinh
sng xy ra trong mt nm trong mt dn s gm 100 ngi. Th d nu mt x c 5.000 ngi
v sinh sut l 2% th mi nm s c khong 100 tr c sinh v trong 2 nm s c khong 200
tr c sinh. T sut khc vi t l ch gi s t l khng c mi lin h ni ti vi thi gian.
Th d nu ta bit t l nam trong dn s l 49%, ta khng th tin on g v s thay i ca s
ngi nam trong tng lai.
56
IV. S o dch t
A. Tn sut
1. S ca mi mc (Incidence):
L s ln mi va xy ra ca mt bnh, chn thng hay t vong trong dn s nghin cu trong
khong thi gian xc nh
2. S ca hin ang bnh (Prevalence):
L s ngi trong mt dn s xc nh c mt bnh nht nh mt thi im (thng l thi
im iu tra).
3. Minh ha khi nim v bnh tt:
a. Khi nim v s mi mc, s hin ang bnh c minh ha trong hnh 2-1 da trn phng
php c pht minh bi Dorn (1957).
- S mi mc bnh trong khong thi gian mt nm l 4
- S hin ang bnh ti thi im 1/1 l 3
- S hin ang bnh ti thi im 1/9 l 4
4. Mi quan h gia s hin ang bnh v s mi mc:
S hin ang bnh = S mi mc x Thi gian mc bnh trung bnh
H n h 1 . M i n h h o a v e d i e n t i e n b e n h t a t c u a 7 o i t n g A , B , C , D , E , F , G t r o n g s o
1 0 0 o i t n g . n g e n n a m n g a n g l a t h i g i a n m a c b e n h c u a c a c o i t n g v i
d a u c h a m a u l a t h i i e m m a c b e n h v a d a u c h a m c u o i l a t h i i e m k e t t h u c
b e n h .
A
C
B
D
F
E
G
57
B. Nguy c
1. nh ngha
a. Nguy c l t l ngi khng b nh hng u nghin cu v sau vng phi mt bin
c nguy c (cht, bnh, chn thng) trong thi gian nghin cu.
c nguy so dan
co bien ra xay ngi so
c nguy
Nguy c rt hu ch trong o lng (tin on) kh nng mc bnh ca mt c nhn trong mt
khong thi gian nht nh.
b. Hn ch ca nim nguy c:
- Trn l thuyt, ch c dn s nhy cm mi c k trong mu s ca nguy c nhng trong
thc t mu s bao gm tt c mi ngi b phi nhim ch khng ch nhng c nhn nhy
cm.
- Nguy c khng hu ch nu mt c nhn c th mc bnh (c quan tm) nhiu ln hay khi
c t l i tng cng mc bnh ti mt thi im kh cao.
c. Mt s khi nim thng gp c bn cht l nguy c
- T s bnh-vong (case fatality) l t l ngi bnh b cht do bnh . y l ch s ca c
lc.
- T l ngi b nhim trng c triu chng lm sng c gi l tnh sinh bnh (pathogenicity)
ca vi sinh vt.
- T l ngi b phi nhim tr nn b nhim trng c gi l tnh truyn nhim ca vi sinh vt
(infectiousness).
C. T sut
1. nh ngha:
T sut l s bin c xy ra trong mt n v thi gian chia cho dn s nguy c trung bnh.
T sut cn c th c nh ngha l s bin c xy ra chia cho tng thi gian nguy c.
bnh trung c nguy so dan
gian thi v n 1 trong ra xay co bien so
suat t
2. Lin h gia t sut v nguy c
- Nu nguy c c tnh trong thi gian mt nm v mi i tng ch c th c mt bin c
nguy c th s ngi c bin c nguy c s bng vi s bin c nguy c trong 1 n v
thi gian.
- Nu s ngi b nh hng bi bin c nguy c t th dn s nguy c trung bnh s bng vi
dn s nguy c u nghin cu. Khi ta ni t sut s xp x vi nguy c trong mt
n v thi gian. Ni cch khc chng ta c th c tnh t sut bng nguy c trong mt
n v thi gian khi:
- Mi i tng ch c b nh hng bi bin c nguy c nhiu nht mt ln, mi ngi ch c
th c mt ln mc bnh v
- Khong thi gian nghin cu ngn hay i vi bnh him.
58

S o hu qu v s o tc ng
I. Nhc li v s o s xut hin ca bnh: t sut, nguy c v s chnh
S mi mc (incidence) l o lng ca s xut hin ca bnh. S mi mc c th trnh by
di dng s tuyt i hay s tng i. Nhng o s tng i ca s xut hin bnh thng
gp l nguy c, t sut mi mc, hay s chnh.
Nguy c (risk) l xc sut xut hin bnh trong mt khong thi gian nht nh. Do bn cht ca
nguy c l xc sut nn nguy c khng c th nguyn v
0 < nguy c < 1
S chnh (odds) la t s gia nguy c mc bnh v nguy c khng mc bnh
risk / (1 - risk)
S chnh l mt s khng m, s chnh bng 0 khi nguy c bng 0, s chnh bng 1 khi nguy c
bng 0,5 v s chnh tin n v cc khi nguy c bng 1. Nh vy, s chnh cng l thc o
o lng s xut hin ca bnh.
T sut mi mc (incidence rate): nguy c mc bnh tc thi trong mt n v thi gian. Do n
v thi gian c chn l ty , t sut mi mc khng c gii hn v gi tr. Th nguyn ca t
sut mi mc l thi gian
-1
, th d t sut mi ca bnh mch vnh tim ngi c cholesterol
245 mg% l 0,02/nm.
Thng thng, t sut mi mc ca mt bnh thng c gi l t sut ca bnh . Th d, ta
c th ni t sut bnh mch vnh l 0,02/nm nhng ngi c cholesterol 245 mg% ngha
l trong 100 ngi c cholesterol 245 mg% v cha b bnh mch vnh tim, trung bnh c hai
ngi b xut hin bnh mch vnh sau thi gian theo di 1 nm.
II. S o s kt hp - s o hu qu
Bng 2 x 2 c dng t rt lu chng minh s kt hp thng k gia mt yu t nguy c
v s xut hin ca bnh tt. Nhng ch ring s kt hp thng k khng ni ln c tm quan
trng v mt lm sng (hoc y t cng cng) ca mi lin quan nhn qu gia yu t nguy c v
bnh tt. Mt s kt hp d khng c tm quan trng ln nhng u c th c chng minh l
c ngha thng k vi c mu ln.
Khoa hc dch t hc nhn thc c hai vn (1) Trong thc t khng c mt nguyn nhn
n l l nguyn nhn duy nht cho mt vn y t. Mt vn y t lun lun c gy ra bi
rt nhiu nguyn nhn v nhng nguyn nhn ny chng cho ln nhau, ngi ta gi l mng
li nguyn nhn (web of causation) v (2) Ngnh y t khng th gii quyt c mi nguyn
nhn ca mt vn y t cng mt lc m n ch c th gii quyt c tn gc r nu dch t
hc tm ra c v gii quyt nguyn nhn quan trng nht.
V vy, dch t hc xut vic s dng t s v hiu s ca nguy c lm thc o ca s kt
hp gia nguyn nhn v hu qu.
III. S o t s
S o t s thng dng nht l t s nguy c (Risk ratio - RR). T s nguy c l t s ca nguy c
trong nhm phi nhim (r
1
) trn nguy c trong nhm khng phi nhim (r
0
).
RR = r
1
/ r
0
T s nguy c cn c gi l nguy c tng i (Relative risk - RR). T s nguy c ni ln
ngi b phi nhim c nguy c b mc bnh gp bao nhiu ln ngi khng b phi nhim.
Th d:
59
Bng 1 trnh by mt v d rt ra t nghin cu Framingham, trnh by s mi mc bnh mch
vnh tim trong 6 nm theo di ty theo nng cholesterol huyt thanh ban u trn nam gii
tui t 40-59. Nu ta xem nhm c cholesterol huyt thanh <210 mg% l nhm khng phi
nhim, th nguy c mc bnh mch vnh tim nhm khng phi nhim l 0,0352 (iu ny c
ngha l xc sut mc bnh mch vnh tim ngi c cholesterol < 210 mg% trong thi gian 6
nm vo khong 3,5%). Nu ta xem nhm c cholesterol 245 mg% l nhm phi nhim th
nguy c nhm phi nhim l 0,1203 (xc sut ngi c cholesterol 245 mg% b bnh mch
vnh tim trong thi gian 6 nm l 12%). Ta c t s nguy c (RR) l t s ca 2 nguy c trn =
0,1203 / 0,0352 = 3,4. iu ny c ngha l xc sut b bnh mch vnh tim ngi c
cholesterol 245 mg% cao gp 3,4 ln xc sut ngi c cholesterol < 210 mg%.
a tr khng c chng nga vaccine bi lit c nguy c mc bnh bi lit hn a tr c
chng nga t 5 n 10 ln. Ta ni t s nguy c mc bnh bi lit trong nhm khng c
chng nga so vi nhm c chng nga l t 5 n 10.
Nh vy, t s nguy c c lng ln ca hu qu ca yu t nguy c, v do , t s nguy c
l s o ca mnh ca s kt hp gia yu t nguy c v bnh tt. Ta ni, t s nguy c l s
o hu qu hay s o s kt hp. Ngoi t s nguy c, cn c nhng s o s kt hp khc nh t
s t sut (rate ratio), t s chnh (odds ratio), v t s s hin mc (prevalence ratio).
T s t sut thng c dng trong nhng nghin cu on h. i vi bnh tt khng qu ph
bin, t s nguy c bng vi t s t sut v mt con s, do , trong y vn, ngi ta thng dng
ln ln t s nguy c v t s t sut. Khi bnh tng i ph bin th t s nguy c s b sai lch
tin ti gi tr n v v ngi ta cho rng t s t sut l c lng tt hn cho mnh ca s
kt hp.
Th d: Trong s liu ca nghin cu Framingham c trnh by trong bng 1. T s t sut mc
bnh mch vnh tim trong nhm cholesterol cao (cholesterol 245 mg%) so vi nhm c
cholesterol thp (cholesterol < 210 mg%) = 0,0200 / 0,0059 = 3,4, gn bng gi tr ca t s
nguy c c tnh trn.
Trong nghin cu bnh-chng (v c trong nghin cu on h nu mun), ngi ta thng
dng t s chnh c lng nguy c tng i ca vic phi nhim vi mt yu t nguy c.
Ngi ta chng minh ty theo bnh c nghin cu l bnh him hay ph bin v ty theo
c cu ly mu, t s chnh c th c lng cho t s nguy c hay t s t sut v u c th ni
ln mnh ca s kt hp. Vi c cu ly mu c in v RR > 1 th OR ( RR trong trng
hp bnh him v 1 < RR < OR trong trng hp bnh ph bin.
V d:
Trong mt dn s gi thuyt gm 10.000 ngi trong c 4.000 ngi ht thuc l v 6.000
khng ht thuc. Nu chng ta c th theo di nhm ngi ny trong 5 nm lin tc ta c kt
Table 1. S mi mc bnh mch vnh tim trong 6 nm theo di ty theo nng cholesterol huyt
thanh ban u trn nam gii tui t 40-59
cholesterol
huyt thanh
mg/100 ml
S ngi
trong nhm
S ca bnh Nguy c T sut RR Nguy c quy
trch
< 210 454 16 0,0352 0,0059 1,0 0,0000
210 - 244 455 29 0,0637 0,0106 1,8 0,0285
245
422 51 0,1203 0,0200 3,4 0,0851
Tng cng 1333 96 0,0720 0,0120

60
qu sau (Bng 2):
Table 2. Tnh trng b nhi mu c tim sau 5 nm theo di phn theo tnh trng ht thuc l
Nhm ngi B nhi mu c tim trong 5
nm theo di
Khng b nhi mu c tim sau
5 nm theo di
Tng s
Ht thuc 400 3.600 4.000
Khng ht
thuc
120 5.880 6.000
Tng s 520 9.480 10.000
Trong nhng nguyn tc ca nghin cu thng k c in, nh nghin cu ch lp bng 2 2 ri
tnh gi tr
2
, sau c lng xc sut ca sai lm loi 1 (mc ngha p) v quyt nh chp
nhn hay loi b gi thuyt H
0
.
Cc bc tin hnh nh sau:
Gi thuyt H
0
: khng c s lin quan gia ht thuc l v nguy c nhi mu c tim
Chi-square = 311.59, 1 t do do mc ngha p < 0,05
Nh vy ta bc b gi thuyt H
0
. Ni cch khc, c s lin h gia ht thuc l v nhi mu c
tim.
Tuy vy theo dch t hc hin i, li gii trn l khng y , bi v n ch cho cu tr li nh
tnh l c s kt hp gia ht thuc l v nhi mu c tim m khng nu r s kt hp c
ln l bao nhiu. tnh s o kt hp, ta cn nhng tnh ton thm nh sau:
Nguy c nhi mu nhng ngi ht thuc (Risk
1
) = 400/4.000 = 0.1
Nguy c nhi mu nhng ngi khng ht (Risk
0
) = 120/6.000 = 0.02
Nguy c tng i (hay t s nguy c) RR= Risk
1
/Risk
0
=0.1/0.02=5
l nhng s o s kt hp c in trong nghin cu on h. D vy trong nghin cu on
h cng c th dng t s s "chnh".
S "Chnh" nhi mu nhng ngi ht thuc
(Odds
1
) = 0.10/(1-0.10) =400/(4.000-400) = 0.11
S "Chnh" nhi mu nhng ngi khng ht
(Odds
0
) = 0.02/(1-0.02) =120/(6.000-120) = 0.02
T s s "Chnh" nhi mu trong 2 nhm tip xc v khng tip xc
OR= Odds
1
/Odds
0
= (400/3600):120(5880)=(400*5880)/3600/120= 5.44
Ta thy OR RR v OR hi ln hn RR (trong trng hp RR ln hn 1).
Trong nghin cu bnh chng cng c th tnh c OR. V nu khng c sai lch trong nghin
cu th OR tnh c trong nghin cu bnh chng cng bng OR tnh c trong nghin cu
on h. V d minh ha cho iu ny s c trnh by trong bi nghin cu bnh chng.
IV. S o hiu s
Hiu s nguy c (Risk difference) l hiu s ca nguy c nhm phi nhim v nhm khng
phi nhim
RD = r
1
- r
0
Hiu s nguy c ni ln ngi b phi nhim phi gnh chu mt nguy c thng d l bao nhiu.
Th d:
Nu ta xt tr li s liu bng 1 v tm hiu s nguy c nhm phi nhim (nhng ngi c
cholesterol 245 mg%) v nhm khng phi nhim (cholesterol < 210 mg%) ta c:
61
RD = 0,1203 - 0,0352 = 0,0851
Ta ni ngi c cholesterol cao s c mt nguy c thng d b bnh mch vnh tim l 0,0851.
Ni cch khc, loi b nhng nguyn nhn khc, ch ring cholesterol tng cao s to ra nguy c
l 0,0851. Ni thm mt cch khc na, nu mt ngi b cholesterol cao v hon ton khng c
mt yu t nguy c no khc (khng ht thuc l, khng b tng huyt p v.v. ) s c xc sut b
bnh mch vnh tim l 8,5% trong thi gian c theo di l 6 nm.
Ta cng c th tnh hiu s t sut trong nghin cu on h. Tuy vy, hiu s s chnh khng
c s dng bi v n khng c ngha sinh hc.
Phn s nguy c quy trch (Attributable risk fraction) - cn c gi l phn s quy trch l t s
ca hiu s nguy c v nguy c ca nhm phi nhim.
ARF= (r
1
-r
0
)/r
1
= 1 - 1/RR
Phn s nguy c quy trch ni ln rng vic phi nhim chim bao nhiu phn trong nguy c
ca ngi b phi nhim.
V. Bin lun thm v t s nguy c v hiu s nguy c
1. Gi s c mt yu t nguy c l nguyn nhn ca mt bnh tt no (hay bnh tt l
hu qu ca yu t nguy c). Khi , nu c mt qun th b phi nhim vi yu t nguy c v
mt qun th khng b phi nhim th nguy c (hoc t sut mi mc) hai qun th s khc
nhau. Hu qu ca vic phi nhim c th c thy bng s gia tng nguy c (hoc t sut mi
mc) mt qun th khi so snh vi qun th khc. Hai nguy c (hoc t sut mi mc) c th
c so snh bng cch tnh t s hay hiu s ca chng. Tm li, t s nguy c hay hiu s nguy
c c th dng nh gi mnh ca s kt hp gia yu t nguy c v s xut hin bnh, v
nh gi hu qu ca vic tip xc vi yu t nguy c. T s nguy c v hiu s nguy c l s o
s kt hp hay s o hu qu. Nhng n khng th dng nh gi s tc ng ca yu t
nguy c ln dn s. S tc ng ln dn s khng nhng ph thuc vo t s nguy c m cn
ph thuc vo mc ph bin ca bnh v mc ph bin ca yu t nguy c
2. Nu yu t nguy c l nguyn nhn ca bnh tt th t s nguy c v hiu s nguy c s
cho thy s kt hp. Do t s nguy c ln hn n v (RR 1) l iu kin cn, nhng cha
chng minh mi quan h nhn qu.
3. Chn la gia t s hay hiu s ph thuc vo hiu bit ca chng ta vo c ch lm tng
t sut mi mc ca yu t nguy c: nu chng ta ngh yu t nguy c lm nhn ln t sut mi
mc th t s l o lng tt nht (nhng yu t nguy c c tc dng gy bnh phi hp -
Synergic), nu chng ta ngh rng yu t nguy c lm cng thm t sut mi mc th hiu s l
s o lng tt nht (nhng yu t nguy c c tc dng gy bnh cng - Additive).
Th d: Xt vic truyn mu v vt l c quan sinh dc vi t cch l yu t nguy c ca
nhim HIV. Bi v truyn mu l nguy c cng thm v s hin din ca vt l c quan sinh
dc l nguy c phi hp nn ngi ta cho rng nn dng hiu s nguy c nh gi hu ca
dng bao cao su v t s nguy c nh gi hu qu ca dng bao cao su.
4. Trn y, ta trnh by th d v bnh mch vnh tim l hin tng sc khe c s
phn bit rch ri gia bnh v khng bnh (ni cch khc, bnh mch vnh tim c xem l
bin nh phn - ri rc) v ta c th dng t s nguy c (RR) hay hiu s nguy c (RD) nh
gi s kt hp. D vy nu hin tng sc khe l bin lin tc (th d nh tnh trng dinh
dng ca tr hoc huyt p tm thu) ta khng nn dng RR hay RD m nn dng h s hi quy
nh gi s kt hp.
5. Trong trng hp c nhiu mc phi nhim, nh trong th d trnh by bng 1.Ta
phi chn mt mc phi nhim (th d nh cholesterol < 210 mg%) lm nn tng v tnh RR ca
nhng mc phi nhim khc bng cch tnh nguy c mi mc v chia cho nguy c mc phi
nhim nn tng. Tr li v d bng 1, nguy c bnh mch vnh tim mc phi nhim nn tng
la 0,0352. T s nguy c ngi c cholesterol t 210 n 245 mg% l 0,0637 / 0,0352 = 1,8.
62
T s nguy c ngi c cholesterol 245 mg% l 0,1203 / 0,0352 = 3,4.
6. Nhm c chn lm nn tng thng l nhm c nguy c thp nht. Khi c nhiu mc
phi nhim, ngi ta c th chn nhm ng nht lm nhm nn tng lm tng tnh chnh
xc ca c lng.
7. Khi c hai nhm phi nhim v khng phi nhim c th c chia thnh nhng tng
(strata) theo mt bin s khc -th d nh tui - ta c th tnh t s nguy c c hiu theo tng
(stratum specific ratio) bng cch xem xt nguy c tng tng ring bit.
Th d: Bng 3 trnh by t sut cht do bnh mch vnh tim nhng ngi ht thuc v khng
ht thuc theo nhm tui. nhm tui 35-44, ngi ht thuc c nguy c b cht do bnh mch
vnh tim cao gp 5 ln ngi khng ht thuc, trong khi nhm tui t 55-64 nguy c tng
i ch khong 1,5 ln.
8. C th tnh t s t sut tm tt (summary rate ratio). C th tnh t s t sut tm tt bng
cch ly trung bnh cng nhng t s t sut c hiu theo tng. Nhng ngi ta thng gn
trng s (weight) cho t s t sut c hiu. C nhiu cch gn trng s, hai cch ph bin l
nguy c tng i tm tt ca Mantel-Hanenszel v t s t vong chun ha (Standardized
mortality ratio - SMR).
9. Hiu lc vaccin (vaccine efficacy - VE) l t l s mi mc c gim bt do vic chng
nga vaccin. Nu xem nhm khng tim chng vaccin l nhm khng phi nhim c t sut mi
mc l r0 v nhm c tim chng c t sut mc bnh r
1
, th
VE = 1 - RR = 1 - (r
1
/ r
0
)
Nu ta c t l chng nga trong dn s P
N
v t l chng nga trong nhng trng hp bnh P
C
ta c th c tnh hiu lc vaccin theo cng thc sau:
VE = (P
N
- P
C
) / [P
N
(1-P
C
)]
Th d: Chng trnh tim chng m rng c thc hin Huyn A v ngi ta bo co rng
90% a tr di 3 tui c tim chng phng si (P
N
= 0,9). bnh vin ngi ta thy
rng 70% a tr b si di 3 tui c chng nga si (P
C
= 0,7). VE c c tnh s l
74%.
VI. S o tc ng
Mt s yu t nguy c c nguy c tng i cao cha hn c tc ng quan trng ln sc khe
ca cng ng. Th d, tnh trng v toan d dy l mt yu t nguy c ca bnh dch t (RR
t 10 n 20) tuy vy, tnh trng v toan d dy ch gp phn rt nh trong nhng case bnh
Table 3 T sut cht do bnh mch vnh tim nhng ngi ht thuc v khng ht thuc theo
nhm tui
Tui T sut ngi ht
thuc
T sut ngi
khng ht thuc
T s t sut
35-44 0,61 0,11 5.5
45-54 2,40 1.12 2,1
55-64 7,20 4,9 1,5
65-74 14,69 10,83 1,4
75-84 19,18 21,20 0,9
85 + 39,52 35,93 1,1
Tnh chung 4,29 3,30 1,3
63
dch t cng ng. Thc vy, bnh vin truyn nhim chng ta rt him khi (c th ni l
khng bao gi) gp c mt bnh nhn dch t do tnh trng v toan m chng ta thng gp
bnh nhn b bnh dch t do khng c ngun nc sch. V vy ngi lm y t cng cng
khng quan tm lm n tnh trng v toan d dy nh l mt yu t nguy c ca bnh dch t,
bi v vic loi b hon ton yu t nguy c ny ch c th gim mt phn rt nh s case bnh
dch t. Ta ni yu t nguy c ny c tc ng nh ln bnh trng ca dch t. lng ha tc
ng ca yu t nguy c ta s dng nguy c quy trch dn s v phn s nguy c quy trch dn
s.
Hiu s nguy c dn s (Population Risk Difference - PRD) l hiu s gia nguy c (hay t sut)
ca ton b dn s r v nguy c (hay t sut) ca nhm khng phi nhim (r0).
PRD = r - r
0
Nu ta k hiu p l t l trong dn s b phi nhim th
r = pr
1
+ (1 - p)r
0
Do
PRD = pr
1
+ (1 - p)r
0
- r
0
= pr
1
+ r
0
- pr
0
- r
0
= pr
1
- pr
0
= p(r
1
- r
0
)
Nguy c quy trch dn s ni ln nguy c thng d gy nn do s hin din ca yu t nguy c
trong dn s. Nguy c quy trch dn s l tch s ca t l dn s b phi nhim v hiu s nguy
c. Tnh trng v toan d dy c nguy c quy trch dn s thp bi v t l dn s b phi nhim
vi yu t nguy c (t l dn s b v toan d dy) thp.
Phn s nguy c quy trch dn s (Population Attributable Risk Fraction - PAF): l t l ca
nhng trng hp b bnh trong ton th dn s nghin cu c th quy kt cho s phi nhim
(vi gi nh l s kt hp nhn qu). Phn s nguy c quy trch dn s cn c gi l phn s
cn nguyn (etiological fraction - EF), phn trm nguy c quy trch dn s (percentage
population attributable fraction) hay phn s quy trch (attributable fraction - AF)
PAF = PRD / r = p (r
1
- r
0
)/ [pr
1
+ (1 - p)r
0
] = p(RR - 1)/[pRR + 1 - p]
= p(RR - 1)/[p(RR - 1) + 1]
Th d:
1. Gi s phn s nguy c quy trch dn s (PAF) tng ng gia ht thuc l v t vong
do ung th phi l 0,80. Kt qu ny c ngha l 80% nhng t vong do ung th phi l do ht
thuc l. Hn na, ta c th tin on nu ht thuc l b loi b hon ton, t sut t vong do
ung th phi s gim i 80%
2. Xem li s liu c trnh by trong bng 2. Ta tnh c nhng s o tc ng nh sau:
Nguy c nhi mu trong dn s Risk =520 / 10.000 = 0.052
Hiu s nguy c dn s PRD = 0.052-0.02 = 0.032
= Risk
0
p (RR-1) = 0.02 x 0.4 x (5-1) = 0.032
Phn s nguy c quy trch dn s PAF = 0.032/0.052 = 0.62 = 62%
3. i vi bnh him, ta c th tnh c PAF da trn kt qu ca mt nghin cu bnh
chng (lu rng i vi bnh him OR l c lng kh tt cho RR). Da vo kt qu c
trnh by trong bng 4, ta c th tnh c:
RR OR = 40 320 / (80 60) = 2,67
T l phi nhim trong dn s = t l phi nhim trong nhm chng = 80/400 = 0,2
PAF = 0,2 (2,67 - 1)/[0,2 (2,67 -1) + 1] = 0,25
64
Table 4. S cc i tng chia theo tnh trng phi nhim v tnh trng bnh trong mt nghin cu
bnh chng (S liu gi lp)
Phi nhim Khng phi
nhim
Tng s
Bnh 40 60 100
Chng 80 320 400
Tng s 120 380 500
VII. Bn lun thm v phn s nguy c quy trch dn s
1. Vic s dng phn s nguy c quy trch i hi mt s nhng gi nh: (1) s kt hp
gia yu t nguy c v bnh tt l nhn qu (2) RR v p c o lng chnh xc (3) vic loi
b nguy c loi b hon ton nguy c do n gy ra (iu ny cha chn ng bi v ngi b
thuc l s khng th c nguy c b ung th phi bng ngi cha tng ht thuc l) v (4) c
th loi b hon ton yu t nguy c.
2. Cng thc tnh ton ny ch ng khi p dng cho mt yu t nguy c duy nht v nhng
yu t nguy c khng tng tc vi nhau. Nu p dng cho nhiu yu t nguy c c th xy ra
trng hp tng s nhng phn s nguy c quy trch dn s ln hn 100%.
65
Phng php thu thp s liu
C nhiu phng php chnh thu thp s liu: hi cu h s ti liu, quan st, s dng b cu
hi t in, phng vn mt i mt, tho lun nhm tp trung nh s dng nhm danh nh
(nomial group), k thut delphi, v bn (mapping). Cn phn bit phng php thu thp s
liu v cng c thu thp s liu (cng c thu thp s liu ch l mt phn ca phng php). Th
d b cu hi ch l cng c thu thp s liu v c th s dng trong nhiu phng php thu thp
s liu khc nhau nh b cu hi t in, phng vn c nhn mt i mt, phng vn nhm, v.v.
Nhn chung c hai k thut nghin cu chnh: nghin cu nh tnh v nghin cu nh lng.
Nghin cu nh tnh nhm mc ch tm hiu bn cht, nguyn nhn v hu qu ca vn ca
vn nghin cu ( tr li cho cc cu hi ti sao, nh th no) trong khi nghin cu nh
lng nhm tm hiu quy m ca vn (Trong mt nghin cu c th kt hp c hai loi k
thut nghin cu nh tnh v nh lng) Do cc phng php thu thp s liu s cho cc thng
tin khc nhau, vic chn la k thut thu thp ph hp phi da trn bn cht ca nghin cu l
nh tnh hay nh lng.
S dng thng tin sn c
S dn thng tin sn c cn c gi l phng php hi cu. N c u im l t tn km v
mt thi gian v ngun lc v cho php nh gi cc thng tin trong qu kh. Tuy nhin do bn
cht ca s liu hi cu l khng s dng cho mc ch nghin cu, cht lng s liu thng
thp, cc bin s khng c thu thp khng hng nh v thng khng c cc bin s m
nh nghin cu quan tm (c bit l yu t gy nhiu).
ci thin tnh hng nh ca s liu c c nh hi cu, nh nghin cu phi s dng cc
cng c h thng ho cc bin s cn thu thp nh bn kim hay s ci.
Quan st
Chn lc, quan st v ghi nhn hnh vi hay c tnh ca con ngi, vt th hay hin tng. Cc
th d ca quan st c th bao gm: quan st hnh vi ra tay cc cn b y t trc khi lm thu
thut y khoa, o lng huyt p v ly thn nhit ca bnh nhn, nh gi phng tin thanh
kh trng ti khoa phng, theo di din tin lm sng ca bnh nhn b shock nhim trng. Khi
quan st hnh vi con ngi trong cc hot ng x hi, qu trnh quan st c th chia thnh quan
st c tham gia v quan st khng tham gia.
Cc u im ca phng php quan st
Cho thng tin chi tit c lin quan tnh hung: th d gi s chng ta mun quan st hnh
vi ra tay ca iu dng trc khi thay bng cho bnh nhn, chng ta c th c thng
tin v mc v khun ca dng c lm th thut
Cho thng tin nm ngoi b cu hi: C nhng thng tin chng ta khng d nh thu
thp trong b cu hi (hoc kh c th thu thp c chnh xc nh b cu hi) th d
nh thng tin v k thut s dng bn chi trong khi ang ra tay c ng hay khng c
th c c mt cch chnh xc v n gin nh quan st
Cho php kim tra tnh tin cy ca tr li cu hi: Nu chng ta quan st mt ngi iu
dng ra tay trc khi lm th thut, thng tin ny s ng tin cy hn l vic phng
vn h c ra tay hay khng? Ra tay trong bao lu? Ra tay c ng k thut hay
khng?
Khuyt im
Sai lch do quan st: y l sai lch do ngi quan st. Phng php khc phc l Cn
o to ng mc nhng tr l nghin cu
66
HW Hawthorne: y l sai lch do ngi (hay hin tng) c quan st s thay i
hnh vi khi bit rng ang c quan st. iu ny c th khc phc bng cch quan st
nhng khng cho bit nhng iu ny c th c th gp phi mt s vn v o c.
o lng l quan st s dng mt thang o xc nh t trc
Phng vn mt i mt v b cu hi t in
Phng php phng vn c th p dng cho tng i tng hay cho mt nhm ngi. Phng
vn tng ngi c dng c c nhng kt qu nh lng; phng vn mt nhm ngi
nhm mc ch hiu r suy ngh ca ngi dn v kin ca h trong iu kin cuc sng
thc t: phng php ny thng c dng trong cc nghin cu nh tnh.
Phng vn c th c tin hnh vi cc mc cu trc khc nhau. Phng vn c gi l c
cu trc nu n tun th theo mt k hoch cht ch v c hi theo nhng cu hi son
sn. Phng vn bn cu trc l phng vn c tun th nhng khng cht ch theo k hoch nh
trc, cu hi cng c th c ci bin sao cho ph hp vi i tng. Phng vn c gi l
khng cu trc khi n khng theo mt k hoch no c v vic t cu hi l ty tin: phng vn
khng cu trc thng c coi l t c tnh khoa hc.
Bng 1. u v khuyt im ca phng php s dng b cu hi v phng vn.
Khuyt im u im
K hoch phng vn gip
nhngi phng vn hi cc
cu hi
- Tn km, cn phi s gip
ca chuyn gia.
- Sai lch do ngi phng
vn
- Thng tin ring t c th b
sai lch
- Ph hp vi i tng c
trnh vn ho thp
- T l tr li cao hn
- C th khu gi nhiu chi
tit hn.
- C s kim sot tt hn i
vi cu tr li (c th lm
sng t cu hi)
B cu hi t in - T l tr li thp hn
- Kh khu gi cu tr li chi
tit
- Kim sot km hn cu tr
li
- Khng dng cho ngi c
trnh vn ho thp
- R tin hn
- t nhy cm vi sai lch do
ngi phng vn
- C th dng bu in gi
b cu hi.
Phng vn c cu trc, bn cu trc hay thu thp s liu bng b cu hi t in u cn phi s
dng b cu hi. B cu hi (questionnaire) l mt vn bn gm nhiu cu hi dng thu thp
s liu. Vic son tho b cu hi tt l mt trong nhng khu then cht m bo cht lng
s liu thu thp c.
Thit k b cu hi
Nhng im cn xem xt
Cn phi xem xt b cu hi s dng cho mc ch g (dng cho b cu hi t in hay b cu
hi phng vn mt i mt, s dng cho k thut nghin cu nh tnh hay nh lng, s
dng cho ch no, v.v.), s dng trn i tng no, nhng i tng ny c trnh hc vn
nh th no v b cu hi ny s dng cho c mu bao nhiu.
B cu hi thng c phn loi l b cu hi c cu trc hay b cu hi mm do. Thng
67
thng b cu hi c cu trc c s dng cho nghin cu nh lng, s dng my tnh
phn tch v s dng cho c mu ln, b cu hi c tnh mm do c s dng ch yu cho
nghin cu nh tnh nhm hiu su hn v mt vn cha bit v khng ph hp phn tch
thng k trn my tnh.
Cu trc b cu hi
Cu trc b cu hi bao gm qu trnh thit k v tin hnh b cu hi
Vic thit k b cu hi bao gm cc bc sau:
1. Ni dung: Nh nghin cu xc nh nhng thng tin cn thu thp: nhng thng tin ny bao
gm nhng bin s c lp, bin s ph thuc v cc bin s gy nhiu. Vic ny cn rt nhiu
suy ngh v tho lun. Cm hng trong vic chn la nhng thng tin cn thit xut pht t mc
tiu ca nh nghin cu, t vic tho lun vi nhng ngi khc v nhng ngun khc. Kt qu
ca giai on ny l mt danh sch nhng thong tin cn c chuyn thnh dng cu hi.
2. t cu hi: S phc b cu hi. Nh nghin cu xut pht t danh sch nhng thng tin cn
thu thp v s phc b cu hi. Nh s c tho lun su hn, vic t cu v thit k b cu
hi l rt quan trng trong vic t c tnh gi tr ca thng tin. Nu b thit k c thit k
km, cu tr li s khng phn nh chnh xc tnh trng thc t ca nh nghin cu. C hai dng
thc cu hi chnh, cu hi m v v cu hi. Trong cu hi m khng c nhng cu tr li nh
trc. Trong cu hi ng c nhiu cu tr li nh trc m ngi c hi ch vic la chn
trong . u v khuyt im ca nhng cu tr li l nh sau:
Khuyt im u im
Cu hi m - C tnh cu trc thp
- Kh m ha cu tr li
c th phn tch thng k
- Tn nhiu thi gian
- Kh tr li hn
- C nhiu chi tit hn
Cu hi ng - C t chi tit hn
- C th khin ngi c
hi kh chu
- C tnh cu trc cao
- Cu tr li d m ha hn
- Tn t thi gian hn
Tuy nhin nu nghin cu nh tnh, ngi ta thch dng cu hi m hn bi v n cho php
ngi tr li c th trnh by bng ngn t ca h. Cn vic dng b cu hi trong nghin cu
nh lng ngi ta nhm vo tin li v tc ch khng ch trng n phn tch su.
iu quan trng trong danh sch nhng cu tr li cho cu hi ng cn phi c thit k cn
thn. Nu phm vi cc cu tr li b gii hn th cu tr li s b sai lch.
Thang o Likert v thang o buc la chn
Mt loi cu hi ng c bit c gi tr l thang o Likert. Thang o Likert do mt nh tm l
hc ngi M tn l Likert pht minh. Thang o ny c ba u im chnh:
- Lm d dng hn vic xy dng cu hi xc nh thi ca ngi dn
- Thun tin trong vic tr li, phn tch cu hi
- Cho php phn bit nhiu mc khc nhau ca thi .
Thang o Likert truyn thng l mt cu hi ng gm mt mnh v c 5 la chn: c la
chn dng tnh, la chn m tnh v la chn trung bnh. Th d:
Bng 3. Dng thc Likert v dng thc buc la chn
68
Q1. Bc s ca trm y t lun lun gii thch vic iu tr cho ti (khoang mt la chn)
Rt ng 1
ng 2
Khng kin 3
Khng ng 4
Rt khng ng 5
Q2. Bc s ca trm y t lun lun gii thch vic iu tr cho ti (khoang mt la chn)
Rt ng 1
ng 2
Khng ng 3
Rt khng ng 4
Tuy nhin nu nhng ngi dn c v e d khi dng cu tr li ph nh th chng ta c th s
dng thang o buc la chn. Trong cu hi buc la chn khng cho php ngi tr li tr li
khng kin v cu tr li ny trnh tnh trng ngi tr li lun lun ba phi (acquiescent
response mode). (Trong bng trn cu hi 1 l thang o Likert c in. Cu hi 2 l thang o 4
im buc la chn).
Bng 4. u v khuyt im ca dng thc Likert v buc la chn
Dng thc tr li u im Khuyt im
Likert Lun lun cho php tr li trung
tnh
Tr li ba phi
Buc la chn Ngi tr li phi chn hoc ng
hoc khng ng
Khng cho php tr li ba phi
3. Sp xp cu trc b cu hi:
B cu hi thng thng c cu trc nh sau:
1. Phn gii thiu: phn gii thiu m t mc ch ca nghin cu, thng tin cn thu thp
v cch s dng b cu hi. N cng trnh by cho ngi c hi l thng tin ny s
c gi kn hay khng?
2. Thng tin v dn s hc: thng thng chng ta cn phi thu thp thng tin v dn s
hc ca ngi c phng vn nh tui, gii tnh, ngh nghip, hc vn, v.v. Chng ta
nn a thng tin ny ln u bi v n d tr li v ng vai tr "lm nng" cho vic hi
nhng thng tin tip theo.
3. Cu hi v s kin: Cu hi v s kin d hi (v tr li) hn cu hi v kin nn
thng c t trc.
4. Cu hi v kin
5. Phn kt thc v hng dn gi tr li b cu hi (nu s dng b cu hi t in).
Phn kt thc l phn cm n ngi c phng vn v s hp tc ca h v cung cp
thng tin h c th gi tr b cu hi.
Trong b cu hi t in nn trnh nhng cu trc phc tp nh "Nu bn tr li c
cu 6 v tr li khng cu tr li 9, xin tr li cu 10 nu khng xin tr li cu 11".
4. Xy dng hnh thc b cu hi
5. Tin hnh th b cu hi: Cn tin hnh th b cu hi vi mt nhm nh nhng ngi m ta
s tin hnh nghin cu v trn ng nghip lm sng t b cu hi v pht hin cc vn .
6. Son li b cu hi: Nh vo vic tin hnh th cc b cu hi chng ta c th pht hin c
69
vn v cn phi s cha chng bng cch son li b cu hi. Nu vn nay l nghim
trng, chng ta cn phi lp li vic th b cu hi. Nu vn l nh th nh nghin cu ch
cn thay i v c th tin hnh nghin cu trn quy m thc s.
7. Tin hnh b cu hi. Sau khi b cu hi hon chnh, chng ta s tin hnh b cu hi trn
dn s nghin cu. Cc tr li s c phn tch theo mc tiu ca nghin cu.
Cch dng t v vic thit k cu hi
Vit c mt cu hi tt l mt ngh thut v tn nhiu thi gian. c c mt cu tr li
c gi tr v ng tin cy chng ta phi c cch dng t trong cu hi tt. Nhng sai lm cn
phi trnh l:
Cu hi 2 ni dung: Th d "ng c thch cch i x ca bc s v cc iu dng trong bnh
vin hay khng". Nhng cu hi nh th ny cn c tch ra ngi tt li c th nhn thc
cu hi mt cch r rng hn.
Cu hi m h: Th d i vi hc sinh ph thng ngi gi l ngi trn 30 tui, nhng i
vi ngi 50 tui ngi gi l ngi trn 60 tui.
Trnh dng t qu chuyn mn: Th d "Trong nh b c ai b bnh Trisomy 21 hay khng?"
Trnh nhng cu hi gi : "Mi nm ng (hoc b) i khm rng my ln?". Cu hi ny khin
cho ngi c gi c cm gic rng mi ngi u khm i khm rng v cm thy rt kh
khn khi tr li "Khng bao gi ti i khm rng". hoc "B a chu i khm u nu chu
b tiu chy?"
Hn na cng cn lu , ngay c khi cu hi khng gi cng c th b sai lch, ty thuc vo
cch s dng b cu hi. Th d nu chng ta hi kin ca ngi dn v trm y t m chng ta
li c nhn vin trm y t i phng vn th chc chn cu tr li s b sai lch.
70
Ly mu iu tra
Mc tiu:
Su khi nghin cu bi ny, hi tho vin c kh nng:
(i) Phn bit c phng php ly mu xc sut v ly mu khng xc sut
(ii) Lit k 5 s ly mu xc sut thng dng c v cc u khuyt im ca n
(iii) Trnh by c cc bc tin hnh ca 5 s ly mu xc sut
(iv) Lp c mt danh sch dn s nghin cu bng cch rt chn mu ngu nhin n.
i cng v phng php ly mu:
Trn nguyn tc, chng ta ch c th c nhng kt lun c gi tr v mt dn s no nu
chng ta kho st hon ton dn s . Tuy vy, iu ny s gy ra mt s nhng hn ch v
ngun ti nguyn v v vn v o c. Mt iu may mn l nhng phng php thng k
s cho php chng ta c th rt ra nhng kt lun c gi tr v dn s (vi mt tin cy nht
nh) m ch cn kho st mt phn dn s . Phng php ly mu l phng php rt chn
mt phn ca dn s sao cho vic kho st mu cho php cho php chng ta rt ra nhng kt
lun v dn s. Nhng nguyn tc thng k i hi mt mu c gi tr khi mu c kch thc
ln ( c mu) v mu i din cho dn s
C nhiu phng php m bo tnh i din ca mu: Chng ta c th dng trc gic kt
lun v tnh i din ca mu. Th d nh chng ta c th cho rng huyn An Ph tnh An giang
l i din cho vng sinh thi l lt ca vng ng bng sng Cu Long. Tuy nhin tnh i din
theo s nh gi trc gic c th khng c tt c mi ngi ng . Mt cch khc tt hn
m bo tnh i din bng cch chn mu xc sut.
Mu xc sut l mu rt t dn s theo cch sao cho mi phn t trong dn s u c mt xc
sut c a vo mu. Nm phng php chn mu xc sut thng c dng ph bin nht
trong nhng cuc iu tra a phng hay c quy m nh l:
1. Ly mu ngu nhin n (Single random Sampling)
2. Ly mu h thng (systemic sampling)
3. Ly mu phn tng (Stratified sampling)
4. Ly mu cm (Cluster sampling)
5. Ly mu nhiu bc (Multistage sampling)
Trc khi tin hnh ly mu, trc tin ta cn phi xc nh n v nghin cu. n v nghin
cu (study unit) l n v cn bn nht hay nh nht m cuc nghin cu quan tm. Trong cuc
iu tra, n v ly mu l ni m ngi nhn vin iu tra phi n thm ving phng vn,
khm lm sng v thu thp cc thng tin khc. n v nghin cu c th l mt bnh nhn, mt
h gia nh, mt ngi nh, mt lng, mt x hay c th l mt n v hnh chnh ln hn. Tp
hp tt c nhng n v nghin cu hp l trong dn s c gi l khung mu (sampling
frame).
Th d: Trong nghin cu v trng lng trung bnh ca tr s sinh trong nm 1997 ca Qun
11, thnh ph H Ch Minh, n v nghin cu l nhng a tr s sinh. Khung mu l tt c
cc a tr s sinh sinh trong nm 1997 ca cc gia nh c ng ti Q11, thnh ph H Ch
Minh.
Trong nghin cu v t l s dng cc bin php sinh k hoch huyn Chu thnh tnh Cn
th. n v nghin cu l cc cp v chng. Khung mu l tt c cc cp v chng c ng ti
huyn Chu thnh, tnh Cn th.
Trong nghin cu v s h c cu tiu hp v sinh Tnh Sc trng. n v nghin cu l ngi
71
nh. Khung mu l tt c cc ngi nh trong tnh Sc Trng.
Cc phng php ly mu xc sut:
1. Mu ngu nhin n:
Mu c c mu n c rt t trong dn s c N phn t sao cho mi cch ly mu c n u c
mt xc sut la chn nh nhau, mu c gi l mu ngu nhin n.
Phng php ly mu cn c chia theo 2 loi: phng php ly mu c hon li v ly mu
khng hon li. Trong phng php ly mu hon li,mt phn t sau khi c rt chn a
vo mu vn c kh nng c rt chn thm - nh vy, mt phn t c th lm i din cho
dn s 1, 2, 3 hay nhiu hn ln. Trong phng php ly mu khng hon li, nhng phn t
c rt chn ri s khng c chn mt ln na. Do mt phn t c th c a vo mu
ti a 1 ln.
c th ly mu nhin n, trc tin ta cn xy dng danh sch cc n v nghin cu trong
dn s (khung mu). Mi tn trn danh sch phi c mt con s v con s ny khng c dng
cho cc tn khc.
Phng php chn mu ngu nhin n bng cch rt thm:
Ct giy thnh nhng hnh vung ln vit (thng dng gy vung c cnh t 4 n 5
cm). mnh giy u ghi 1, mnh giy th nh ghi 2, trn mnh giy th ba ghi 3 v tip
tc nh th cho n s cui cng trong bn danh sch iu tra. Sau khi gp k v ring r cc t
giy khng ai c th nhn thy s. t tt c cc mnh giy gp vo hp v lc k vi ln.
Khi lc xong, mt ngi no rt nhng mnh giy gp ty theo yu cu ca c mu.
M cc mnh giy c rt v chn trong bn danh sch iu tra nhng tn c s ging vi
s trn t giy c rt chn.Cn lu : Mnh giy ch c mt s, s trn t giy phi tng ng
vi s trong danh sch khng thm s no v bt s no.
Chn s ngu nhin n dng bng s ngu nhin
Cch dng bng s ngu nhin
a s cc bng s ngu nhin gm nhiu khi, mi khi c 5 s, mi s c 5 ch s. Nhng s
ny c th c theo bt k th t no, ln hoc xung theo ct hay qua hay qua tri ca hng.
Ngi ta chn cc s trong bng ny v tip theo a vo nghin cu nhng tn trong danh
sch c s trng vi s c chn. i khi s ngu nhin c bt gp 2 hay nhiu ln nhng
khi ngi nghin cu b qua s ny. i khi ngi c c s trong bng s ngu nhin ln
hn s ln nht c trong danh sch (ngoi danh sch, "ln qu c th mc") th ngi nghin
cu cng khng xt n s ny.
Thao tc s dng cc bng s ngu nhin:
Bc 1:
Xc nh cc ch s c trong s ln nht ca bn danh sch iu tra. Th d, nu c 317 i
tng trong khung mu, s ln nht l 317 v s ny c 3 ch s.
Bc 2:
Bng ch s ngu nhin thng cha 5 ch s, nh vy n thng ln hn cn thit cho cc
cuc iu tra. Nhng s ny c th bin i thnh s nh hn bng cch loi b mt s cc ch
s. Th d nu ta cn 3 ch s, th mt s 5 ch s (nh 44983) c th tr thnh s c 3 ch s
bng nhng phng php sau:
(i) loi b 2 ch s cui (tr thnh 449)
(ii) loi b ch s u v ch s cui (tr thnh 498)
(iii) loi b 2 ch s u (nh 983)
72
Tt c 3 s ny u l nhng s ngu nhin 3 ch s hp l
Lu : Chng ta c th tm mt bng s ngu nhin bng cch tra cu trong sch thng k.
Chng ta cng c th to ra bng s ngu nhin bng cch dng chng trnh Epi-Info. Trc
tin chng ta vo chng trnh Epitable, chn trnh n Sample ri chn trnh n con Random
number table (Bng s ngu nhin). Khi trn mn hnh s c kt qu nh sau
Chng ta nhp vo s cc s ngu nhin m chng ta mun to ra (How many random
numbers): th d nh 60 v nhp vo s cc ch s c trong s ngu nhin (How many digits
per number), th d nh 3, chng ta s c kt qu sau.
Bc 3:
Chn mt s c ch s mong mun. Chn i tng tng ng trn bn danh sch iu tra
a vo nghin cu tr khi:
(i) s c chn c chn t trc
_ Describe Compare Study Sample Probability Setup
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_________+----------------------------------------------------------+___________
_________ +-[_]------- Random number table generator ------------+___________
_________ ___________
_________ How many random numbers 550 ___________
_________ How many digits per number 5 ___________
_________ ___________
_________ ___________
_________ Calculate _ Reset _ Quit _ ___________
_________ ____________ ____________ ____________ ___________
_________ ___________
_________ +------------------------------------------------------+___________
_________+----------------------------------------------------------+___________
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________
________________________________________________________________________
F1-Help F3-Move F4-Zoom F5-Print F6-Next F9-_ F10-Quit Mem:224824
_ Describe Compare Study Sample Probability Setup
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_________+----------------------------------------------------------+___________
_________ +----------- Random number table generator ------------+___________
_________ ___________
_________ How many random numbers 60 ___________
_____+-[_] Files Edit Search []-+_____
_____454 712 771 345 042 124 978 077 899 904 914 680 374 784 925 _____
_____133 359 974 535 150 661 443 010 944 509 897 462 692 565 277 -_____
_____487 622 044 787 542 892 801 795 586 689 510 109 682 209 261 ______
_____456 577 455 221 199 460 010 198 588 416 215 216 098 291 423 ______
_____ ______
_____ ______
_____ ______
_____ ______
_____ ______
_____ _____
_____+----- 5:2 ------________________________________________________-+_____
__________________________________________________________________________
________________________________________________________________________
F1-Help F3-Move F4-Zoom F5-Print F6-Next F9-_ F10-Quit Mem:223680
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(ii) S c chn ln hn s ln nht c trong danh sch.
Bc 4:
Kho st s bn cnh trong bng s ngu nhin v tin hnh nh trong bc 2 v 3, s tip theo
c th c chn bt k ch no trong bng s ngu nhin. Cch n gin nht l i xung dc
theo ct (nu ht ct ny th li m qua ct bn cnh) cho n khi s nghin cu c chn t
danh sch iu tra bng vi s mu cn thit. im cn lu l chn hng v ct u tin phi
ngu nhin.
Chn mu ngu nhin dng chng trnh Epi-Info
Trc tin chng ta vo chng trnh Epitable, chn trnh n Sample ri chn trnh n con
Random number list (Bng s ngu nhin). Khi trn mn hnh s c kt qu nh sau (Xem
hnh 3).
Nu chng ta mun c danh sch gm 50 s ngu nhin trong phm vi t 1 n 457 ta nhp gi
tr 30 vo How many radom numbers; 1 vo Minimumrange of numbers v 457 vo
Maximum range of number. Ta s c kt qu sau:
_ Describe Compare Study Sample Probability Setup
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_________+--+-[_]-------- Random number List generator ------------++___________
_________ ___________
_________ How many random numbers 100 ___________
_________ Minimum range of numbers 0 ___________
_________ Maximum range of numbers 1000 ___________
_________ ___________
_________ [ ] Drawing with replacement ___________
_________ ___________
_________ Calculate _ Reset _ Quit _ ___________
_________ ____________ ____________ ____________ ___________
_________ ___________
_________+--+------------------------------------------------------++___________
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________
________________________________________________________________________
F1-Help F3-Move F4-Zoom F5-Print F6-Next F9-_ F10-Quit Mem:224504
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Nh vy chng ta s chn cc i tng s 6, 10, 15, 22, ...., v 449 trong khung mu a
vo mu.
u v khuyt ca phng php ly mu ngu nhin n:
Phng php ly mu ngu nhin n i hi phi c danh sch ca ton b dn s kho st.
Danh sch ny c th khng c hoc c nhng khng hon ton v li thi. Nu khng c c
danh sch hay chi ph lp danh sch rt tn km th khng th s dng phng php ngu nhin
c. y l khuyt im chnh ca phng php ly mu ny.
Tuy vy, khi c hay khi c th lp danh sch ca ton b dn s mt cch d dng th phng
php ny l phng php ly mu n gin v c tnh i din cao.
2. Phng php ly mu h thng:
Thay v rt chn ngu nhin ngi ta c th chn nhng i tng c mt khong cch nht
nh, phng php ny c gi l phng php rt chn h thng. Th d, ly mu h thng l
chn cc i tng mang s 8, 17, 26, 35, 44, 53, ... vo mu. Phng php ly mu h thng
cng c gi tr nh lymu ngu nhin nu khng c tnh tun hon ca cc i tng. Tuy vy,
cn bit rng phng php mu ngu nhin n lun lun tt hn bi v n khng cn thit gi
nh ny. Phng php ly mu h thng c bit c gi tr khi chng ta khng th c c ton
b danh sch ly mu vo thi im ly mu. Th d nh chng ta c th ly mu h thng
chn nhng bnh nhn c s h s nhp vin cch nhau mt khong nht nh.
3. Phng php ly mu phn tng
Ly mu phn tng c dng khi dn s bao gm cc nhm khc bit hay tng (strata), khc
nhau v cc c tnh nghin cu v bn thn s khc bit ny cng cn quan tm. Nhng th d
thng gp l cc nhm tui, nhm gii tnh hay nhng vng a l hay sinh thi khc nhau
trong quc gia. Mt mu ngu nhin n c rt ra t mi tng m bo rng chng i
din. c lng chung cng s chnh xc hn da vo phng php ly mu ngu nhin n
khng xt n cu trc ca cc nhm nh trong dn s. Chin lc thng ddng l chn cc c
nhn trong tng vi t l nh nhau, ngha l c cng chung mt phn s ly mu (sampling
fraction) cho cc tng. D vy, i khi cng cn phi thay i c mu ca mi tng khng
qu nh.
_ Describe Compare Study Sample Probability Setup
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_________+--+------------ Random number List generator ------------++___________
_________ ___________
_________ How many random numbers 50 ___________
_________ Minimum range of numbers 1 ___________
_____+-[_] Files Edit Search []-+_____
_____ 6 10 15 22 35 43 _____
_____ 50 80 81 83 105 105 -_____
_____ 126 157 158 164 191 194 ______
_____ 215 221 224 227 234 236 ______
_____ 243 243 255 256 283 285 ______
_____ 295 319 324 326 333 343 ______
_____ 347 355 369 377 378 384 ______
_____ 393 414 421 434 435 435 ______
_____ 447 449 ______
_____ _____
_____+---- 10:2 ------________________________________________________-+_____
__________________________________________________________________________
________________________________________________________________________
F1-Help F3-Move F4-Zoom F5-Print F6-Next F9-_ F10-Quit Mem:223360
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Bng 1. Kt qu mt mu phn tng c tin hnh c lng t sut bnh hin mc ca mt
bnh trong mt quc gia c ba vng a l chnh. T sut bnh hin mc chung c tnh bng
cch cng s cc ngi bnh c lng c trong mi vng v chia cho tng s dn (Cu hi
tho lun: Cc tng c cng mt phn s ly mu hay khng?)
Khu vc Dn s C mu S b bnh T sut bnh
hin mc
tng s bnh
c lng
ng bng ven
bin
1500000 200 120 0,6 900000
Vng ni 150000 50 5 0,1 15000
Bn hoang mc 300000 50 15 0,3 90000
Tng s 1950000 300 140 0,52* 1005000
Th d: Ngi ta mun c lng t sut hin mc ca mt bnh trong mt quc gia vi 3 vng
sinh thi chnh, vng ng bng ven bin, vng ni v vng bn hoang mc. Bi v dn s phn
phi ng u trong quc gia, v bi v ngi ta ngh rng c trng sinh thi c th nh hng
n t sut hin mc ca bnh, ngi ta chn mu phn tng. Bng 1 trnh by kt qu thu c
vi t sut mc ton b trong mi vng.
T sut mc ton b chung c tnh bng cch c lng s ngi b bnh trong mi vng. Th
d trong vng ng bng ven bin t sut hin mc ca mu l 120/200 hay 0,6. p dng s ny
cho tng s dn s trong vng ng bng ven bin cho s c lng 0,5 x 150.000 = 90.000. S
ngi b bnh ca vng ni v vng hoang mc c tnh theo cch tng t l 15000 v 90000.
Tng s ngi mc bnh trong ton quc gia l 1.050.000. Kch thc dn s l 1.950.000 cho
nn t s mc ton b chung l 1.050.000/1.950.000 = 0,52.
Lu rng con s ny khng ging vi t sut hin mc ca mu l 140/300 = 0,47. Hai con s
ny ch ging nhau khi dng phn s ly mu ging nhau cho mi tng (nhng iu ny khng
ng trong trng hp ny). Vic tnh ton sai s chun ca t sut mc hin mc cho ton b
dn s da trn s kt hp cc sai s chun ca cc t sut hin mc ca mi vng. C th s
dng phn mm Epi-Info hoc xem Moser v Kalton bit thm chi tit.
4. Ly mu cm
Nu chi ph ph tri khng nhiu, nn iu tra tt c cc n v bc hai t mt n v bc mt
c chn trong lc ly mu hai bc. iu c gi l ly mu cm (cluster sampling)
v n v ly mu bc mt c gi l cm (cluster) trong trng hp ny. C th t c lc
xc sut bng nhau bng cch ly mu ngu nhin n cc cm bt k chng c kch thc
bng nhau hay khng.
Ly mu cm c dng nu c ch li c phn pht cho mi ngi tham gia v nu ch phn
pht quyn li cho mt s thnh vin ca n v l khng thch hp v khng o c. Th d,
trog khi ly mu trng c lng t sut hin mc ca bnh khi mun s dng mt phng
php iu tr c hiu qu cho tt c ngi b bnh, ngi ta s khm cho tt c cc hc sinh
trong cc trng c chn ch khng khm mt mu trong .
5. Ly mu nhiu bc
Ly mu nhiu bc c tin hnh trong trong nhiu bc dng cc cu trc ng cp
(hierarchical structure) ca dn s. Th d, ly mu 2 bc (two stage sampling) c th bao gm
ln th nht ly mt mu ngu nhin cc trng hc v sau ly mu ngu nhin cc tr em
trong cc trng c chn. Cc trng hp c gi l n v bc mt (first stage units hay
primary sampling units) v tr em l n v bc hai (second stage units - secondary sampling
units). u im l ti nguyn c th tp trung ti mt s a im v khng cn c cu ly mu
76
cho ton dn s. Cn danh sch cc n v bc mt nhng ch cn danh sch cc n v bc hai
ca cc n v bc mt c chn. Khuyt im l c lng chung km chnh xc hn khi da
trn ly mu ngu nhin n c cng mt c mu. Ni cch khc, t c cng chnh xc
nh ly mu ngu nhin n cn mt c mu ln hn.
Ly mu bc hai gm ly cc mu ngu nhin n c cng kch thc t cc cc n v bc
mt. Phng php ly mu bc mt ph thuc vo chng c cng s cc n v ly mu bc hai
hay khng. Nu c, c th ly mu ngu nhin n. Nu chng c c mu khc nhau, c th t
c lc epsem, bng cch ly mu xc sut t l vi kch thc (probability proportional to
size _ PPS). Th d, nu mt trng hc c nhiu gp i hc sinh so vi trng kia th n c c
hi c chn gp i. Ly mu PPS c tin hnh bng cch thay th (with replacement), c
ngha l sau khi mt n v bc mt c chn n vn cn c rt chn v c th c chn
ln na. Khi mt n v bc mt c chn hai ln, chn mu n v bc hai nhiu gp i. Tc
dng chung l cho mi n v bc hai trong dn s mt c hi c chn bng nhau.
Cc bc tin hnh ly mu PPS c minh ho trong v d sau:
Gi s chng ta c 10 bnh vin vi s h s trong mi bnh vin c trnh by trong bng
sau:
Cm S h s S h s tch
ly
S ngu nhin tng ng
1 4288 4288 1-4288
2 5036 9324 4289-9324
3 1178 10502 9325-10502
4 638 11140 10503-11140
5 27010 38150 11141-38150
6 1122 39272 38151-39272
7 2134 41406 39273-41406
8 1824 43230 41407-43230
9 4672 47902 43231-47902
10 2154 50056 47903-50056
Tng s 50056 50056
chn 4 cm v iu tra 100 h s trong mi cm (nh vy tng c mu l 400 h s) c th
tun theo cc sau:
- Tnh s h s ly tch
- Gn mt cm cho cc s ngu nhin t s h s ly tch ca cm trc +1 n s
h s ly tch ca cm .
- Rt chn ngu nhin 4 s t 1 n 50056: th d nh 36699; 35700; 11883; 4285 v
ng vi mi s chn 100 h s t cm tng ng vi cc s ny. Trong trng hp ny
chng ta s iu tra 300 h s ca bnh vin 5 v 100 h s t cm s 1.
Cng cn lu chng ta c th chn cc s ngu nhin bng phng php ly mu h thng nh
thng c thc hin trong chng trnh tim chng m rng (EPI program).
C th c lc ly mu c nhiu bc hn, th d nh chn tnh, qun, ng ph v cui
cng l nh. Phng php ly mu ny c gi l ly mu nhiu bc (multi-stage sampling).
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Th d 2
Ly mu phn tng c ngh trong th d 1 c lng t sut hin mc ton b trong mt
quc gia vi 3 vng chnh c th c ci tin thnh cng ng th nht (thnh ph, lng, p) v
cc nh trong vng, khm tt c cc thnh vin trong nh. Lc s l s kt hp gia ly mu
phn tng (khu vc) ly mu hai bc (cng ng v nh) v ly mu cm (tt c cc thnh vin
trong nh).
Ly mu cm
Ly mu phn tng
Ly mu h thng
Ly mu ngu nhin n
78
Cch tnh c mu
Mc tiu
Sau khi nghin cu bi ny, hi tho vin c kh nng:
(i) Hiu c hai cch tip cn trong cch tnh c mu, bao gm khi nim v nng lc nghin
cu
(ii) Bit c nhng yu t no nh hng n vic tnh ton c mu v nh hng nh th no
(iiI) Bit c cch tnh c mu cho nhng tnh hung khc nhau
(iv) Bit c nh hng ca c mu ln nhng kha cnh thit k khc.
(v) nh gi c nhng vn khc ca c mu
Gii thiu
C mu s c nh hng ln n chnh xc ca c lng thng k. T nh l gii hn trung
tm chng ta hi vng rng con s trung bnh c c lng t mt mu s tp trung ti trung
bnh ca dn s . Tuy vy chng ta cng bit rng con s c lng s khng chnh xc bng
trung bnh ca dn s m mc phn tn ph thuc vo c mu: Nu c mu nh phn
tn ln, nu c mu ln th phn tn nh v ta hi vng s trung bnh ca mu s bng trung
bnh ca dn s. Ngi ta c th trnh by mc phn tn theo khong tin cy 95%. Nu
phn tn ln th khong tin cy 95% s rng v chng ta kh lng thc s bit c trung bnh
ca dn s s nm u trong khong ny. Ni rng ra, nu c mu nh chng ta khng th c
lng mt cch chnh xc, chng ta khng th chng minh s khc bit gia hai nhm l khng
c ngha.
Vn xc nh c mu trong nghin cu khoa hc l mt vn quan trng. Nu chng ta ly
mu qu nh, n giai on phn tch ta c th thy c iu qua s khng chnh xc ca
uc lng, s tht bi trong chng minh gi thuyt. Tuy vy khi chng ta i vo giai on
phn tch s liu th lc l qu chm tr c th thay i c c mu. Ngc li nu
chng ta ly mt c mu qu ln th chng ta r rng lng ph tin bc v thi gian.
Hai cch tip cn trong tnh c mu
Trn c bn c hai cch tip cn trong tnh c mu:
(a) da tn s c lng ca mt t l, mt trung bnh, hiu s, nguy c tng i vi
mt mc chnh xc nht nh. Th d, c lng t le tr em trong la t 12-23
thng tui c tim chng y (vi chnh xc) trong vng 10%. Cu hi cha
kha ca cch tip cn ny l khong tin cy s l bao nhiu?
(b) Da trn kim nh gi thuyt. Th d,so snh thi gian b sa m hon ton 2
nhm c gio dc sc khe v nhm chng.Cu hi cha kha trong cch tip cn ny l
xc sut kt lun sai lm trong kim nh gi thuyt l bao nhiu?
c lng mt hu qu vi mt chnh xc nht nh
chnh xc ca mt c lng (vi khong tin cy 95%) = d c ngha l sai s ti a ca c
lng l d (vi tin cy 95% hay xc sut iu trn khng b sai l 95%)
Cng thc tnh c mu c lng khong tin cy (1- ) ca mt t l p vi sai s d l nh
sau:
2
2
2 / 1
) 1 (
d
p p z
n


Mt thc mc hay ny sinh trong khi nghin cu cng thc ny l trong khi chng ta mun
79
nghin cu c lng p nhng trong khi tnh ton tnh c mu chng ta phi c gi tr ca t
l p! Ton b logic ca vn l ch chng ta c th c lng p trc lc nghin cu mt
cch khng chnh xc, sau nghin cu chng ta c th c lng p mt cch chnh xc hn
nhiu. Ta c th c lng p s dng phn on ca chng ta, s dng nhng nghin cu trc
, c th tin hnh nghin cu dn ng. Trong trng hp chng ta khng th c on p, ta
c th c on p =0,5, mt c on an ton nht v s cho mt c mu an ton nht (ln
nht).
Khng c quy tc cng nhc chnh xc d, iu ny ph thuc vo mc ch ca nghin cu
v vo ti nguyn hin c.
Lu :
- Cng thc c trnh by l dnh cho php ly mu ngu nhin n. Nu nghin cu s dng
phng php ly mu cm cn phi hiu chnh tc ng lm gim chnh xc ca vic chn
cm bng cch tng c mu. C mu trong nghin cu ly mu cm thng c nhn ln vi
mt h s (c gi l h s thit k) c gi tr t 2 n 4. H s thit k c th tnh c t vic
nghin cu th. Nu khng c iu kin tnh h s thit k c th chn h s thit k l 3.
- Cng thc tnh c mu trn l dnh ly mu t mt dn s v hn hay kh ln. Nu c mu
vo khong t 10% dn s tr ln, ta c th iu chnh c c mu nh hn.
P N
P N
N
hc
+

Vi N l c mu cha hiu chnh, P l kch thc ca dn s ch v N


hc
l c mu sau
khi hiu chnh.
- Chng ta cng nn phi tr liu cho nhng s liu b mt, nhng trng hp t chi nghin
c bng cch tng c mu.
Kim nh mt gi thuyt, so snh 2 nhm
Gi s chng ta mun so snh hai t l (th d t l tr em c b sa non trong hai nhm b
m: mt nhm c gio dc sc khe v mt nhm khng). Chng ta c th kim nh xem hai
t lny c khc nhau ng k hay khng, ni cch khc kim nh xem hiu s ca hai t l ny
c khc mt cch c ngha vi zero khay khng. Sau khi tin hnh phn tch chng ta c th
bc b hay khng bc b gi thuyt ny. V phng din thng k, d khi chng ta bc b hay
khng bc b, chng ta u c kh nng b sai lm: sai lm m chng ta mc phi khi bc b gi
thuyt c gi l sai lm loi I, sai lm chng ta mc phi khi khng bc b c gi l sai
lm loi II.
Khi kim nh H
0
: Khng c s khc bit (p
1
=p
2
; OR=1 ; RR=1 ; =0)
Chn l l Ho ng
(Khng c s khc bit)
Chn l l Ha ng
(Khng c s khc bit)
Bc b gi thuyt H
0
Sai lm loi 1
(Xc sut = )
Kt lun ng
(Xc sut = 1- =
Power ca nghin cu)
Khng bc b gi thuyt H
0
Kt lun ng
(Xc sut = 1- )
Sai lm loi II
(Xc sut = )
L tng, chng ta mun gim thiu c hai loi sai lm trong nghin cu. Lu rng chng ta
nh ngha ci gi l nng lc (power) ca nghin cu=1-sai lm loi II. Nng lc l xc sut
t c kt qu c ngha thng k nu thc s c s khc bit gia p
1
v p
2
. Mc tiu ca
chng ta khi chn c mu l nu c s khc bit v lm sng quan trng gia hai nhm, chng ta
c c hi tt tm thy s khc bit c ngha thng k trong 2 nhm. iu ny l mt nim
ht sc quan trng trong thit k nghin cu v l gii. Nu trong giai on phn tch nu kt qu
80
l c ngha thng k, th hu ht mi ngi u tha mn. Mt khc nu kt qu khng c
ngha thng k th iu ny c th xy ra do (a) khng c s khc bit thc s gia hai nhm v
(b) c s khc bit nhng mu ca chng ta khng cho thy s khc bit bi v nng lc ca
mu thp (c mu nh) do chng ta khng c kt lun r rng. Do , nu chng ta chn
mu c nng lc cao v kt qu khng c ngha thng k th chng ta c th chc hn v s
khc bit.
chn c mu (trong trng hp c mu ca 2 nhm so snh bng nhau), chng ta phi c 4
tham s
- Sai lm loi I hay cn gi l mc ngha m chng ta mun c trong nghin cu (thng l
5%)
- Sai lm loi II chng ta mun c trong nghin cu (Sai lm loi hai khong 10-20% tng ng
vi nng lc t 80-90%)
- T l trong mt nhm c bn (th d t l tip xc vi yu t nguy c trong nhm chng ca
mt nghin cu bnh chng)
- T l trong mt nhm khc (th d t l tip xc vi yu t nguy c trong nhm bnh ca mt
nghin cu bnh chng). i khi chng ta khng trnh by t l ca nhm ny mt cch c th
m trnh by nguy c tng i hay t s s chnh m chng ta mong mun pht hin trong mt
nghin cu on h hay nghin cu bnh chng.
Cng thc tnh c mu (cho mi nhm) so snh hai t l
1
v
2
ca hai nhm:
2
2 1
2
2 / 1 2 2 1 1 1
) (
} ) 1 ( 2 ) 1 ( ) 1 ( {


+ +


z z
n
Cc im cn lu trong tnh c mu
- Nh ni trn, cch tnh c mu ch cho chng ta mt c lng th ca c mu cn thit
bi v n da trn s c on v gi tr ca thng s, quyt nh ch quan ca chng ta v hu
qu m chng ta mun pht hin v cng thc c s dng l cng thc gn ng. Do con
s tnh ra gip chng ta phn bit gia c mu 50 v 100 ch khng phn bit c mu 50 v 53.
- Chng ta phi cn i gia iu chng ta mong mun v tnh kh thi. i khi c th dng
cng thc tnh c mu i ngc li nng lc ca nghin cu. Th d nu chng ta c mt kinh
ph hn ch thc hin mt nghin cu nn ch c mt c mu nht nh. Chng ta c th tnh
ngc li t c mu bit nng lc ca nghin cu. Nu ha ra nng lc ca nghin cu rt
thp (th d nh 20%) tt nht chung ta khng nn tin hnh nghin cu v chng ta nm
chc kt qu tht bi.
- Nu mt nghin cu c nhiu mc tiu th c mu cho mt mc tiu ny c th khng
cho mc tiu khc. tnh c mu, tt nht phi ch trng vo bin s (hoc nhng bin s
quan trng nht).
- Tnh c mu khng kh, ci kh l phi cung cp nhng gi nh ca nghin cu: sai lm loi
mt, nng lc, s khc bit m chng ta mun pht hin.
Tnh c mu bng phn mm Epi Info:
u tin ta vo phn mm Epitable bng 1 trong 2 cch (gi s th mc cha Epi Info trong l
c:\epi6)
- Vo trc tip:
c:\>c:\epi6\epitable <enter>
- Thng qua trnh n chnh ca epi6
c:\>c:\epi6\epi6 <enter>
Khi vo trnh n chnh ca Epi6 chn program Epitable trong trnh n Programs bng cch
81
dng chut hoc nhn Alt-P ri ko con tr xung EPITABLE Calculator ri nhn <enter>
Sau chn Samle size bng cch dng chut hay nhn Alt-S ri di chuyn con tr vo sample
size ri nhn <Enter>.
Chng trnh Epi Info cho php tnh c mu trong 4 trng hp: c lng mt t l (single
proportion); So snh 2 t l trong hai nhm (Two proportions); Nghin cu on h (cohort
study) v nghin cu bnh chng (Case-control study). Chn loi thch hp bng cch di chuyn
tr ri nhn <Enter>. Khi mn hnh s hin ln mt ca s c nhiu trng. Trong ca s ny
chng ta c th di chuyn con tr gia cc trng bng cch nhn phm <Tab> hoc phm
<Shift><Tab>. Nhp cc gi nh cn thit vo cc trng thch hp. Di chuyn con tr n
Calculate, nhn <Enter> xem kt qu tnh ton.
Lu : Trong cch tnh c mu c lng mt t l, chng ta thy c mt tham s Design effect.
Tham s dng iu chnh nu chng ta ly mu theo cm. Do nu ta ly mu ngu nhin
n th Design effect=1. Nu chng ta ly mu theo cm th tham s ny s ln hn 1 v ln
c th th ph thuc vo mc khng ng nht gia cc cm.
Nu chng ta ly mu theo cm th chn Design effect l bao nhiu? Thng thng chng ta c
th tham kho cc nghin cu trc hoc lm nghin cu pilot xc nh mc khng ng
nht. Nu chng ta c kinh nghim chng ta c th dng trc gic phn on design effect.
Nu chng ta khng c kinh nghim, khng tm c ti liu tham kho v khng th tin hnh
nghin cu pilot, chng ta chn Design effect = 2 c c mu m bo an ton (Design effect
him khi no ln hn 2).
_ Describe Compare Study Sample Probability Setup
_____________________________ +----------------------+ _________________________
_____________________________ Sample size > _________________________
_____________________________ Power calculation > _________________________
_____________________________ Random number table _________________________
_____________________________ Random number list _________________________
_________+------------------- +----------------------+ -------------+___________
_________ ___________
_________ _____ _ _ __ __ ___________
_________ _ _ _ _ ___________
_________ _ ____ __ ____ ___ _ _ ___ ___________
_________ ___ _ _ _ _ _ ____ _ _ _ ___________
_________ _ _ _ _ _ ____ _ _ _ _____ ___________
_________ _ ____ _ __ _ _ _ _ _ _ ___________
_________ _____ _ ___ _ ____ ____ ___ ___ ___________
_________ ___ ___________
_________ ___________
_________+----------------------------------------------------------+___________
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________
________________________________________________________________________
F1-Help F3-Move F4-Zoom F5-Print F6-Next F9-_ F10-Quit Mem:228552
82
Th d
Th d 1: Cho mt nghin cu bnh chng, s dng nhng gi nh sau tnh c mu
cho tng trng hp
Nng lc ca nghin cu = 90%; mc ngha = 5%; 1 bnh cho mt chng
% chng tip xc vi yu t nguy c
OR 5% 20% 50% 70% 90%
1.5 2346
2 244
5 46
10 50
1. Da trn php tnh c mu hy a ra khuyn co khi no nn dng nghin cu bnh chng
v khi no khng.
2. Hy tnh c mu trong mt nghin cu bnh chng c nng lc =90%, mc ngha =5%
OR= 2 v t l tip xc vi yu t nguy c l 30%. Hy tnh c mu khi c 1 chng: 1 bnh; 2
chng: 1 bnh; 3 chng: 1 bnh.
Th d 2: Cho mt nghin cu on h, s dng nhng gi nh sau tnh c mu cho
tng trng hp
Nng lc ca nghin cu = 90%; mc ngha = 5%; nhm c tip xc= nhm khng tip xc
t sut mc bnh trong nhm khng tip xc vi yu t nguy c
RR 0,1% 1% 5% 15% 30%
1.5 108,904
2 3300
3 207
5 15
1. Da trn php tnh c mu hy a ra khuyn co khi no nn dng nghin cu on h v
khi no khng.
2. Hy tnh c mu trong mt nghin cu bnh chng c nng lc =90%, mc ngha =5%
OR= 2 v t sut mc bnh l 5%. Hy tnh c mu khi c nhm khng tip xc = nhm tip
xc; nhm khng tip xc = 2 nhm tip xc; nhm khng tip xc = 3 nhm tip xc
Th d 3: Phng y t huyn A. mun kim tra bo co v t l tim chng ca mt x l
80% bng cch tin hnh mt cuc iu tra (vi sai s tuyt i di 5%, tin cy = 95%).
Nu phng y t quyt nh chn mu bng phng php chn mu ngu nhin th c mu cn
thit l bao nhiu? Nu chn theo cm th c mu cn thit l bao nhiu?
83
Chin lc phn tch s liu
1. Gii thiu
Chng ta bit qua nhng k thut thng k chuyn bit cho cc tnh hung dch t nht inh.
Trong bi cnh ca mt nghin cu dch t thc s bao gm s liu ca rt nhiu cc bin s, rt
kh quyt nh thao tc no c p dng v p dng theo trnh t nh th no. Trong phn ny,
chng ta s trnh by mt s nguyn tc chin lc phn tch s liu t nghin cu dch t.
2. Bin tp s liu
Kim tra v bin tp cn thn b s liu l rt cn thit trc khi bt u phn tch thng k.
Bc u tin l xem s phn phi ca tng bin s pht hin cc sai lm c th. i vi
bin s phn loi, iu ny thc hin bng bng phn phi tn sut xem rng cc bn ghi u
trong cc nhm c xc nh v tn sut ca mi nhm l hp l. i vi bin s nh
lng, kim tra phm vi cn c tin hnh pht hin nhng gi tr nm ngoi phm vi mong
i. T chc cng c th dng tm kim cc gi tr bt thng (outliers) khng ph hp
vi phn s liu cn li.
Bc tip theo l tin hnh kim tra tnh hng nh, tm kim nhng trng hp m 2 hay
nhiu bin s l khng hng nh. Th d, nu c 2 bin s gii tnh v s ln mang thai trong b
s liu, chng ta c th s dng bng cho chc rng khng c ngi nam gii no c s ln
mang thai l mt hay nhiu hn. Phn tn cng c th c s dng kim tra tnh hng
nh ca s liu s; th d chng ta c th v phn tn ca trng lng theo tui, trng lng
theo chiu cao, dung tch sng theo chiu cao. Nhng gi tr bt thng cng c th c pht
hin bng cch ny.
Nhng sai st c th c kim tra so vi ti liu gc. Trong mt s trng hp cn phi iu
chnh li s liu. Mt s trng hp khc cn phi a m s gi tr khuyt (missing value) nu
chc chn rng s liu sai (th d mt b m c trng lng trc khi sinh l 45 kg v tng
cn 35kg trong thi gian c thai). Trong trng hp cn cha r, khi s liu l bt thng nhng
khng b xem l khng th xy ra, tt nht l s liu gi nguyn. Mt cch cht ch, vic
phn tch sau phi c kim tra m bo l kt lun khng b nh hng qu mc v gi
tr cc oan ny. Trn thc tin, gi tr bng s thng c chia thnh cc nhm trc khi
phn tch v do mt hay hai gi tr bt thng kh c th c nh hng ng k n kt qu.
Vic kim tra cn phi c tin hnh ring bit cho nhm mc bnh v nhm khng mc bnh
bi v phn phi ca 2 nhm ny c th hon ton khc nhau.
3. M t s liu
Sau khi s liu c lm sch, phn phi ca tng bin s phi c r sot li. iu ny
c thc hin cho 2 mc ch. Th nht, m bo rng tt c cc s liu u c sp
xp ph hp v th hai c mt cm gic v s liu. Cm gic v s liu l s hiu bit v c
tnh ca dn s i vi bin s phi nhim v cc gi tr khc cn o lng. Khi thc hin
nghin cu bnh chng, chng ta cn phi xem xt s liu mt cch ring bit.
4. Phn loi bin s
Ni chung s rt hu ch nu chng ta phn bit cc loi bin s "kt cuc", "phi nhim", "gy
nhiu" v "thay i tc ng". Bin s kt cuc v bin s phi nhim l cc bin s trung tm
ca nghin cu trong bin s kt cuc m t vn nghin cu v bin s phi nhim l bin
s m chng ta mun xem xt v c lng tc ng ca n ln bin s kt cuc.
Bin s gy nhiu l bin s lm bin dng quan h gia bin s phi nhim v kt cuc. Chng
ta thu thp s liu ca cc bin s gy nhiu loi b tc ng ca yu t gy nhiu trong khi
phn tch. Bin s thay i tc ng l bin s thay i tc ng ca bin s phi nhim ln
84
nguy c. Chng ta thu thp s liu ca cc bin s thay i tc ng xem xt tc ng ca
bin s phi nhim ln nguy c thay i nh th no tu theo gi tr ca bin s thay i tc
ng.
Trn thc tin, mi lin h gia cc bin s c th phc tp hn. Th d mt bin s c th gy
nhiu tc ng ca mt yu t phi nhim cn quan tm nhung bn thn n c th l bin s
phi nhim quan tm. Mt bin s khc c th gy nhiu cho mt bin s phi nhim ny nhng
lm thay i tc ng cho mt bin s phi nhim khc.
Ngoi ra trong nghin cu c th c cc yu t thm d, s liu ca bin s ny c th tr thnh
bin s phi nhim quan trng hoc nu n khng tr thnh bin s phi nhim quan trng, n
c th c xem l bin s gy nhiu hay thay i tc ng.
5. Rt gn s liu
Trc khi bt u phn tch chnh thc, c th vn phn nhm gi tr ca cc bin s. Bi v
phng php "c in" da trn vic phn tng l cn thit cho giai on u ca nghin cu,
vic phn nhm l quan trng cho cc bin s lin tc. Vic phn nhm cng cn thit cho bin
s phn loi hay bin s ri rc nu cc bin s ny c cha mt s ln cc nhm (th d nh
ngh nghip, s ln mang thai). S nhm c phn chia ph thuc vo tng loi bin s: i
vi bin s phi nhim cn phn chia thnh nhiu nhm hn i vi bin s gy nhiu hay bin
s thay i tc ng.
i vi bin s phi nhim, khi chng ta mun xem xt s ph thuc ca nguy c vo mc
phi nhim (quan h liu lng p ng), chng ta s mc sai lm nu chng ta s dng qu t
nhm. Nguyn tc chung l nhm khng phi nhim nn t ring (th d nhm khng ht
thuc) v nhm phi nhim nn chia thnh nhiu nhm (thng l 4 hay 5 nhm l c th
xem xt mi quan h liu lng p ng). i vi bin s lin tc nh tng huyt p, c th chia
cc gi tr ca bin s lm 5 nhm c tn sut bng nhau (c gi l quintiles ng v). iu
ny gip cho chnh xc ca c lng tc ng ln mi nhm nhng i khi c th sai lm
do nu c mt t i tng c mc phi nhim rt cao b ghp chung vi cc i tng c
phi nhim va phi. Mt cch khc l chn cc im ct da trn nn tng ca cc nghin cu
trc , mc ch l xc nh cc nhm m nguy c tng i t thay i trong tng nhm.
i vi bin s gy nhiu, hai hay ba nhm l i vi phn ln cc yu t gy nhiu. D vy
nu bin s gy nhiu mnh (th d nh tui) th c th phn thnh nhiu nhm hn. Trc khi
quyt nh s nhm cn dng trong phn tch, chng ta c th nh gi sc mnh quan h gia
bin s gy nhiu v bin s kt cuc. Nu s quan h ny l yu th chng ta c th kt hp
nhiu nhm li vi nhau.
6. o lng tc ng
C cc la chn khc nhau o lng tc ng cho cc thit k nghin cu. Cc la chn bao
gm:
Thit k nghin cu o lng tn sut bnh o lng tc ng
on h (ngi thi gian) T sut T s t sut
Hiu s t sut
on h (khng c s liu
ngi thi gian)
Nguy c
S chnh
T s nguy c
Hiu s nguy c
T s s chnh
Hin mc T l hin mc
S chnh
T s nguy c (hin mc)
Hiu s nguy c
T s s chnh
85
Bnh chng T s s chnh
i vi nghin cu on h, nu c s liu v ngi thi gian phi nhim, t sut mi mc
thng l s o tn sut c chn la v t s t sut l s o tc ng c chn la.
i vi nghin cu on h da trn nguy c v cho nghin cu bnh hin mc, t s nguy c s
c xem l d l gii hn t s s chnh. Tuy nhin t s s chnh thng c s dng do tnh
cht thng k ca cc thao tc da trn t s s chnh l tt hn. Bi v hi quy logistic thng
c s dng c lng t s s chnh, t s s chnh cng c s dng do n cho k qu
hng nh vi kt qu ca phn tch hi quy logistic.
Trong nghin cu bnh chng, t s s chnh thng c dung o lng tc ng mc d
n c th c lng cho t s nguy c hay t s t sut, ph thuc vo phng php chn la
nhm chng.
7. Phn tch n bin
Thng thng nn bt u vi phn tch th n bin, s dng cc phng php c in xem
xt s lin quan gia kt cuc v cc yu t phi nhim quan tm v b qua cc bin s khc.
Mc d phn tch ny s b thay th bi cc phn tch phc tp hn v c xem xt n tc ng
ca cc bin s khc, phn tch n bin vn c ch li v:
i) xem xt cc bng phn tch n cho ngi nghin cu nhng thng tin hu ch v b s liu;
th d n c th cho thy c rt t bn ghi hay rt t trng hp t vong mt nhm phi nhim
nht nh.
ii) N cho chng ta khi nim ban u v cc bin s c th lin quan mnh n kt cuc
iii) Mc thay i ca c lng tho so vi c lng khi cc bin s khc c a vo
s dng trong phn tng fl mt ch s quan trng nh gi s hin din ca yu t gy nhiu.
Khi phi nhim c trn 2 mc , mt mc phi nhim c chn lm mc nn. Thng
thng ngi ta chn mc nn l mc khng c phi nhim (hoc phi nhim t nht nu ai
u b phi nhim t nhiu). Tuy nhin nu nhm ny c t ngi th c lng s c sai s
chun ln v chgn ta c th c li khi chn nhm ln hn lm nn tng. Phnt ch phi nhim
vi 2 hoc hn cc mc (c khi phn tch th v phn tch phn tng) s bao gm:
i) Cc bng 2x2, so snh cc mc phi nhim vi nhm nn
ii) Xem xt cc c lng ca tc ng c theo mt khuynh hng no hay khng?
iii) Nu ph hp, thc hin mt kim nh khuynh hng (test for trend) tm bng chng v
s tng gim nguy c theo mc phi nhim tng dn.
8. Kim sot cc yu t gy nhiu
Yu t gy nhiu hin din t nhiu trong cc nghin cu quan st v cn phi thc hin loi b
cc yu t gy nhiu trong cc phn tch ca bin s phi nhim quan tm. Chng ta c 2
cng c cho nhim v ny: phng php c in (Mantel-Haenszel) da trn phn tng v
phng php m hnh ho vi cc phng trnh hi quy.
Chng ta nn dng phng php c in trong bc u ca phn tch v cc l do sau:
i) Cc bng s liu n gin gip nh nghin cu c lin h vi s liu. Ngc li, phng trnh
hi quy l mt hp en c th gy ra nhng sai s tai ha khi m hnh ho.
ii) Phng php c in i hi t gi nh nn c th pht hin c cc mi lin quan phc
tp. Phng php m hnh ho c th b qua mt s tng tc.
Tuy nhin phng php c in gp kh khn khi c mt s ln cc bin s gy nhiu v khi
mun kim sot cc yu t gy nhiu ny ng thi th do s hin din ca qu nhiu tng s
khin cho s liu ca mi tng tr thnh qu nh v s khin sc mnh thng k b km v
86
khong tin cy ca c lng s rng ra.
Mc d vy, nu phng php c in c p dng mt cch sng sut s cho mt c lng
c gi tr v loi b cc sai lch do yu t gy nhiu gy ra. iu ny ng cho hu ht cc loi
nghin cu ngoi tr nghin cu bnh chng bt cp c nhn trong k thut phn tng c in
c rt t gi tr.
Chng ta thy rng phng php hi quy cho tc ng ca hai bin s phn loi c gi nh
ging nh gi nh trong phng php phn tng v do cho kt qu hon ton ng nht.
Phng trnh hi quy ngoi ra cn c mt s li ch sau:
i) Gi nh rng khng c tng tc gia cc bin s gy nhiu, chng ta c th lm gim s
tham s cn thit
ii) C th xc nh c tc ng ca tng bin s, c kim sot cho tc ng ca cc bin s
khc.
iii) C th xem xt tc ng liu lng hu qu mt cch linh hot hn.
9. Cch a vo bin s gy nhiu
i) Thng thng s c hai hay ba bin s ccho l cc bin s gy nhiu quan trng (nhng
bin s ny uc gi l bin s gy nhiu tr nh - a priori confounders) nhng bCc bin s
ny thng l tui v mt hay hai yu t nguy c quan trng ca bnh v c cho l c th c
lin quan n bin s phi nhim quan tm. Theo cc quy tc chung, nhng bin s ny phi
c kim sot trong phn tch.
ii) Chng ta c xem xt cc bin s c th gy nhiu khc. Kim sot tng bin s mt v xem
c lm thay i con s c lng tc ng hay khng.
iii) i khi ch c mt hoc hai bin s gy nhiu c lm thay i c lng tc ng. Khi
phn tch cui cng thc hin vic kim sot cc bin s gy nhiu tr nh vi cc bin s gy
nhiu b sung c tc ng. Khng cn thit phi a tt c cc bin s tt c cc bin s gy
nhiu b sung vo phn tch cui cng bi v mt s bin s gy nhiu khng lm thay i c
lng tc ng ca bin s phi nhim quan tm nu c kim sot cho cc bin s gy
nhiu khc.
Nu c 3 hay t hn cc bin s gy nhiu th ch cn s dng phng php c in l . Trong
trng hp ny, ln lt phn tng cho tng bin s v sau phn tng cho ng thi cc bin
s xem cc c lng tc ng thay i nh th no. Chin lc ny loi b hu ht
cc nh hng gy nhiu.
Khi s cc bin s gy nhiu l qu ln v khng th kim sot bng phng php phn tng
n thun, phng trnh hi quy (gi nh khng c hay ch c t tng tc gia cc bin s gy
nhiu) s c gi tr.
Bc u tin ca phng php m hnh l lp li nhng phn tch n gin v kim tra xem kt
qu c ph hp vi phn tch phn tng n gin hay khng. iu ny gip chng ta trnh c
cc sai lm tai ho do s dng phng php hp en. Sau c th xy dng cc m hnh phc
tp hn bao gm:
- Bin s phi nhim hoc cc bin s phi nhim quan tm
- Tt c cc bin s c cho l yu t gy nhiu t trc (yu t gy nhiu tr nh)
- Tt c cc bin s khc c cho l c th gy nhiu v s liu cho thy c tc ng gy nhiu
ng k.
Trnh vic a vo cc bin s khng phi l yu t gy nhiu cho bnh c bit l nu bin s
ny c lin quan mnh n phi nhim quan tm bi v n s to ra sai s chun ln v khin
c lng km chnh xc.
Cn lu rng cc bin s c xem l gy nhiu ph thuc mt phn vo quyt nh tr nh
(a priori decision) v mt phn vo mc ca c lng b thay i sau khi kim sot cho yu
87
t gy nhiu . Chng ta hon ton khng da vo kt qu ca kim nh ngha. Do cc
nh thng k v dch t hang u thng khng khuyn co s dng phng php hi quy tng
bc (stepwise) trong phn tch dch t.
10. Phn tch tng tc
Hi quy l mt cng c rt ph hp cho phn tch s tng tc. C 3 loi tng tc cn c
phn bit
i) tng tc gia cc bin s gy nhiu
S khc bit chnh gia phng php m hnh ho v phng pp c in l phng php c
in cho php xem xt s tng tc gia cc bin s gy nhiu. iu may mn l trn thc th,
hu nh khng bao cn xem xt s tng tc gia cc bin s gy nhiu.
ii) Tng tc gia bin s gy nhiu v bin s phi nhim chng ta quan tm:
Trn l thuyt thng k, vic tnh ton con s c lng tc ng chnh xc, sau khi hiu chnh
cho cc yu t gy nhiu ch cn thit nu tc ng l ng nht cc mc khc nhau ca yu t
gy nhiu. Tuy nhin trn thc t, c th l tc ng s thay i t nhiu gia cc nhm gnha l
t nhiu c s tng tc ca phi nhim quan tm v yu t gy nhiu c kim sot trong
phn tch. Khi c s hin din ng k ca tng tc, tc ng c hiu ca tng tng phi c
bo co.
iii) Tng tc gia cc bin s phi nhim quan tm
Nu c s tng tc gia cc bin s phi nhim quan tm th iu ny l rt quan trng cho
vic l gii khoa hc ca kt qu phn tch v cho vic ng dng cc can thip d phng.
Tuy nhin vic tch cc tm kim s tng tc vi tt c cc bin s c th l khng c ch li.
Kim nh thng k cho s tng tc c chng minh l c lc rt km v nu chng ta ln
lt tm kim s tng tc c ngha thng k ca tt c cc bin s s d dng b qua nhng
tng tc thc s v tnh c a ra cc pht hin gi to. Chng ta cng nn nh rng mc tiu
ca nghin cu dch t l tm ra mt bc trnh n gin nhng chn tht v hu dng ca thc
t. Nu c tng tc yu, bn thn iu ny khng c ngha quan trng lm cho nn vic tnh
ton c lng gp ca tc ng cho tng phi nhim l s xp x hp l cho s tht.
V nhng l do ny, nn tr hon vic phn tch tng tc vo giai on cui ca phn tch v ch
nn xem xt tng tc phi nhim-phi nhim v phi nhim-gy nhiu, c bit ch n
nhng yu t tng tc tr nh ng c nghin cu. Nn xem xt tng yu t tng tc mt
trnh nhng m hnh qu phc tp vi nhiu tham s.
11. Nghin cu bnh chng bt cp
Phn tch bnh chng ng cch s kim sot cc tc ng gy nhiu do bin s bt cp. Tuy
nhin nu c nhng bin s gy nhiu khc khng c bt cp s c th l bin s gy nhiu.
Vic phn tng c th c s dng kim sot nhng yu t gy nhiu b sung nu chng ta
ch rng cc tp hp ca ca bnh v chng (cc tng) phi ng nht v phng din yu t
gy nhiu quan tm. iu ny s khin cho cc tng ny c rt t s liu nn s to ra cc c
lng km tin cy. C hai cch gii quyt vn ny:
1. S dng hi quy logistic c iu kin. Cch tip cn ny rt ch li cho php s dng ton b
s liu v phn tch nhiu yu t gy nhiu cng mt lc, mc d iu ny i hi thm cc gi
nh.
2. Nu bnh v chng ch c bt cp da trn cc bin s c o lng trong nghin cu
(th d nh tui v gii), cch tip cn khc l ph v vic bt cp v phn tch s liu nh l
nghin cu bt cp tn sut. Trong trng hp ny, tui v gii s c kim sot nh l mt
tng trong phn tch. Chng ta c th s dng phng php phn tng hay hi quy logistic
khng iu kin tip tc phn tch.
88
12. Nhng tr ngi trong phn tch v l gii s liu
Nu chng ta c mt nghin cu th nghim ngu nhin ln so snh 2 can thip. S so snh
c thit lp trong cng nghin cu v c thng nht trc khi nghin cu c tin
hnh. Nu nghin cu ln th vic ngu nhin ho s m bo 2 nhm cn bng vi nhau v
tt c cc bin s gy nhiu v vic phn tch kt qu s rt n gin.
Nghin cu dch t thng gp thng c lin quan n nhiu bin s, ngay c khi chng ta
xc nh bin s phi nhim quan tm t trc. S khc bit trong vic quyt nh phn nhm
s liu v chin lc m hnh ho s cho nhng kt lun c th rt khc bit.
C nhng quan im khc nhau v cch x l s liu t cc nghin cu thm d. Nhng l do
cho s cn trng trong phn tch v l gii s liu bao gm:
(i) Nhiu so snh:
Ngay c khi khng c s lin quan gia bin phi nhim v kt cuc, chng ta s hi vng s c 1
trong 20 so snh s c ngha thng k mc 5%. Do l gii mi lin quan trong nghin cu
m tc ng nhiu yu t phi nhim c o lng s cn phi cn thn hn trong mt nghin
cu vi mt gi thuyt c tr nh t trc. Tm kim tt c cc linq uan vi mt bin s kt
cuc c cc nh thng k gi l "no vt s liu"
(ii) Phn tch tng nhm nh:
Cn phi c bit cn thn khi l gii kt qu v s lin quan "biu kin" trong cc nhm s liu,
c bit l khi khng c bng chng v mi lin quan chung. Chng ta thng d b cm d v
cho rng l mt kt qu l th ca nghin cu, nht l khi nu loi b n ra nghin cu ny l
mt nghin cu m tnh.
(iii) So snh c ch nh do kt qu phn tch
Chng ta khng nn phn nhm s liu c th to ra mt s khc bit thng k ri l gii gi
tr p ny nh th gi tr p ny l ca mt so snh c tr nh. Th d nu chng ta c 10 nhm
tui v chng ta so snh nhm tui 1 vi nhm 2, nhm 3, , nhm 10 ri so snh nhm tui 1
v 2 vi nhm 3, 4,10 v tip tc. Chng ta c 9 so snh nh vy v sau chng ta s chn
cch so snh no c s khc bit nhiu nht v c ngha thng k nht gia nhm tr v nhm
gi. Cch ny l cch so snh ch nh do kt qu phn tch. L ra chng ta phi quyt nh vic
phn nhm cng sm cng tt trc khi xem s khc bit trong phn nhm tui nh hng n
kt lun ca nghin cu.
iu ny khng c ngha l tt c cc nghin cu dch t phi c gi thuyt nghin cu v
phng php phn tch c ch nh t trc khi tin hnh thu thp s liu. Vic l gii kt qu
phi b nh hng bi vic phn tch. Nu chng ta tm c mt mi lin quan c ngha trong
50 mi lin quan c kim nh th iu ny s phi c khng nh r rang. Chng ta ch nn
xem mi lin h ny ch nhm to ra gi thuyt c kim nh trong tng lai.
89
Ci t chng trnh Stata 8.0 v s liu mu
1. Ci t chng trnh Stata
C nhiu cch ci t chng trnh Stata. Di y s trnh by cch ci t chng trnh
Stata 8.0 khi c a CD ca b mn Thng k Y hc.
- a a CD vo u c CD ca my tnh (th d vo u c E:)
- Vo th mc Statistic softwares ca a CD
- Tm tp tin Stata8Setup.exe v nhp p vo tp tin ny. Tp tin ny s thc hin vic khi
ng ci t trong vng vi giy.
V tip theo, ca s cho mng (Welcome) s hin ra
Nhp vo nt lnh Next sang ca s tip theo. Cng tip tc lm nh vy cho 2 ca s tip
theo (Choose Destination Location, Ready to Install) tin hnh vic ci t

90
Sau khi ci t, ca s Finished s hin ra. Lc ny c th nhp vo nt lnh Close kt thc.
2. Ci t tp tin s liu mu
c th thc tp cc bi tp c trong ti liu ny, cc bn nn ci t cc tp tin s liu. Vic
ci t cng c thc hin bng cch s dng a CD ca b mn Thng k Y hc.
- a a CD vo u c CD ca my tnh (th d vo u c E:)
- Vo th mc Statistic softwares ca a CD
- Tm tp tin StataData.exe v nhp p vo tp tin ny. Tp tin ny s thc hin vic khi ng
ci t trong vng vi giy.
Tip theo l ca s Choose Destination Location s hin ra.
Nu mun ci t s liu vo th mc khc hy nhp vo nt lnh Browse trong khung
Destination Directory chn th mc ci t ri nhp vo nt lnh Next. Nu chp nhn th
mc ci t mc nh l C:\DATA, hy nhp vo nt lnh Next tip tc.
Khi chng trnh s tip tc thc hin vic ci t v t chm dt.
3. Ci t chng trnh chuyn i s liu
i khi chng ta c s liu c nhp bng chng trnh Epi-Info 6.04, Epi-Info for Windows,
Access hay Excel nhng chng ta li mun phn tch s liu bng Stata chng ta cn phi s
dng chng trnh chuyn i s liu nh DBMSCopy for Win hay StatTransfer. Sau y l
hng dn ci t chng trnh StatTransfer 7.0 s dng a CD ca ca b mn Thng k Y
hc.
- a a CD vo u c CD ca my tnh (th d vo u c E:)
- Vo th mc Statistic softwares ca a CD
91
- Tm tp tin StatTransfer7Setup.exe v nhp p vo tp tin ny. Tp tin ny s thc hin vic
khi ng ci t trong vng vi giy.
Tip theo cc ca s Welcome, Choose Destination Location, Ready to Install s hin ra. tt
c cc ca s ny bn nn nhp vo nt lnh Next tip tc. Sau khi nhp vo nt lnh Next
ca ca s Ready to Install, chng trnh s ci t.
Sau khi ci t chng trnh StatTransfer, ca s Finished s hin ra. Lc ny c th nhp vo
nt lnh Close kt thc.
Khi ci t cc chng trnh StatTransfer v Stata theo cch trn, 2 chng trnh ny s nm
trong MediStat trong All Programs ca Windows.
92
Khi ng v kt thc Stata
1. Khi ng Stata
khi ng Stata trong Windows XP hy thc hin
Nhp chut vo Start
Nhp chut vo All Programs
Di chuyn chut th mc MediStat v
Nhp chut vo mc Stata 8
Hoc nu c biu tng ca Stata trn desktop ca my tnh c th khi ng Stata bng cch
nhp p chut vo biu tng ca Stata 8 (Stata icon)
Ngi dng s nhn thy mn hnh nh sau khi khi ng Stata 8.0
93
Nu mn hnh Stata khng khi ng c, nguyn nhn thng thng nht l ngi s dng
cha ng k v m kho s dng Stata. Trong trng hp ny ngi s dng cn lin h vi
cng ty Stata c c s hiu (serial number) m chng trnh (code) v cha kho ch quyn
(Authorization key). Cng c th xy ra trng hp ngi s dng m kho ri nhng do v
xo file Stata.lic. Trong trng hp ny c th chp li tp tin Stata.lic ca ngi c
kha hp l.
2. Kim tra tnh hp l ca Stata
Trong ln khi ng Stata u tin, bn c th mun kim tra rng bn ci t ng. Hy
g lnh verinst v bn s thy kt xut tng t nh sau:
. verinst
You are running Stata/SE 8.0 for Windows.
Stata is correctly installed.
You can type exit to exit Stata.
Lnh verinst l mt lnh cn nh. Gi s nu chng ta thay i cu hnh ca my tnh v khng
bit mnh lm tn thng cho Stata hay khng, chng ta c th g verinst c trn an
rng Stata vn cn c ci t ng.
3. Thot khi Stata
thot khi Stata/SE 8.0 for Windows chng ta c th thc hin mt trong 2 vic sau:
- Nhp vo ng nm pha trn phi ca ca s Stata
Lu : Trong trng hp c d liu trong b nh v d liu c thay i nhng
cha c lu vo a th khi chng nhp vo ng, my tnh s hi chng ta rng
94
chng ta c mun thot m khng lu li s liu hay khng. Nu chng ta ng th
Stata s thot, nu khng th chng ta li tr li Stata chng ta c th lu li s liu.
- G lnh exit trong ca s Stata Command.
Lu : Trong trng hp c d liu trong b nh v d liu c thay i nhng
cha c lu vo a th khi chng g exit, my tnh s khng ng cho chng ta
thot v s thng bo no; data in memory would be lost. Trong trng hp ny nu
chng mun thot m khng lu li s liu th chng ta hy g exit, clear. Nu chng ta
mun lu li s liu hy s dng lnh save.
4. Cc loi hnh ca Stata
C mt s loi hnh ca Stata chy trn cc h iu hnh khc nhau: Stata cho Windows
98/95/NT, Stata cho Windows 3.1, Stata cho Power Macintosh, Stata cho 680x0 Macintosh,
Stata cho Linux, Stata cho RS/6000, v.v. Tuy nhin bt k bn dng loi hnh Stata no, Stata
vn l Stata v bn c th s dng cng mt cu lnh v Stata s cho ra cng mt kt qu,
chnh xc n s l tn cng.
Ngay c cc tp tin cng c th chia x. Th d tp tin s liu, tp tin chng trnh, tp tin
ho ca Stata cho Macintosh c th dng trn cc my tnh khc m khng cn phi chuyn
i.
5. Stata nh, Intercooled Stata v Stata bn c bit (Stata SE)
Stata cho Windows v Stata cho Macintosh c hai kiu: Stata nh v Intercooled Stata (trn
h iu hnh Unix ch c Intercooled Stata). C hai kiu Stata ny u c nhng nt chung
nhng Intercooled Stata c th lm vic vi tp tin d liu ln hn v nhanh hn. Tu theo
loi my Intercooled Stata c th nhanh hn Stata nh t 50 n 600%.
Sau y l s khc bit gia v gii hn kch thc gia Intercooled Stata v Stata nh
Stata nh Intercooled Stata
S quan st 1.000 Tu thuc vo b nh
S cc bin s 99 2.047
Chiu rng s liu 200 8.192
Kch thc ma trn ti a 40 800
S k t trong mt macro 1.000 18.632
S k t trong mt dng lnh 1.100 18.648
Ti sao Intercooled Stata chy nhanh hn Stata nh? iu ny l do s khc bit trong vic lp
chng trnh. Th d c tch s ca cc ma trn RZR, Intercooled Stata s s dng b nh
c th ghi nh kt qu tm thi l ma trn T=RZ ri sau tnh TR. Stata nh do khng c
th s dng nhiu b nh nn phi tnh ton trc tip RZR, v do mt s kt qu trung gian
phi tnh ton li nhiu ln v iu ny lm Stata nh b chm .
D sao, s khc bit ca Intercooled Stata v Stata nh mang tnh k thut v ni b, i vi
ngi dng, vic s dng Intercooled Stata v Stata nh khng c g khc bit. Nu Stata
c ci t v bn mun bit bn ang dng Stata g th c th g lnh about:
. about
Stata/SE 8.0 for Windows
Born 30 Jan 2003
95
Copyright (C) 1985-2003
Total physical memory: 261616 KB
Available physical memory: 37056 KB
Single-user Stata for Windows perpetual license:
Serial number: 196201410
Licensed to: Do Van Dung
Univ of Medicine & Pharm
Nh vy, chng ta ang s dng Stata Phin bn c bit 8.0 cho Windows.
96
M t ngn gn v Stata
Stata l mt b phn mm thng k qun l, phn tch v v th ca s liu.
Stata c th chy trn nhiu h iu hnh nhng bt k h iu hnh no, Stata c th cho
php iu khin bi dng lnh (command-driven) v iu khin bng menu (menu-driven)khc
vi SPSS ch c php iu khin bng menu (menu-driven). Sau y l mt on s dng
Stata vi
. use "C:\Program Files\STATA8\auto.dta", clear
. summarize mpg weight
Variable | Obs Mean Std. Dev. Min Max
---------+-----------------------------------------------------
mpg | 74 21.2973 5.785503 12 41
weight | 74 3019.459 777.1936 1760 4840
y ngi dng g vo summarize mpg weight v Stata tr li bng mt bng thng k m
t. Mt s lnh khc c th to ra kt qu khc:
. correlate mpg weight
(obs=74)
| mpg weight
---------+------------------
mpg | 1.0000
weight | -0.8072 1.0000
. gen w_sq=weight^2
. regress mpg weight w_sq
Source | SS df MS Number of obs = 74
---------+------------------------------ F( 2, 71) = 72.80
Model | 1642.52197 2 821.260986 Prob > F = 0.0000
Residual | 800.937487 71 11.2808097 R-squared = 0.6722
---------+------------------------------ Adj R-squared = 0.6630
Total | 2443.45946 73 33.4720474 Root MSE = 3.3587
mpg | Coef. Std. Err. t P>|t| [95% Conf. Interval]
---------+--------------------------------------------------------------------
weight | -.0141581 .0038835 -3.646 0.001 -.0219016 -.0064145
w_sq | 1.32e-06 6.26e-07 2.116 0.038 7.67e-08 2.57e-06
_cons | 51.18308 5.767884 8.874 0.000 39.68225 62.68392
S liu ca Stata, tng t nh ca phn ln cc phn mm thng k khc, c m t di
dng l mt bng vi cc hng l cc i tng v cc ct l cc bin s:
. list mpg weight in 1/10
mpg weight
1. 22 2,930
2. 17 3,350
3. 22 2,640
4. 20 3,250
5. 15 4,080
6. 18 3,670
7. 26 2,230
97
8. 20 3,280
9. 16 3,880
10. 19 3,400
Trong cc quan st c nh s v cc bin s c t tn (nh mpg, weight, v.v)
Stata c c im l chy rt nhanh. Tc nhanh mt phn l do chng trnh c vit ht
sc khn kho v mt phn l do Stata gi s liu trong b nh. Tng t nh winword: khi lm
vieej s liu c np vo trong b nh v c phn tch, bin i m khng nh hng g n
s liu c gi trong a cng. Do chng ta c th thoi mi lm vic m khng s b nh
hng ln s liu gc tr khi chng ta ra lnh cho Stata ghi s liu tr li vo a.
Do s liu c a vo b nh nn kch thc ca s liu b gii hn bi kch thc b nh.
Do khi chng ta lm vic vi s liu c kch thc ln chng ta cn dnh nhiu b nh cho
Stata. Thng thng 32 megabyte b nh c dnh cho Stata v ta c th tng lng b nh
dnh cho Stata bng cch dng lnh set memory. Nu chng ta mun dnh cho Stata 64
megabyte hy g: set memory 64m
Nu mun chng ta c th bit c lng b nh t do bng cch g vo: memory. Stata
c th hot ng ti u, sau khi np s liu nn cn khong 1 megabyte b nh t do.
98
Lnh more
1. M t
Khi chng ta g mt cu lnh v Stata c mt cu tr li di qu mt ca s mn hnh chng ta
s thymore-- cui mn hnh. Khi chng ta c th:
G phm trng xem cu tr li mn hnh kt tip
G l (ch el-l) hay Enter xem dng tip
G q ngng hin ra cu tr li --Break--
morel cch ca Stata cho bit rng n cn tip tc tr li nhng n cng c l ni
cn c nhng thng tin khc y cc thng tin c sn trn mn hnh i.
Nu chng ta g set more off thmores khng bao gi hin ra v cu tr li ca Stata s
tri nhanh ht tc . Nu chng ta g li set more on thmores c phc hi tr li.
Trong do-file chng ta thng s dng lnh set more off bi v chng ta khng quan tm n s
tng tc vi kt qu v mun Stata thc hin cng nhanh cng tt nhm kt qu c a vo
log-file v file ny s c c sau. Trong do file nu chng ta mun chng trnh dng ti mt
ni no , chng ta c th thm lnh more vo chng trnh. Khi chng trnh gp lnh ny
n s dng li v i chng ta nh Enter, phm trng hay q d rng ca s kt xut c y hay
cha.
99
Thng bo li v m phn hi
1. Li
Khi c mt li xy ra, Stata to ra mt thng bo li v mt m tr v. Th du:
. list myvar
no variables defined
r(111);
Chng ta yu cu Stata lit k gi tr ca bin myvar. Stata tr li bng thng bo no variables
defined v dng thng bo r(111)
no variables defined l thng bo li (error message).
111 c gi l m tr v (return code).
Trong ch tng tc, tt c cc li u c tha th. Ngha l sau khi ra thng bo li v m
tr v, Stata xem nh li cha h xy ra.
Trong ch chng trnh khi c mt li xy ra, do-file s ra thng bo li v m tr v ng
thi vi vic ngng thc hin ngay lp tc.
Th d, xem do-file sau y:
------------------------------------------------- u ca myfile.do----------------
use auto
decribe
list
------------------------------------------------- cui ca myfile.do---------------
Lu dng s hai - chng ta mun m t (describe) nhng li g sai l decribe. Sau y l
nhng g xy ra khi chng ta thc hin do-file bng cch g do myfile:
(1978 Automobile Data)
. do myfile
. use auto
(1978 Automobile Data)
. decribe
unrecognized command: decribe
r(199);
Decribe to ra thng bo li v m tr v 111. iu ny s lm chm dt vic thc hin do-file
v khi lnh list (d rng ng) vn khng c thc hin.
2. B qua li lm trong lp trnh
Th d mt cu lnh c th l ng trong mt tp s liu A nhng li l sai mt tp s liu B.
V nhng li nh vy c th c tin liu t trc: Trong trng hp nu cu lnh khng
li th chng ta c tip tc, nu c li th chng ta m tp s liu A ra.
Nh vy ngi lp trnh c th yu cu Stata khng ra thng bo li bng cch dng lnh
capture. Nh c th c trc tip m tr v v bit c li xy ra hay khng v li g, lp trnh
vin c th c nhng hnh ng thch hp.
3. M tr v bit thi gian tnh ton
Ngoi thng bo li v m tr v, Stata cn c th c thng bo tr v (return message) cho bit
thi gian thc hin mt lnh v thi im lnh hon thnh. Thng thng th Stata khng
cung cp thng bo tr v tr khi chng ta yu cu bng lnh set rmsg on.
Th d nu bn g sum mpg, bn s thy
. sum mpg
100
Variable | Obs Mean Std. Dev. Min Max
---------+-----------------------------------------------------
mpg | 74 21.2973 5.785503 12 41
Nu chng ta g lnh u trong chng trnh
. set rmsg on
th Stata s trnh by thng bo tr v nh sau:
. sum mpg
Variable | Obs Mean Std. Dev. Min Max
---------+-----------------------------------------------------
mpg | 74 21.2973 5.785503 12 41
r; t=0.11 7:52:45
Dng r; t=0.11 7:52:45 l thng bo tr v cho bit thi gian Stata thc hin lnh ny l 0,11
giy v lnh ny hon thnh lc 7 gi 52 sng.
Nu chng ta khng mun xut hin thng bo tr v na, chng ta hy g:
. set rmsg off

101
Phm break
1. Lm Stata ngng thc hin vic ang lm
Khi chng ta mun Stata ngng thc hin vic n ang lm v tr v du chm nhc (dot
prompt), chng ta nhn phm Control-Break (Thng c vit l ^Break hay Ctrl-Break). Vic
ny c thc hin bng cch nhn v gi phm Ctrl v ng thi nhn phm Pause/Break.
Nu bn nhn ^Break trong khi chng ta ang g mt dng lnh, Stata s b qua dng lnh
bi v bn trong tnh trng kim sot.
Nu bn nhn ^Break khi Stata ang lm iu g th Stata s ngng vic ang lm, tr v
trng thi c v a ra mt du chm nhc. trng thi c c ngha Stata hon tr li tnh trng
nh l bn cha h ra cu lnh. Tuy nhin c hai trng hp ngoi l:
1. Nu bn ang c s liu t a bng cc lnh insheet, infile, hay infix, th khi bn nhn
^Break Stata s ngng cng vic nhng bn khng tr v trng thi c m cc s liu c s
cn li trong b nh. iu ny l c ch nu bn mun xem xt qu trnh nhp s liu c ng
hay khng trc khi bn nhp vo ton b. Nu khng bn c th g lnh drop _all
2. Nu s liu ang c sp xp cho bin s sex v bn mun sp xp li cho bin s age . Gi
s trong khi Stata ang sp xp cho age th bn i kin v nhn ^Break. Khi s liu s
khng cn sp xp cho age v cng khng cn sp xp cho sex na: n trng thi khng sp
xp (unsorted).
2. im cn lu trong lp trnh
C nhng trng hp trong chng trnh bn mun chng trnh phi thc hin ton b mt
nhm lnh m khng ngng bi v nu ngng s liu trng thi bt nh. Trong trng hp
ny Stata cung cp cu trc:
no break {
. . .
}

102
S dng bn phm trong Stata
1. Bn phm
V Stata c iu khin theo dng lnh (command-driven) nn bn phm l rt cn thit trong
vic s dng ngoi tr 2 trng hp sau:
c c nhng cu lnh m chng ta nhp t trc, chng ta c th nhn cc phm
PgUp v PgDn. Ngoi ra chng ta c th a con chut n dng lnh trong ca s
hi kim (review window) v nhp np cu lnh vo ca s dng lnh.
Chng ta c th s dng cc phm chc nng (F-keys) c cc ngha c bit v chng
ta c th thay i cc nh ngha ny tu theo s thch ca chng ta.
2. Phm chc nng
Stata mc nh cc phm chc nng cc ngha sau:
F-keys
F1 help
F2 #review;
F3 describe;
F7 save
F8 use
Du chm phy (;) sau #review v describe ch nh rng cc phm ny bao gm phm
Enter
help gi hng dn ca Stata - nu chng ta mun c hng dn v mt lnh no (th d nh
lnh summarize) chng ta c th g help summarize hoc nhn F1, ri g summarize v nhn
Enter.
#review l cu lnh nhm hin th mt s cu lnh bn va s dng. Bn c th g vo #review
ri Enter hoc bn c th nhn F2
describe l cu lnh yu cu Stata bo co ni dung s liu c trong b nh. Thng thng bn
c th g describe ri Enter hoc nhn F3
save nhm lu li s liu trong b nh vo trong tp tin. Cn lu c php ca save l sau n
phi c tn tp tin. Chng ta c th g cu lnh hoc nhn F7 ri g tn tp tin.
use, ngc li, nhm a s liu t tp tin vo b nh. Sau use cng phi c tn tp tin.
Bn c th thay i nhng nh ngha mc nh ny, th d nu bn mun F3 c ngha l
summarize bn c th g:
. global F3 "summarize"
Cn lu trn F3 l ch F v s 3 ch khng phi l phm F3. Lu F l ch in hoa v c
khong trng gia global v F3 cng nh c khong trng gia F3 v summarize
Sau ch summarize nn c mt du trng khi cn c th nhanh chng g vo tn cc bin s cn
c summarize
Nu chng ta mun gn phm F5 summarize tt c cc bin s ta c th g:
. global F5 "summarize;"
Nh vy chng ta c hai cch tm tt tt c cc bin s : (1) nhn F3 v sau nhn Return
hoc (2) nhn F5. Du chm phy (;) cui nh ngha ca F5 s thay chng ta nhn phm
Return.
Nu chng ta mun thay i nh ngha ca F3 v F5 mi khi chng ta khi ng Stata, chng ta
c th g hai lnh trn mi khi chng ta vo Stata. Cch khn ngoan hn l g 2 lnh ny trong
103
mt tp tin vn bn, t tn l profile.do v t trong th mc khi ng. Stata s thc hin
cc lnh trong profile.do mi khi n c thc hin.
3. Phm hiu chnh
Ngi dng Windows s c quyn s dng nhng phm hiu chnh tiu chun ca Windows.
Cho nn Stata cho Windows s hiu chnh nhng g bn g vo mt cch t nhin nh mt ca
s hiu chnh tiu chuan.
Hn na, bn c th a cc cu lnh t ca s Review vo ca s Command. Nhp vo mt
lnh ca s Review s np lnh v ca s Command, v bn c th hin chnh n. Nu bn
nhp p vo mt lnh ca s Review, n s np l thc hin lnh ngay.
Mt cch khc np cc lnh ca s Review l dng phm PgUp v PgDn. g PgUp v Stata
s np lnh cui cng bn va g ln ca s Cmmand. G PgUp thm ln na n s np thm
lnh trc v tip tc. G PgDn c tc dng ngc li.
Mt phm hiu chnh khc lm phm Esc, phm ny c tc dng xo sch ca s Command.
Tm li:
G Hiu qu
PgUp i li tng lnh v chuyn cc lnh t ca s Review sang ca s Command
PgDn i ti tng lnh v chuyn cc lnh t ca s Review sang ca s Command
Esc Xo ca s Command
104
Khi ng Stata
1. Khi ng Stata
Khi ng chng trnh STATA bng cch nhp vo nt Start :: All Programs :: Medistat ::
Stata 8 hoc nhp vo biu tng (icon) Stata 8 trn mn hnh Desktop.
2. M t giao din ca chng trnh Stata
Giao din ca Stata s hin ra vi 3 thanh v 4 ca s:
3 thanh bao gm:
1. Thanh tiu vi dng ch "Intercooled Stata 6.0"
2. Thanh menu vi cc menu File (ng m tp tin); Edit (hiu chnh); Prefs (Ty chn); Data
(S liu) Graphics ( ha) Statistics (Thng k) User (Ngi dng) Window (m ra cc ca
s) v Help (Tr gip)
3. Thanh cng c (toolbar)
Thanh cng c gm 12 nt cng c (1- Open file; 2- Save; 3- Print Results; 4- Begin (Close)
log; 5- Start Viewer (Bring Viewer to Front) ; 6- Bring results window to Front 7-Bring
graph windows to Front; 8- Do-file Editor; 9-Data Editor; 10-Data Browser; 11-Clear -
more - Condition v 12- Break)
ngha ca tng cng c nh sau:

1- Open file (m tp tin)
2- Save (Lu tp tin)
3- Print Results (In kt qu)
4- Begin (Close) log: (Bt u (Kt thc) ghi bin bn kt qu)
5- Start Viewer (Bring Viewer to Front) : Bt u s dng ca s Viewer
6- Bring results window to Front : (a ca s kt qu ra trc)
7-Bring graph windows to Front (a ca s ha ra trc)
8- Do-file Editor: (Bin son tp tin chng trnh - do file)
9-Data Editor: Bin tp s liu (sa cha, thm bt s liu)
10-Data Browser: Duyt s liu (xem nhng khng sa cha)
11-Clear - more - Condition (Xa lnh more tip tc thc hin chng trnh)
12- Break: (Ngng tp tin chng trnh)
Bn ca s lit k theo ngc chiu kim ng h bao gm
105
1. Ca s Command (ca s lnh)
2. Ca s Result (ca s Kt qu)
3. Ca s Review (ca s Lu tr)
4. Ca s Variables (ca s Bin s)
3. Cch cch thc hin lnh trong chng trnh Stata
C hai cch thc hin lnh trong chng trnh Stata: Dng bn phm g lnh vo ca s
lnh (Stata Command) hay s dng con tr chut chn cc trnh n (menu) giao din ha
(Graphic Interface)
Dng bn phm g lnh
Dng bn phm g lnh vo ca s lnh (Stata Command). y l cch s dng Stata
ca ngi chuyn nghip v n cho php thc hin tt c cc lnh ca Stata mt cch
nhanh chng vi y cc chc nng ph ca lnh. Tuy nhin phng php ny c
th khng thch hp cho ngi mi s dng do n i hi ngi dng phi thuc cc cu
lnh v c php ca n
Con tr chut vi giao din ha (Graphic Interface)
C th dng chut thc hin cc lnh nhm thao tc s liu (menu Data), v th (menu
Graphics) v phn tch s liu (menu Statistics). Phng php s dng chut v menu l
phng php d s dng nn s c u tin trnh by trong ti liu ny.
4. Lu li kt qu phn tch
Kt qu ca phn tch c th hin trn ca s Stata Result v ca s ny c mt thanh trt
dc cho php xem li nhng kt qu phn tch c. Tuy nhin trnh gy nhm ln cho ngi
phn tch, ca s ny ch lu li nhng kt qu gn nht. Do nu chng ta mun lu tr li
ton b kt qu phn tch chng ta cn phi m ca s log bng cch nhp vo nt cng c Stata
Log nm v tr th t t tri trn thanh cng c . Khi ca s Open Stata Log m ra,
chng ta c th nhp tn ca tp tin lu tr (log file) vo hp vn bn File name.
106
Gi s chng ta chn tp tin ny l "baitap.smcl" hy g "baitap" vo hp File Name ri nhp
OK.
Khi trn ca s kt qu (Stata results) s hin ra thng bo cho bit rng bin bn kt qu
phn tch s c lu ti tp tin "D:\Dung\Science\BSCK2_Hieu_mat\baitap.smcl"
. log using "D:\Dung\Science\BSCK2_Hieu_mat\baitap.smcl"
------------------------------------------------------------------------------
log: D:\Dung\Science\BSCK2_Hieu_mat\baitap.smcl
log type: smcl
opened on: 10 Oct 2004, 12:01:34
Sau bn c th thc hin cc bc phn tch.
Khi mun xem li bin bn (kt qu phn tch) hy nhp vo nt cng c log mt ln na
hin ra ca s Stata Log Options.

Sau chn vo nt chn View snapshot of log file v nhp vo nt lnh OK xem bin bn.
Khi mun chm dt vic ghi bin bn (kt qu phn tch) hy nhp vo nt cng c log
hin ra ca s Stata Log Options.
107

Sau chn vo nt chn Close log file v nhp vo nt OK.
Li khuyn: Ngi s dng Stata c kinh nghim sau khi m tp tin s liu lun lun m tp tin
log trc khi tin hnh cc phn tch thng k khng b mt cc kt qu ca qu trnh phn
tch.
108
M t s liu vi Stata 8.0 for Windows
Chng ny s hng dn bn phng php m t s liu vi phn mm Stata 8.0 s dng b s
liu ivf.dta c trong th mc C:\DATA sau khi bn ci t cc tp tin s liu mu.
Thng thng trc khi m t s liu chng ta cn thc hin bc chun b v vic thao tc s
liu (data processing). Cng tc chun b bao gm vic m tp tin s liu, m tp tin log (Open
log file), kho st s liu c bao nhiu bn ghi v c nhng bin s no cng nh nghin cu
cng nghin cu (ch yu l mc tiu nghin cu) gip vic phn loi bin s. Vic thao tc
s liu l vic r sot s liu c b sai st hay nhm ln g hay khng, to bin s mi theo yu
cu ca phn tch v tin hnh vic dn nhn s liu gip cho vic hiu r hn s liu v c
kt qu ca phn tch thng k.
Trc tin chng ta hy khi ng Stata theo cch hng dn chng Khi ng Stata.
Sau thc hin cc bi tp 1 n 3 cho cng tc chun b v cc bi tp 4 n 6 cho cng tc
thao tc s liu.
1- M tp tin ivf_v.dta v m tp tin log
Khi ng ca s Use New Data bng cch 1 trong 2 cch:
- Nhn nt cng c m file ( v tr u tin trn thanh cng c).
- Chn menu File :: Open
Sau khi ca s Use New Data s hin ra. Nhp vo mi tn bn phi hp Look in chn a
thch hp v dng con chut nhp vo cc th mc chn th mc c cha s liu (thng
thng tp tin s liu nm th mc C:\Data). Tm tp tin s liu ivf_v.dta, nhp p vo tn
tp tin ny m tp tin (hoc nhp vo tp tin ny tn tp tin ri vo hp File Name ri sau
nhp vo nt lnh Open m tp tin).
lu tr li ton b kt qu phn tch s c thc hin, cn nh nhp vo nt cng c Stata
109
Log nm v tr th t t tri trn thanh cng c bt u log kt qu (begin log). My
tnh s hin ra hp thoi Begin Logging Stata Output chng ta chn tn tp tin (File name)
v th mc lu (Save In) ca tp tin log.
Th d chng ta mun lu tp tin log vi tn l ivf_v.smcl vo th mc c:\data; chng ta nhp
vo cc thng tin nh trn.
2. Kho st cc bin s ca tp tin v nghin cu mc tiu nghin cu phn loi bin s
Hng dn: xem lit k cc bin s chng ta c th nhn phm chc nng F3 hay s dng
menu (nhp vo menu Data :: Describe data :: Describe variable in memory) xem cc bin
s ca s liu
Chng ta c th xem danh sch cc bin s lit k sau:
110
. describe
Contains data from C:\DATA\ivf_v.dta
obs: 641
vars: 7 15 Aug 2006 15:27
size: 20,512 (99.8% of memory free)
-------------------------------------------------------------------------------
storage display value
variable name type format label variable label
-------------------------------------------------------------------------------
maso float %9.0g ma so
tuoime float %9.0g tuoi me (nam)
tangha float %9.0g tang huyet ap thai ki - 1=tang
ha, 0=khong tang ha
tuoithai float %9.0g tuoi thai (tuan)
gioi float %9.0g gioi tinh tre - 1=trai, 0=gai
tlsosinh float %9.0g trong luong so sinh (gram)
nghenghiep float %9.0g nghe nghiep me - 1=tu do,
2=cong nhan, 3=vien chuc
-------------------------------------------------------------------------------
Sorted by: maso
Gi s t cng nghin cu chng ta bit y l tp tin ca s liu 641 a tr c sinh t
b m th thai trong ng nghim (in-vitro fertilisation) vi mc tiu nghin cu l xem tui thai
v tng huyt p trong thai k c nh hng ln trng lng thai hay khng. Cch l gii s liu
c minh ha
STT Tn bin ngha ca bin Phn loi bin s:
(c lp hay Ph thuc)
(nh tnh hay nh lng)
1 Maso M s
2 Tuoime Tui ca m (nm tui)
3 Tangha Tng huyt p thai k 1= c
0= khng
4 Tuoithai Tui thai (tnh theo tun)
5 Gioi Gii tnh ca tr 1=trai 0=gi
6 Tlsosinh Trng lng sinh tnh theo
grams
7 Nghenghiep Ngh nghip ca m 1=t do
2=cng nhn 3=vin chc
3. Lm th no xem s liu
Hng dn: C th xem s liu bng 2 cch:
- Dng nt lnh Data Browser (v tr 11 tnh t bn tri ca thanh cng c)
- Dng menu Data :: Data browser (read-only editor)
111
S dng Data Browser cho php nhn s liu trong li (nh cc ca chng trnh Excel)
nhng n khng cho php in s liu. Mun nhn s liu ra ca s kt xut (output) sau in
ra hy s dng menu Data:: Describe Data :: List data.
4. Hy thc hin thng k m t tt c cc bin s trong b s liu ny:
Hng dn: trc tin chng ta phi xc nh bin s no l bin s nh lng v bin s no l
bin s nh tnh. Sau thc hin thng k m t cho cc bin s: i vi bin nh lng, thc
hin lnh summarize c trung bnh v lch chun, i vi bin nh tnh thc hin lnh
tab1 c bng phn phi tn sut ca cc bin s.
Trong b s liu ny c cc bin tuoime, tuoithai, tlsosinh l bin nh lng. m t
bin s ny chng ta s dng menu Statistics :: Summaries, tables, & tests :: Summary
Statistics.
Sau khi hp thoi Summarize hin ra, thc hin cc bc sau:
Bc 1: t con tr vo hp vn bn Variables
Bc 2: Di chuyn con tr vo ca s Variables, v nhp vo cc bin cn m t thng k
(tuoime, tuoithai, tlsosinh) tn cc bin ny xut hin trn hp vn bn Variables
Bc 3: Nhp vo nt lnh OK
112
Kt qu c trnh by nhu sau:
. summarize tuoime tuoithai tlsosinh
Variable | Obs Mean Std. Dev. Min Max
-------------+--------------------------------------------------------
tuoime | 641 33.97192 3.87046 23 43
tuoithai | 641 38.68725 2.329931 24.69 42.35
tlsosinh | 641 3129.137 652.7827 630 4650
Cc bin s nh tnh bao gm tang_ha (tng huyt p), gioi (gii tnh ca tr), nghenghiep
(ngh nghip ca m). tm tt cc bin s nh tnh ny (tang_ha, gioi, nghenghiep) chng ta
s dng menu Statistics :: Summaries, tables & test :: Tables :: Multiple one-way tables.
113
Cc bc thc hin gm:
- Bc 1: a con tr vo hp vn bn categorical variable(s)
- Bc 2: a con tr vo ca s Variables v nhp vo cc bin tang_ha, gioi, nghenghiep
a cc tn bin ny vo hp vn bn Categorical variables(s)
- Bc 3: nhp nt lnh OK hon tt
. tab1 tang_ha gioi nghenghiep
-> tabulation of tang_ha
tang huyet |
ap thai ki |
- 1=tang |
ha, 0=khong |
tang ha | Freq. Percent Cum.
------------+-----------------------------------
0 | 552 86.12 86.12
1 | 89 13.88 100.00
------------+-----------------------------------
Total | 641 100.00
-> tabulation of gioi
gioi tinh |
tre - |
1=trai, |
0=gai | Freq. Percent Cum.
------------+-----------------------------------
0 | 315 49.14 49.14
1 | 326 50.86 100.00
------------+-----------------------------------
Total | 641 100.00
-> tabulation of nghenghiep
114
nghe nghiep |
me - 1=tu |
do, 2=cong |
nhan, |
3=vien chuc | Freq. Percent Cum.
------------+-----------------------------------
1 | 104 16.22 16.22
2 | 238 37.13 53.35
3 | 299 46.65 100.00
------------+-----------------------------------
Total | 641 100.00
5. Cc tm tt s liu nh trn l t yu cu. Tuy nhin vic m ho cc gi tr ca bin s
khin cho vic c bng bng tn sut ca bin s danh nh (nh gioi v nghenghiep) b kh
khn (nht l cho nhng ngi khng trc tip lm thng k hay phi c li kt qu sau mt
khong thi gian di). Do nhng ngi lm thng k chuyn nghip lun lun thc hin ghi
ch (dn nhn) cho cc bin s nh tnh. Hy thc hin vic dn nhn s liu.
Hng dn:
Vic dn nhn cho cc gi tr m ha l vic lm tn cng nhng n gip phn bit ngi lm
thng k chuyn nghip v ngi lm thng k khng chuyn nghip. Mc d tn cng nhng
li ch do n em li vt qua cng sc b ra v vy chng ta cn phi thc hin vic dn nhn
ny.
Vic dn nhn gi tr bin s c thc hin qua 2 bc: to nhn (define label value) v dn
nhn cho gi tr (Assign value label to variable).
- To nhn sex, tang_ha, nhn nghenghiep
to nhn s dng menu Data :: Labels & Notes :: Define value label. Ca s Define value
label s c hin ra.
Gi s chng ta mun to nhn sex theo quy tc 1 =nam v 2=n, cc bc c th nh sau:
-Bc 1: nhp vo nt lnh Define hin ra hp nhp liu Define new lable
115
- Bc 2: g sex vo hp vn bn Label name
- Bc 3: nhp vo nt lnh OK khi hp nhp liu Add value s hin ra
- Bc 4: Nhp 1 vo hp vn bn value
- Bc 5: nhp nam vo hp vn bn Text
- Bc 6: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add Value
bin mt
- Bc 7: Nhp vo nhn sex trong hp vn bn Defien label names
- Bc 8: Nhp vo nt lnh Add hp nhp liu Add value s hin ra
- Bc 9: Nhp 0 vo hp vn bn value
- Bc 10: nhp n vo hp vn bn Text
- Bc 11: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add
Value bin mt
Sau c th nhp vo nt lnh Close (ca hp thoi Define value labels) thot ra hay nhp
vo nt lnh Define (ca hp thoi Define value labels) tip tc to nhn tang_ha.
Cc bc c th to nhn tang_ha gm:
-Bc 1: nhp vo nt lnh Define hin ra hp nhp liu Define new lable
- Bc 2: g tang_ha vo hp vn bn Label name
- Bc 3: nhp vo nt lnh OK khi hp nhp liu Add value s hin ra
116
Cn lu : tn nhn c th khc vi tn bin (th du nh trng hp trn ta t tn nhn l sex
trong khi tn bin l gii) hoc tn nhn c th trng vi tn bin (th d ta c th t tn nhn l
tang_ha cho bin tng ha).
- Bc 4: Nhp 1 vo hp vn bn value
- Bc 5: nhp huyet ap tang vo hp vn bn Text
- Bc 6: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add Value
bin mt
- Bc 7: Nhp vo nhn tang_ha trong hp vn bn Define label names
- Bc 8: Nhp vo nt lnh Add hp nhp liu Add value s hin ra
117
- Bc 9: Nhp 0 vo hp vn bn value
- Bc 10: nhp huyet ap bt vo hp vn bn Text
- Bc 11: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add
Value bin mt
tip tc to nhn nghenghiep ta nhp vo nt lnh Define (ca hp thoi Define value
labels).
-Bc 1: nhp vo nt lnh Define hin ra hp nhp liu Define new lable
- Bc 2: g nghenghiep vo hp vn bn Label name
- Bc 3: nhp vo nt lnh OK khi hp nhp liu Add value s hin ra
- Bc 4: Nhp 1 vo hp vn bn value
118
- Bc 5: nhp tu do vo hp vn bn Text
- Bc 6: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add Value
bin mt
- Bc 7: Nhp vo nhn nghenghiep trong hp vn bn Define label names
- Bc 8: Nhp vo nt lnh Add hp nhp liu Add value s hin ra
- Bc 9: Nhp 2 vo hp vn bn value
- Bc 10: nhp cong nhan vo hp vn bn Text
- Bc 11: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add
Value bin mt
119
- Bc 12: hp Define label names vn tip tc chn nhn nghenghiep, nhp vo nt lnh
Add hp nhp liu Add value s hin ra
- Bc 13: Nhp 3 vo hp vn bn value
- Bc 14: nhp vien chuc vo hp vn bn Text
- Bc 15: Nhp vo nt lnh OK ca hp nhp liu Add Value. Khi hp nhp liu Add
Value bin mt. Ta c kt qu nh sau:
- Bc 16: hon tt vic to nhn ta nhn vo nt lnh Close
Dn nhn gi tr (Assign value label) cho cc bin gioi, tang_ha, v nghenghiep
Sau khi d to c nhn, chng ta hy dn nhn gi tr cho bin s bng cch dng menu
Data :: Labels & Notes :: Assign value label to variable
120
Khi hp thoi labels value Attach value label hin ra dn nhn cho mi bin s cn thc
hin 4 bc sau:
- Bc 1: t con tr vo hp vn bn Variable
- Bc 2: a con tr vo ca s Variable v nhp vo bin gioi tn bin ny xut hin trn
121
hp vn bn Variable.
- Bc 3: a con tr vo nhn sex trong hp vn bn Attach value label dn nhn sex vo
tn bin sex
- Bc 4: Nhp vo nt lnh Submit thc hin vic dn nhn.
tip tc thc hin tng t dn nhn tang_ha cho bin tang_ha, hy tin hnh cc bc
sau:
- Bc 5: t con tr vo hp vn bn Variable
- Bc 6: a con tr vo ca s Variable v nhp vo bin gioi tn bin ny xut hin trn
hp vn bn Variable.
- Bc 7: a con tr vo nhn sex trong hp vn bn Attach value label dn nhn sex vo
tn bin sex
- Bc 8: Nhp vo nt lnh Submit thc hin vic dn nhn.
tip tc thc hin tng t dn nhn nghenghiep cho bin nghenghiep, hy tin hnh cc
bc sau:
122
- Bc 9: t con tr vo hp vn bn Variable
- Bc 10: a con tr vo ca s Variable v nhp vo bin gioi tn bin ny xut hin trn
hp vn bn Variable.
- Bc 11: a con tr vo nhn sex trong hp vn bn Attach value label dn nhn sex vo
tn bin sex
- Bc 12: Nhp vo nt lnh OK thc hin vic dn nhn. Cn lu , trong nhng ln dn
nhn trc chng ta nhp vo nt lnh submit hon thnh vic dn nhn nhng khng ng
ca s label values. Sau khi dn nhn nghenghiep cho bin nghenghiep, chng ta khng cn dn
nhn tip tc nn chng ta nhp vo nt lnh OK ng ca s label values sau khi hon thnh
vic dn nhn.
6. Lp bng phn phi tn sut cho cc bin s nh tnh sau khi dn nhn cho cc bin ny.
Hng dn:
Cc bin s nh tnh c dn nhn bao gm tang_ha sex matagegp gestcat. tm tt cc
bin s nh tnh ny (tang_ha sex matagegp gestcat) chng ta s dng menu Statistics ::
Summaries, tables & test :: Tables :: Multiple one-way tables.
123
Khi hp thoi tab1 One-way tables hin ra, chng ta tin hnh 3 bc (1) t con tr vo hp
Categorical value (2) Nhp vo ca s variable chn cc bin s tin hnh phn tch v (3)
Nhp vo nt lnh OK. Kt qu s xut hin nh sau:
. tab1 gioi tang_ha nghenghiep
-> tabulation of gioi
gioi tinh |
tre - |
1=trai, |
0=gai | Freq. Percent Cum.
------------+-----------------------------------
gai | 315 49.14 49.14
trai | 326 50.86 100.00
------------+-----------------------------------
Total | 641 100.00
-> tabulation of tang_ha
tang huyet ap |
thai ki - |
1=tang ha, |
0=khong tang |
ha | Freq. Percent Cum.
--------------+-----------------------------------
huyet ap bt | 552 86.12 86.12
huyet ap tang | 89 13.88 100.00
--------------+-----------------------------------
124
Total | 641 100.00
-> tabulation of nghenghiep
nghe nghiep |
me - 1=tu |
do, 2=cong |
nhan, |
3=vien chuc | Freq. Percent Cum.
------------+-----------------------------------
tu do | 104 16.22 16.22
cong nhan | 238 37.13 53.35
vien chuc | 299 46.65 100.00
------------+-----------------------------------
Total | 641 100.00
7. V t chc (histogram) ca bin trng lng s sinh (tlsosinh)
Hng dn:
v t chc , ta phi s dng menu Graphics :: Histogram
Khi hp thoi histogram hin ra, chng ta thc hin cc bc sau:
125
Bc 1: t con tr vo hp vn bn Variable
Bc 2: a con tr vo ca s Variables v nhp vo bin tlsosinh a bin ny vo hp vn
bn Variable.
Bc 3 Bc 4: nhm xc nh t chc s bt u t gi tr 600 (Lower limit of first bin)
v mi khong tip theo (bin) c rng l 300 (Width of bins)
Bc 5: Cho bit t chc s ghi nhn t l ca cc khong gi tr bng cch nhp vo nt
chn Fraction.
Nu mun th hin mt ca phn phi, nhp vo nt chn Density, nu mun th hin
tn sut th nhp vo nt chn Frequency. Mi lin h gia cc hm phn phi ny nh
sau:
T l (Fraction) = Tn sut (Frequency) / C mu (N)
Mt (Density) = T l (Fraction) / rng ca khong chia (Width of bins)
Kt qu tip theo s c trnh by trong hnh sau.
126
0
.
0
5
.
1
.
1
5
.
2
.
2
5
F
r
a
c
t
i
o
n
1000 2000 3000 4000 5000
trong luong so si nh (gram)
8. th ny cho chng ta thy hnh dng ca phn phi s liu, tuy nhin chng ta cng c th
thay i thc hin vic chia khong cho trc honh, ghi ch cho trc honh, chia khong cho
trc tung v ghi ch cho trc tung. Gi s chng ta mun thc hin cc yu cu chia khong v
ghi ch nh sau:
Trc honh phi c khong gi tr t 600 n 4800 (bin l 4200). Chng ta mun chia
lm mi khong c ln l 300 nh vy cn thit phi c 14 khong. Chng ta cng mun
ghi gi tr t 600 n 4200 v mi nhn gi tr cch nhau 600 gram.
Trc honh c ghi ch l "trong luong so sinh (gram) cua 641 tre"
Trc tung c khong gi tr l 0 n 0.3, ghi nhn cho cc gi tr v cc nhn ny cch nhau
0.1
Trc tung c ghi ch l "t l" (ch khng phi l fraction).
127
Cc bc thc hin chia khong v ghi ch cho trc hong (trc X) nh sau:
Bc 1: Nhp vo Tab X-axis
Bc 2: nhp ghi ch cho trc honh, hp vn bn Title, nhp vo ghi ch l "trong
luong so sinh (gram) cua 641 tre"
Bc 3: chia khong cho trc honh, hp vn bn Rule, nhp vo 600(600)4800.
Nguyn tc ca quy tc ny l: S u thang o ( rng khong chia) S cui thang o.
Cc bc thc hin chia khong v ghi ch cho trc hong (trc Y) nh sau:
Bc 4: Nhp vo Tab Y-axis
Bc 5: nhp ghi ch cho trc tung, hp vn bn Title, nhp vo ghi ch l "Ti le"
Bc 6: chia khong cho trc honh, hp vn bn Rule, nhp vo 0(0.1)0.3. Nguyn
tc ca quy tc ny l: S u thang o ( rng khong chia) S cui thang o.
Bc 7: Nhp vo nt lnh OK cui ca s hon tt
128
0
.
1
.
2
.
3
T


l
e

600 1200 1800 2400 3000 3600 4200 4800


Trong lng s sinh (gram) cua 641 tre
9. Chng ta cng c th v th xut (p-p plot) xem bin s tlsosinh c tun theo phn phi
bnh thng
Hng dn:
S dng menu Graph Distributional graph - normal quantile plot
Khi ca s qnorm hin ra, chng ta tin hnh cc bc sau:
Bc 1: t con tr vo hp vn bn Variable
Bc 2: a con tr vo ca s Variables v nhp vo bin tlsosinh a bin ny vo hp vn
129
bn Variable.
Bc 3: nh du vo hp kim: Show grid at percentiles:
Bc 4: Nhp vo nt lnh OK
Kt qu nh sau:
Nu phn phi bnh thng th ng cong phn phi (ng nt m) s trng vi ng cho
130
ca hnh ch nht (ng thng mnh). Nu phn phi lch m th xc sut 0,5 ng cong
phn phi nm bn tri ng cho. Nu phn phi lch dng th xc sut 0,5 ng cong
phn phi s nm bn phi ng cho.
Nu dc ca ng cong phn phi ln hn mt (1) c ngha l phn phi thc nghim tng
chm hn phn phi bnh thng, nu ng cong phn phi nh hn mt (1) c ngha l ng
cong thc nghim tng nhanh hn phn phi bnh thng.
Nh vy, phn phi ca trng s sinh b lch tri v khong trng lng thp, phn phi trng
lng s sinh tng chm hn phn phi chun. khong trng lng cao trng lng s sinh
tng hi nhanh hn phn phi chun.
0
.
0
5
.
1
.
1
5
F
r
a
c
t
i
o
n
1000 2000 3000 4000 5000
trong luong so sinh (gram)
10. Hy v biu hnh thanh (bar chart) ca nhm ngh nghip
Hng dn:
Trc tin s dng menu Graphics :: Easy graphs :: Bar chart
hin ra ca s graph bar Chng ta hy 2 th Main v th Over l 2 th nm bn tri
ca ca s.
131
th Main tin hnh cc bc sau:
Bc 1: Chn mc count nonmissing trong hp Combo Statistic
Bc 2: t con tr vo hp vn bn variable(s)
Bc 3: a con tr chut vo ca s variable v nhp vo bin maso bin ny xut hin trn
hp vn bn Variable(s)
Bc 4: Nhp vo th (tab) Over hin th ny ra
132
Bc 5: Khi th Over, a con tr chut vo hp vn bn Variable
Bc 6: a con tr chut vo ca s Variables v nhp vo tn bin nghenghiep tn bin
ny xut hin trn hp vn bn Variable.
Bc 7: Nhp vo nt lnh OK xem biu hnh thanh c to ra.
133
11. Hy v biu hnh thanh (bar chart) trung bnh trng lng s sinh ca cc a tr con ca
nhng b m c ngh nghip khc nhau.
Hng dn:
Trc tin s dng menu Graphics :: Easy graphs :: Bar chart
hin ra ca s graph bar Chng ta hy 2 th Main v th Over l 2 th nm bn tri
ca ca s.
th Main tin hnh cc bc sau:
Bc 1: Chn mc mean trong hp Combo Statistic
Bc 2: t con tr vo hp vn bn variable(s)
134
Bc 3: a con tr chut vo ca s variable v nhp vo bin tlsosinh (trng lng s sinh)
bin ny xut hin trn hp vn bn Variable(s)
Bc 4: Nhp vo th (tab) Over hin th ny ra
Bc 5: Khi th Over, a con tr chut vo hp vn bn Variable
Bc 6: a con tr chut vo ca s Variables v nhp vo tn bin nghenghiep tn bin
ny xut hin trn hp vn bn Variable.
Bc 7: Nhp vo nt lnh OK xem biu hnh thanh c to ra.
135
12. Hy v biu hnh bnh (Pie chart) phn phi bin s ngh nghip m (nghenghiep).
Hng dn:
Trc tin s dng menu Graphics :: Pie Chart
thc hin biu hnh bnh, chng ta tip tc cc bc sau:
Bc 1: nh du kim (v) vo hp kim (check box) Slices are distinct values of variable
Bc 2: t con tr vo hp vn bn Slices are distinct values of variable di hp kim
Bc 3: a con tr chut vo ca s variable v nhp vo bin nghenghiep (ngh nghip m)
bin ny xut hin trn hp vn bn Slices are distinct values of variable.
Bc 4: Nhp vo nt lnh OK
Chng ta s c c biu hnh bnh nh sau:
136
13. Hy to bin mi nhomtuoi, bin ny c gi tr
0 tng ng vi tui ca m t thp nht n 29
1 tong ng vi tui m t 30 n 34
2 tong ng vi tui m t 35 n 39
3 tong ng vi tui m t 40 tr ln
iu ny c ngha l chng ta chia tui m lm 4 nhm vi 3 im chia l 30, 35 v 40. iu
ny c th thc hin bng cch to bin mi vi hm irecode.
Cch thc hin vic to bin mi c thc hin vi menu Create or Change variables :: Create
new variable
Sau khi ca s generate - Generate a new variable thc hin vic to bin mi vi cc bc sau:
30
29-30 34-35 39-40
0 1 2 3
137
Bc 1: Nhp tn bin mi (nhomtuoi) vo hp vn bn Generate variable
Bic 2: Nhp cng thc to bin mi irecode(tuoime,29,34,39)
Bc 3: Nhp vo nt lnh OK hon tt
Sau khi to ra bin mi nhomtuoi, chng ta nn thc hin thm 2 bc: to nhn (define label
value) v dn nhn gi tr cho bin s (Assign value label to variable) nh c trnh by bi
5. (0 l di 30; 1 l 30 den 34; 2 l 35-39; 3 l 40+)
14. Hy to bin mi sinh non, bin ny c gi tr
1 tng ng vi tui thai <37
0 tong ng vi tui thai >=37 tun
Yu cu c ngha l chng ta cn to ra mt bin nh gi vi 2 gi tr 0 v 1.. iu ny c th
thc hin bng cch to bin mi v s dng biu thc boolean (biu thc th hin mt mnh
c gi tr l ng hay sai)
Vic thc hin c th bao gm vic to bin mi c thc hin vi menu Create or Change
variables :: Create new variable
138
Sau khi ca s generate - Generate a new variable thc hin vic to bin mi vi cc bc sau:
Bc 1: Nhp tn bin mi (sinhnon) vo hp vn bn Generate variable
Bic 2: Nhp cng thc to bin mi tuoithai<37
Bc 3: Nhp vo nt lnh OK hon tt
Sau khi to ra bin mi sinhnon, chng ta nn thc hin thm 2 bc: to nhn (define label
value) v dn nhn gi tr cho bin s (Assign value label to variable) nh c trnh by bi
5. (1 l sinh non, 0 l khng sinh non)
15. Lu li s liu
Hng dn: lu s liu chng ta c th s dng menu File :: Save (hay Ctrl-S) hoc nhn
vo nt save file (v tr th hai ca thanh cng c). Mt hp thoi s bt ln v hi chng
ta c mun chp chng vo tp tin s liu hay khng. Nu ng chng ta hy nhp vo nt
OK ng .

Nu chng ta khng mun thay i tp tin s liu c, chng ta nn nhp vo nt Cancel v lu
s liu vi tn mi s dng menu File :: Save As. khi hp thoi "Save Stata Data File" s
hin ra. G tn mi vo hp File Name (th d nu chng ta mun t tn tp tin l ivf_v2.dta th
chng ta g vo hp vn bn File name: ivf_v2.dta)
139
nhp nt lnh Save hon tt.
16. Hy thot khi chng trnh Stata
Hng dn:
thot khi Stata/SE 8.0 for Windows chng ta c th thc hin mt trong 2 vic sau:
- Nhp vo ng nm pha trn phi ca ca s Stata
Lu : Trong trng hp c d liu trong b nh v d liu c thay i nhng
cha c lu vo a th khi chng nhp vo ng, my tnh s hi chng ta rng
chng ta c mun thot m khng lu li s liu hay khng.
Nu chng ta ng bng cch nhp vo nt lnh Yes th Stata s thot, nu khng (nhp
nt lnh No) th chng ta li tr li Stata chng ta c th lu li s liu.
- G lnh exit trong ca s Stata Command.
Lu : Trong trng hp c d liu trong b nh v d liu c thay i nhng
cha c lu vo a th khi chng g exit, my tnh s khng ng cho chng ta
thot v s thng bo no; data in memory would be lost. Trong trng hp ny nu
chng mun thot m khng lu li s liu th chng ta hy g exit, clear. Nu chng ta
mun lu li s liu hy s dng lnh save.
17. Nu chng ta mun xem li cc kt qu phn tch c thc hin chng ta c th xem li
tp tin log.
Cch xem li tp tin log gm cc bc sau:
140
Bc 1: Vo menu File:: Log :: View
Bc 2: Khi hin ra hp thoi Choose file to View, nhp vo nt lnh Browse, khi ca s
Choose file Name s hin ra
Bc 3: Trn ca s Choose file Name, chn thmc cha tp tin log trong hp thoi Log gin
Bc 4: Chn tp tin log cn xem li (th d tp tin pt_ivf.smcl
Bc 5: Nhp vo nt lnh Open ng ca s Choose file Name v tr v hp thoi Choose
file to view
Bc 6: Nhp vo nt lnh OK xem tp tin log
141
142
Thng k phn tch bin s nh lng vi Stata
S lc l thuyt v so snh 2 trung bnh
Kim nh t dng so snh 2 trung bnh ca ca bin s nh lng c phn phi bnh thng.
Kim nh t gm c (a) Kim nh t bt cp so snh trung bnh trc v sau khi can thip trn
mt nhm v (b) kim nh t khng bt cp so snh trung bnh ca 2 nhm c lp.
C hai loi kim nh t khng bt cp (khi so snh trung bnh ca 2 nhm c lp). Kim nh t
c gi nh 2 phng sai bng nhau v kim nh t khng c gi nh phng sai bng nhau.
Hai loi kim nh ny c chung nguyn l nhng khc nhau trong cch tnh ton t do (ca
kim nh t) v cch tnh sai s chun.
Kim nh t khng bt cp gi nh 2 phng sai bng nhau
Kim nh t khng bt cp gi nh 2 phng sai bng nhau dng so snh trung bnh ca 2
nhm c lp v i hi 2 gi nh.
- Cc gi tr ca bin s ca c 2 dn s c phn phi bnh thng
- lch chun 2 nhm dn s l bng nhau.
Nu chng ta k hiu:
x
1
: gi tr trung bnh nhm 1
x
2
: gi tr trung bnh nhm 2
n
1
: c mu ca nhm 1
n
2
: c mu ca nhm 2
s
1
2
: phng sai nhm 1
s
2
2
: phng sai nhm 2
Chng ta c th xc nh t do, sai s chun v gi tr ca thng k t theo cng thc sau:
- t do ca kim nh t: df = n
1
+ n
2
- 2
- Sai s chun:
2 1
/ 1 / 1 n n s se
p
+
vi
) 1 ( ) 1 (
) 1 ( ) 1 (
2 1
2
2 2
2
1 1
+
+

n n
s n s n
s
p
- Gi tr thng k t:
2 1
2 1 2 1
/ 1 / 1 n n s
x x
se
x x
t
p
+

Sau khi tnh c gi tr thng k t, ngi ta tra bng phn phi t vi (n1 +n1 - 2) t do v
tnh c xc sut p. Thng thng nu p <0,05 ngi ta bc b gi thuyt H
0
.
Kim nh t khng bt cp khng c gi nh 2 phng sai bng nhau
Kim nh t khng bt cp gi nh 2 phng sai bng nhau dng so snh trung bnh ca 2
nhm c lp v ch i hi 1 gi nh.
- Cc gi tr ca bin s ca c 2 dn s c phn phi bnh thng
Nu chng ta k hiu:
x
1
: gi tr trung bnh nhm 1
x
2
: gi tr trung bnh nhm 2
n
1
: c mu ca nhm 1
n
2
: c mu ca nhm 2
s
1
2
: phng sai nhm 1
s
2
2
: phng sai nhm 2
143
Chng ta c th xc nh t do, sai s chun v gi tr ca thng k t theo cng thc sau:
- t do ca kim nh t (theo cng thc ca Satterthwaite):

'

1
]
1

) 1 ( ) 1 (
. .
2
2
2
4
2
1
2
1
4
1
2
2
2
2
1
2
1
n n
s
n n
s
n
s
n
s
f d
- Sai s chun:
2
2
2
1
2
1
n
s
n
s
se +
- Gi tr thng k t:
2
2
2
1
2
1
2 1 2 1
n
s
n
s
x x
se
x x
t
+

Sau khi tnh c gi tr thng k t, ngi ta tra bng phn phi t vi t do ph hp (nh tnh
ton trn) v tnh c xc sut p. Thng thng nu p <0,05 ngi ta bc b gi thuyt H
0
.
Kim nh t bt cp
Gi s so snh hiu qu ca thuc A v thuc B trong ci thin th tch th ra gng sc trong
1 giy u tin (FEV1) ngi ta cho cc bnh nhn tham gia nghin cu dng thuc A (hay
thuc B) trong mt thi gian v cui thi gian ny o lng FEV1 ca bnh nhn (gi l
FEV1
A
). Sau cho li i cho bnh nhn dng thuc B (hay thuc A) trong mt khong thi
gian v cui thi gian ny li o lng FEV1 ca bnh nhn (gi l FEV1
B
). Thit k nghin
cu ny c gi l th nghim lm sng bt cho. Chng ta lu cc c im sau khi phn
tch thng k cho cc nghin cu c cng loi thit k ny.
- Trong nghin cu ny c 2 bin s o lng trn cng dn s: FEV1
A
v FEV1
B
- Cc gi tr ca bin s FEV1
A
v FEV1
B
l ca cng mt bnh nhn nn hiu s (FEV1
A
-
FEV1
B
) cng l bin s ca bnh nhn . V nu khng c s khc bit v hiu qu ca 2 loi
thuc, trung bnh ca hiu s ny bng 0.
- Khi kim nh so snh hiu qu ca thuc A v thuc B cng kim nh so snh gi tr
trung bnh ca FEV1
A
v FEV1
B
kim nh hiu s (FEV1
A
- FEV1
B
)=0
- Php kim nh ny c gi l kim nh t bt cp. Kim nh t bt cp l trng hp c bit
ca kim nh t mt mu.
Tm li kim nh t bt cp l kim nh c s dng khi thit k nghin cu cho mt i
tng (hay 2 i tng rt ging nhau) c th nghim 2 loi thuc khc nhau.
Kim nh phi tham s
Nu phn phi khng phi l bnh thng (th d nh b lch dng), c th s dng php bin
i (thng l bin i log) a phn phi v bnh thng hoc dng test phi tham s. Kim
nh phi tham s c u im l khng i hi gi nh v phn phi ca bin s nh lng
nhng c khuyt im l khng th c lng c tham s, l nh khng th c lng
khong tin cy 95% hiu s ca trung bnh gia 2 nhm.
S lc l thuyt v so snh cc trung bnh ca 3 nhm.
Khi chng ta cn so snh trung bnh ca nhiu nhm, chng ta khng th dng nhiu kim nh
t so snh tng cp ca nhm v nh vy chng ta s lm tng nguy c ca sai lm loi 1.
Phng php thch hp c dng cho trng hp ny c gi l test ANOVA. Test
ANOVA (phn tch phng sai) c xem nh l s tng qut ha ca test t (test t dng cho 2
nhm v test ANOVA dng cho 2 hay nhiu hn cc nhm). iu kin test ANOVA hp l
144
l cc gi tr c phn phi bnh thng v phng sai ca cc nhm xp x nhau.
Trong kt xut ca test ANOVA, chng ta thy c s hin din ca thng k F (thng k Fisher).
Trong trng hp ch c 2 nhm, thng k F chnh xc bng bnh phng ca thng k t v 2
phng php cho ra cng mt mc ngha.
n
Hnh 1. Gii thut la chn kim nh ph hp cho bin s ph thuc l bin nh lng
Thc hnh
1- M tp tin ivf_v2.
Chng ta hy khi ng Stata. M tp tin ivf_v2.dta bng cch s dng menu File :: Open hay
nhp vo nt cng c Open file (Use), nm v tr th hai ca thanh cng c. Khi hp
thoi Use New Data s hin ra. Nhp vo mi tn bn phi hp Look in chn a thch hp
v dng con chut nhp vo cc th mc chn th mc c cha s liu. Khi gp tp tin s
liu ivf_v2.dta, nhp p vo tn tp tin ny m tp tin (hoc nhp vo tp tin ny tn tp
tin ri vo hp File Name ri sau nhp vo nt lnh Open m tp tin). Cn nh nhp vo
nt cng c Stata Log nm v tr th t t tri trn thanh cng c nu mun lu tr li
ton b kt qu phn tch s c thc hin.
2. Sau khi m tp tin, cn c thng tin g trc khi phn tch s liu:
Trc khi phn tch s liu, nh nghin cu (hay chuyn vin thng k) cn c li cng
nghin cu, c bit l s liu (bin s v s cc bn ghi), mc tiu v thit k nghin cu. Gi
s chng ta c thng tin v nghin cu nh sau:
MRC Working Party on Children Conceived by In Vitro Fertilisation. Births in Great Britain
resulting from assisted conception, 1978-87. BMJ 1990;300:1229-33.
BPT: phn phi bnh
thng
2 nhm
Phng sai ng nht
BPT: nh lng
Phn phi bnh thng
BPT: th t
Kim nh phi tham s
BPT: danh nh
Kim nh
2
Kim nh t
Kim nh t
PS khng ng nht
Phng sai ng nht
ANOVA
ng
ng
ng
Trn 3 nhm
Khng ng nht
ng nht
ng nht
Khng ng nht
ng ng
145
Births in Great Britain resulting from assisted conception, 1978-87. MRC Working Party on
Children Conceived by In Vitro Fertilisation.
OBJECTIVE--To describe the characteristics at birth of children conceived by in vitro
fertilisation (IVF) or by gamete intrafallopian transfer (GIFT) and to assess whether they differ
from those of children conceived naturally. DESIGN--Survey of children resulting from IVF or
GIFT and comparison of their characteristics at birth with national statistics. SETTING--
England, Scotland, and Wales from 1978 to 1987. SUBJECTS--1267 Pregnancies conceived by
IVF or GIFT, which resulted in 1581 liveborn or stillborn children. MAIN OUTCOME
MEASURES--Sex ratio, multiplicity, gestational age at birth, birth weight, stillbirth rate,
perinatal and infant mortality, and prevalence of congenital malformations. RESULTS--The
ratio of male to female births was 1.07:1; 23% (249/1092) of the deliveries were multiple births
compared with 1% for natural conceptions; 24% (278) of 1015 deliveries were preterm
compared with 6% in England and Wales; 32% (406) of 1269 babies weighed less than 2500 g
compared with 7% in England and Wales. The high percentage of preterm deliveries and of low
birthweight babies was largely, but not entirely, due to the high frequency of multiple births. The
rate of stillbirth, perinatal mortality, and infant mortality were twice the national average, these
excesses being due to the high frequency of multiple births. One or more major congenital
malformations were detected during the first week of life in 35 (2.2%) of 1581 babies. This
figure is comparable with population based estimates of the prevalence of congenital
malformations. The types of malformations reported varied, and the number of each specific
type was small. The health of the children was not evaluated beyond the perinatal period.
CONCLUSIONS--Multiple pregnancies often result from assisted conception and are the main
determinant of the outcome of the pregnancies and of the health of the children at the time of
birth. Congenital malformations are comparatively rare, so larger numbers of children need to be
studied before firm conclusions can be drawn. The pooling of data from different countries is
recommended.
PMID: 2354290 [PubMed - indexed for MEDLINE]
S liu ny bao gm nhng bin s v nhng a tr sinh mt ca nhng b m c th thai
trong ng nghim (in-vitro fertilisation). Nghin cu ny c bo co trong tp ch BMJ
(1990;300:1229-1233). Tp tin ny bao gm 641 a tr v gm 8 bin s c chi tit nh sau:
STT Tn bin Gii thch ting Anh Gii thch ting Vit
1 Maso
identity number of mother and
baby
M s
2 tuoime maternal age in years Tui ca m (nm tui)
3 tang_ha hypertension 1=yes, 0=no Tng huyt p thai k 1= c 0 = khng
4 tuoithai gestational age in weeks Tui thai (tnh theo tun)
5 gioi sex of baby 1=male, 0=female Gii tnh ca tr 1=trai 0=gi
6 tlsosinh birth weight in gms Trng lng sinh tnh theo grams.
7 nghenghiep
Occupation of mother (1= self
employed; 2=blue collar
worker; 3=white collar worker)
Ngh nghip m (1= ngh t do;
2=cng nhn; 3=vin chc)
8 nhomtuoi
maternal age groups(0=<30;
1=30-34;2=35-39;3=40+)
Tui ca m phn nhm (0=<30;
1=30-34; 2=35-39; 3=40+)
9 sinhnon
gestational category (1= <37 Sinh non (1: di 37 tun; 0: thng
146
tun; 0=37+tun) trn 37 tun thai)
Vic nhn bit s liu cng c th thc hin bng cch s dng lnh describe (nhn phm F3).
iu ny c bit c ch nu cc bin s v gi tr ca bin s c dn nhn y .
Trong nghin cu ny, tc gi mun xc nh tc ng ca tng huyt p ca m v tui thai ln
trng lng thai.
3. Nh vy trong cc bin s k trn, bin no l bin c lp, bin no l bin s ph thuc,
bin s ny l gy nhiu.
Hng dn:
Bng s liu viewivf ny c cha nhng bin s khc nhau. Trong bng sau hy xc nh tnh
cht ca tng bin s bng cch khoanh trn vo la chn thch hp.
Bin s Thang o bin s Quan h
tuoime
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
tang_ha
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
tuoithai
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
gioi
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
tlsosinh
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
nghenghiep
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
nhomtuoi
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
sinhnon
- Nh gi - Danh nh
- Th t - nh lng
- c lp - Ph thuc
- Gy nhiu
4. Trc khi phn tch s liu cn thc hin thao tc s liu v cc thng k m t. Thc hin li
cc bc thao tc s liu v thng k m t nh chng trc
5. Hy so snh trng lng ca tr nam v tr n
Hng dn: Theo gii thut c trnh by u chng, so snh trng lng (bin ph
thuc c phn phi bnh thng) 2 nhm trc tin chng ta cn phi xem phng sai ca 2
nhm c bng nhau hay khng. Nu phng sai 2 nhm tng ng chng ta c th s dng t-
test thng thng (t-test phng sai ng nht). Nu phng sai 2 nhm khng tng ng,
chng ta phi s dng t-test phng sai khng ng nht hay kim nh phi tham s.
Kim nh 1: So snh 2 phng sai
so snh trung bnh ca mt bin nh lng hai hay nhiu nhm, chng ta s dng menu
Statistics :: Summaries, tables, & tests :: Classical tests of hypothesis :: Group variance
comparison test.
147
Sau khi ca s sdtest Two sample test of variance hin ra tin hnh 5 bc sau:
Bc 1: t con tr vo hp vn bn Variable name
Bc 2: a con tr vo ca s Variables v nhp vo bin tlsosinh a bin ny vo hp vn
bn Variable name
Bc 3: t con tr vo hp vn bn Group name variable
Bc 4: a con tr vo ca s Variables v nhp vo bin gioi a bin ny vo hp vn
bn Group name variable.
Bc 5: Nhp vo nt lnh OK.
Kt qu c trnh by nh sau:
. sdtest tlsosinh, by(gioi)
148
Variance ratio test
------------------------------------------------------------------------------
Group | Obs Mean Std. Err. Std. Dev. [95% Conf. Interval]
---------+--------------------------------------------------------------------
gai | 315 3044.127 35.421 628.6603 2974.434 3113.819
trai | 326 3211.279 36.88521 665.9798 3138.715 3283.843
---------+--------------------------------------------------------------------
combined | 641 3129.137 25.78336 652.7827 3078.507 3179.767
------------------------------------------------------------------------------
Ho: sd(gai) = sd(trai)
F(314,325) observed = F_obs = 0.891
F(314,325) lower tail = F_L = F_obs = 0.891
F(314,325) upper tail = F_U = 1/F_obs = 1.122
Ha: sd(gai) < sd(trai) Ha: sd(gai) != sd(trai) Ha: sd(gai) > sd(trai)
P < F_obs = 0.1518 P < F_L + P > F_U = 0.3032 P > F_obs = 0.8482
Vi gi tr p = 0,3032 chng ta khng th bc b gi thuyt Ho: lch chun ca nhm tr trai
bng lch chun ca nhm tr gi. V vy chng ta c th s dng kim nh t phng sai
ng nht nh bc 2.
Kim nh 2: So snh 2 trung bnh s dng t-test phng sai ng nht.
so snh trung bnh ca mt bin nh lng hai hay nhiu nhm, chng ta s dng menu
Statistics :: Summaries, tables, & tests :: Classical tests of hypothesis :: Group mean comparison
test
149
Ca s ttest- group mean comparision tests hin ra. Tin hnh cc bc sau:
Bc 1: t con tr vo hp vn bn Variable name
Bc 2: a con tr vo ca s Variables v nhp vo bin tlsosinh a bin ny vo hp vn
bn Variable name
Bc 3: t con tr vo hp vn bn Group name variable
Bc 4: a con tr vo ca s Variables v nhp vo bin gioi a bin ny vo hp vn
bn Group name variable.
Bc 5: Nhp vo nt lnh OK.
. ttest tlsosinh, by(gioi)
Two-sample t test with equal variances
------------------------------------------------------------------------------
Group | Obs Mean Std. Err. Std. Dev. [95% Conf. Interval]
---------+--------------------------------------------------------------------
gai | 315 3044.127 35.421 628.6603 2974.434 3113.819
trai | 326 3211.279 36.88521 665.9798 3138.715 3283.843
---------+--------------------------------------------------------------------
combined | 641 3129.137 25.78336 652.7827 3078.507 3179.767
---------+--------------------------------------------------------------------
diff | -167.1522 51.18935 -267.6718 -66.63249
------------------------------------------------------------------------------
Degrees of freedom: 639
Ho: mean(gai) - mean(trai) = diff = 0
Ha: diff < 0 Ha: diff != 0 Ha: diff > 0
t = -3.2654 t = -3.2654 t = -3.2654
P < t = 0.0006 P > |t| = 0.0012 P > t = 0.9994
Tr li: Tr trai c trng lng s sinh trung bnh l 3211.28 gram, ca tr gi l 3044.13 gram.
Vi gi tr t = 3,2654 v mc ngha (p-value) l 0.0012 chng ta kt lun c s khc bit v
trng lng s sinh gia tr trai v tr gi (p=0.0012).
6. Hy so snh trng lng s sinh ca con b m tng huyt p v b m khng tng huyt p.
Hng dn: Theo gii thut c trnh by u chng, so snh trng lng (bin ph
thuc c phn phi bnh thng) 2 nhm trc tin chng ta cn phi xem phng sai ca 2
nhm m tng huyt p v m khng tng huyt p c bng nhau hay khng. Nu phng sai 2
nhm tng ng chng ta c th s dng t-test thng thng (t-test phng sai ng nht).
Nu phng sai 2 nhm khng tng ng, chng ta phi s dng t-test phng sai khng
ng nht hay kim nh phi tham s.
150
Kim nh 1: So snh 2 phng sai
so snh trung bnh ca mt bin nh lng hai hay nhiu nhm, chng ta s dng menu
Statistics :: Summaries, tables, & tests :: Classical tests of hypothesis :: Group variance
comparison test.
Sau khi ca s sdtest - Group variance comparison test chng ta a bin tlsosinh vo hp vn
bn Variable name v bin tang_ha vo hp vn bn Group name variable ri nhp vo nt lnh
OK.
Kt qu c trnh by nh sau:
. sdtest tlsosinh, by( tang_ha )
Variance ratio test
------------------------------------------------------------------------------
Group | Obs Mean Std. Err. Std. Dev. [95% Conf. Interval]
---------+--------------------------------------------------------------------
Ha bt | 552 3191.531 25.58435 601.0962 3141.276 3241.786
Ha tang | 89 2742.157 86.17222 812.9471 2570.908 2913.406
---------+--------------------------------------------------------------------
combined | 641 3129.137 25.78336 652.7827 3078.507 3179.767
------------------------------------------------------------------------------
Ho: sd(huyet ap) = sd(huyet ap)
F(551,88) observed = F_obs = 0.547
F(551,88) lower tail = F_L = F_obs = 0.547
F(551,88) upper tail = F_U = 1/F_obs = 1.829
Ha: sd(1) < sd(2) Ha: sd(1) != sd(2) Ha: sd(1) > sd(2)
P < F_obs = 0.0000 P < F_L + P > F_U = 0.0003 P > F_obs = 1.0000
Kt qu cho thy gi tr p = 0,0003 c ngha l phng sai ca trng lng lc sinh ca 2 nhm
khng ng nht. V vy chng ta khng th dng t-test phng sai ng nht m phi s dng
t-test phng sai khng ng nht (kim nh 2A) hay kim nh phi tham s (kim nh 2B).
Kim nh 2A: so snh 2 trung bnh t-test phng sai khng ng nht
so snh trung bnh ca mt bin nh lng hai hay nhiu nhm, chng ta s dng menu
Statistics :: Summaries, tables, & tests :: Classical tests of hypothesis :: Group mean comparison
test (xem li cu 4) v bin tlsosinh vo hp vn bn Variable name; bin tang_ha vo hp vn
bn Group name variable ca ca s ttest- group mean comparison. Cn lu nh du vo hp
kim Unequal variances ri nhp vo nt OK.
151
Kt qu trnh by nh sau:
. ttest tlsosinh, by(tang_ha) unequal
Two-sample t test with unequal variances
------------------------------------------------------------------------------
Group | Obs Mean Std. Err. Std. Dev. [95% Conf. Interval]
---------+--------------------------------------------------------------------
ha bt | 552 3191.531 25.58435 601.0962 3141.276 3241.786
ha tang | 89 2742.157 86.17222 812.9471 2570.908 2913.406
---------+--------------------------------------------------------------------
combined | 641 3129.137 25.78336 652.7827 3078.507 3179.767
---------+--------------------------------------------------------------------
diff | 449.3735 89.88999 271.1197 627.6273
------------------------------------------------------------------------------
Satterthwaite's degrees of freedom: 104.069
Ho: mean(ha bt) - mean(ha tang) = diff = 0
Ha: diff < 0 Ha: diff != 0 Ha: diff > 0
t = 4.9991 t = 4.9991 t = 4.9991
P < t = 1.0000 P > |t| = 0.0000 P > t = 0.0000
Tr li: Con b m b tng huyt p c trng lng s sinh trung bnh l 2742 gram, con ca
b m khng tng huyt p l 3192 gram. S khc bit ny c ngha thng k vi p<0,0001.
Kim nh 2B: so snh 2 trung bnh vi php kim phi tham s Mann-Whitney
Thc hin kim nh phi tham s tng sp hng Mann-Whitney (Mann-Whitney rank sum test)
bng dng menu Statistics :: Summaries, tables, & tests :: Non-parametric test of hypotheses ::
Mann-Whitney two-sample ranksum test.
152
Sau ca s ranksum - Mann-Whitney two-sample statistic hin ra.
Tin hnh cc bc sau:
Bc 1: t con tr vo hp vn bn Variable name
Bc 2: a con tr vo ca s Variables v nhp vo bin tlsosinh a bin ny vo hp vn
bn Variable name
Bc 3: t con tr vo hp vn bn Group name variable
Bc 4: a con tr vo ca s Variables v nhp vo bin tang_ha a bin ny vo hp
vn bn Group name variable.
Bc 5: Nhp vo nt lnh OK.
Kt qu nh sau:
. ranksum tlsosinh, by( tang_ha )
Two-sample Wilcoxon rank-sum (Mann-Whitney) test
tang_ha | obs rank sum expected
-------------+---------------------------------
ha bt | 552 185203 177192
ha tang | 89 20558 28569
-------------+---------------------------------
153
combined | 641 205761 205761
unadjusted variance 2628348.00
adjustment for ties -144.78
----------
adjusted variance 2628203.22
Ho: tlsosinh(tang_ha==ha bt) = tlsosinh(tang_ha==ha tang)
z = 4.941
Prob > |z| = 0.0000
7. Hy so snh trng lng s sinh ca tr sinh ra t con ca cc nhm ngh nghip khc nhau
ca ngi m.
Hng dn: so snh trung bnh ca mt bin nh lng nhiu nhm, chng ta phi s
dng phng php phn tch ANOVA mt chiu. S dng menu Statistics ::
ANOVA/MANOVA :: oneway analysis of variance
Do chng ta mun phn tch tc ng ca yu t ngh nghip m (nghenghiep) ln trng lng
sinh ca tr (tlsosinh) khi ca s oneway hin ln, ta tin hnh cc bc sau:
Bc 1: t con tr vo hp vn bn Response variable
Bc 2: a con tr vo ca s Variables v nhp vo bin tlsosinh a bin ny vo hp vn
bn Response Variable.
Bc 3: t con tr vo hp vn bn Factor
Bc 4: a con tr vo ca s Variables v nhp vo bin nghenghiep a bin ny vo hp
vn bn Factor.
Bc 5: nh du vo hp kim Produce summary table th hin thng k m t trng lng
s sinh trung bnh cc nhm ngh nghip
154
Bc 6: nh du vo hp kim Scheffe c kim nh so snh trng lng trung bnh tng
cp i ngh nghip khc nhau
Bc 7: Nhp vo nt lnh OK

Trn ca s Output, trn cng thng k m t ca s liu v trng lng s sinh theo nhm tui
ca m:
nghe nghiep |
me - 1=tu |
do, 2=cong | Summary of trong luong so sinh
nhan, | (gram)
3=vien chuc | Mean Std. Dev. Freq.
------------+------------------------------------
tu do | 2981.4135 643.76283 104
cong nhan | 3118.084 646.69338 238
vien chuc | 3189.3177 654.19649 299
------------+------------------------------------
Total | 3129.1373 652.78265 641
Con b m ngh nghip t do c trng lng trung bnh l 2981 gram, ca b m vi ngh
nghip l 3118 gram, ca b m vi ngh nghip vin chc l l 3190 gram. Chng ta bit kim
nh ANOVA c th s dng kim nh s khc bit v trung bnh ca nhiu nhm, nhng
trc tin chng ta hy kim tra cc iu kin ca phn tch ANOVA l (a) bin s ph thuc c
phn phi bnh thng - iu ny c xc nhn t th ca trng lng s sinh v (b)
phng sai ca bin ph thuc cc nhm bng nhau - iu ny cng c xc nhn qua thng
k Bartlett vi p-value l 0,973.
Analysis of Variance
Source SS df MS F Prob > F
------------------------------------------------------------------------
Between groups 3381483.56 2 1690741.78 4.00 0.0187
Within groups 269338638 638 422160.875
------------------------------------------------------------------------
Total 272720122 640 426125.19
Bartlett's test for equal variances: chi2(2) = 0.0558 Prob>chi2 = 0.973
V vy trong trng hp ny kim nh ANOVA l c gi tr. Ta c kt qu ca bng ANOVA.
155
Chng ta c c gi tr F = 0.0187 v mc ngha (p-value) l 0.9723 chng ta kt lun khng
c s khc bit v trng lng s sinh con ca nhng b m c ngh nghip khc nhau. Vi
kt lun ny chng ta c th kt lun l c t nht c 1 cp i (2 nhm) ngh nghip ca m c
s khc bit v trng lng con nhng chng ta khng bit l s khc bit ny cp i ngh
nghip no. bit cp i no c s khc bit ta xem kt xut ca so snh sau kim nh (post-
hoc test) ca Scheffe:
Comparison of trong luong so sinh (gram)
by nghe nghiep me - 1=tu do, 2=cong nhan, 3=vien chuc
(Scheffe)
Row Mean-|
Col Mean | tu do cong nha
---------+----------------------
cong nha | 136.671
| 0.202
|
vien chu | 207.904 71.2337
| 0.020 0.451
Kt qu ca kim nh Scheffe c trnh by theo bng v mi ca bng c 2 con s: con
s trn th hin s khc bit v trng lng ca ngh nghip ca hng so vi ngh nghip ca
ct v gi tr di th hin gi tri p (mc ngha) ca s khc bit ny. Da vo gi tr p, c
th kt lun c s khc bit v trng lng s sinh ca con 2 nhm ngh nghip vin chc v t
do (gi tr p=0,020) v nhm ngh nghip vin chc c trng lng trung bnh cao hn nhm
ngh nghip t do l 207,9 gram.
Nhc li l thuyt v Tng quan v c lng
Tng quan l s o mc hai bin s nh lng cng thay i vi nhau. C nhiu loi h s
tng quan, nhng chng u c gi tr t -1 n 1. Nu chng c gi tr dng c ngha l hai
bin s ng bin vi nhau, nu chng c gi tr m ngha l hai bin s nghch bin. Gi tr
tuyt i ca h s tng quan cng gn mt ngha l hai bin s c lin h cht vi nhau v vai
tr ca sai s ngu nhin s t hn. Nu h s tng quan c gi tr bng zero c ngha l hai
bin s c lp v khng quan h g vi nhau. Khi tr tuyt i ca h s tng quan bng mt
c ngha l hon ton khng c sai s ngu nhin. Bnh phng ca h s tng quan (r
2
) th
hin t l cc bin thin ca bin s ph thuc c th c gii thch bng bin s c lp.
Loi h s tng quan c s dng ph bin nht l h s tng quan Pearson r:

2 2
) ( ) (
) )( (
y y x x
y y x x
r
i i
i i
L gii ngha ca h s tng quan:
- H s tng quan lun lun nm trong on [-1,1]
- H s tng quan r dng chng t hai bin s l ng bin; h s tng quan r m chng t
hai bin s l nghch bin; h s tng quan bng zero nu hai bin khng lin h.
- Tr s tuyt i ca h s tng quan r ni ln mc lin quan gia hai bin s. Nu tr tuyt
i ca r bng 1 (r=1 hay r=-1), quan h hon ton tuyn tnh ngha l tt c cc im nm trn
ng hi quy (Hnh 9.2 d v 9.2f). Nu tr tuyt i ca r nh hn 1 s c cc im s liu
phn tn chung quanh ng hi quy.
- Bnh phng ca h s tng quan (r
2
) th hin t l bin thin ca bin s ph thuc c gii
thch bng s bin thin ca bin s c lp (nu mi lin h ny l nhn qu)
- Nu r=0, khng c mi lin h tuyn tnh gia hai bin s. iu ny c ngha l (1) khng c
mi lin h g gia hai bin s hoc (2) mi lin h gia hai bin s khng phi l tuyn tnh.
156
- Theo quy c, quan h vi r t 0,1 n 0,3 l quan h yu, t 0,3 n 0,5 quan h trung bnh
v trn 0,5 l quan h mnh. iu quan trng l s tng quan gia hai bin s cho thy s lin
h nhng khng nht thit c ngha l c quan h 'nhn qu'.
kim nh h s tng quan Pearson c thc s khc 0 hay khng, kim nh t c th c
s dng
t r
n
r

2
1
2
c phn phi student vi n-2 t do.
Hi quy
Hi quy l mt m hnh ton hc m t s bin i ca mt bin s ny theo nhng bin s
khc.
Mt phng trnh hi quy c th c dng nh sau:
cn nng (kg) = 6,85 + 0,18 x thng tui
(phng trnh hi quy tnh cn nng ca tr t 9 n 40 thng tui theo thng tui)
theo phng trnh ny ngi ta gi:
cn nng: bin s ph thuc
thng tui: bin s c lp
6,85: h s ca hng s (Constant), hay cn gi l im chn (intercept)
0,18: h s (Coeficient) ca bin s thng tui hay cn gi l dc (Slope) ca ng hi
quy
9. V phn tn (scattergram) gia ca bin s tui thai (tuoithai) v trng lng thai
(tlsosinh).
Hng dn: s dng menu Graphics :: Overlaid twoway graph
hin ra ca s twoway Twoway graphs
157
Trn ca s twoway Twoway graphs, nhp tn bin s ph thuc vo hp Y-axis variable v
tn bin s c lp vo hp X-axis variable sau nhp OK xem biu phn tn. Cch lm
c th tng bc nh sau:
Bc 1: Trn hp combo Type chn Scatter
Bc 2: t tn bin s c lp (tuoithai) vo vn bn X
Bc 3: t tn bin s ph thuc (tlsosinh) vo vn bn Y
Bc 4: Nhp nt lnh OK
C th cho th phn tn. Tuy nhin chng ta c th thm cc ty chn thc hin cc yu
cu sau:
B sung tiu trng lng tr s sinh (gam)" cho trc tung
Cho cc gi tr trc y t 500 n 5000 gram v chia cc khong 500 gram.
B sung tiu tuoi thai (tuan tuoi)" cho trc honh
Cho cc gi tr ca trc x t 24 tun tui n 42 tun tui v chia lm cc khong 4 tun
Bng cch trong ca s Trn ca s twoway Twoway graphs thc hin cc bc:
Trn th Plot 1: Bc 1: Trn hp combo Type chn Scatter
Bc 2: t tn bin s c lp (tuoithai) vo vn bn X
158
Bc 3: t tn bin s ph thuc (tlsosinh) vo vn bn Y
Trn th Y-Axis: Bc 4: Trn hp vn bn Title g "Trong luong tre so sinh (gam)"
Bc 5: Trn hp vn bn Rule g quy tc "500(500)5000"
Bc 6: Trn hp combo Angle chn "Horizontal"
Trn th X-Axis: Bc 7: Trn hp vn bn Title g "Tuoi thai (tuan)"
Bc 8: Trn hp vn bn Rule g quy tc "24(2)42"
V nhp vo nt lnh OK.
Tr li: C s tng quan thun tuyn tnh gia trng lng s sinh v tui thai. Mi tng
quan ny kh cht do m my c tnh cht i ln (khi n i v phi) v c ng knh b nh
hn nhiu so vi ng knh ln.
10. Hy xc nh h s tng quan gia trng lng s sinh (tlsosinh), tui thai (tuoithai) v
tui ca m (tuoime)
Hng dn: S dng menu Statistics :: Summaries, tables, & tests :: Summary statistics ::
Pairwise correlations.
159
Khi hp thoi pwcorr Pairwise correlations of variables s hin ra.
Tin hnh cc bc sau:
Bc 1: Nhp con tr chut vo hp vn bn Variables
Bc 2: a con tr chut vo ca s Variables v nhp vo cc bin tlsosinh, bin tuoithai v
bin tuoime tn 3 bin ny xut hin hp vn bn Variables.
160
Bc 3: nh du vo hp kim Print significance level for each entry
Bc 4: nh du vo hp kim Significance level for displaying with a star.
Bc 5: Nhp vo nt lnh OK xem kt qu.
. pwcorr tlsosinh tuoithai tuoime, sig star(5)
| tlsosinh tuoithai tuoime
-------------+---------------------------
tlsosinh | 1.0000
|
|
tuoithai | 0.7376* 1.0000
| 0.0000
|
tuoime | 0.0337 0.0151 1.0000
| 0.3941 0.7026
Tr li: Chng trnh cho kt qu h s tng quan ca trng lng thai vi trng lng thai l
1, gia trng lng thai v tui thai l 0.7376 (gi tr p=0,0000), gia trng lng thai v tui
ca m l 0,0337 (gi tr p = 0,3941). Nh vy c s tng quan mnh c ngha thng k gia
trng lng thai v tui thai trong khi s tng quan gia trng lng thai v tui m rt yu
v khng c ngha thng k. Do c s lin h c ngha thng k (gi tr p <0,05) gia trng
lng thai v tui thai nn gi tr ca h s tng quan c nh du sao (*).
11. Hy xy dng phng trnh hi quy ca trng lng thai theo tui thai.
Hng dn: S dng phng php hi quy n bng cch nhp vo menu "Statistics :: Linear
regression and related :: Linear regression" hin ra hp thoi regress Linear regression
Nhp tn bin s ph thuc vo hp Dependent variable v tn bin s c lp vo hp
Independent variable ri nhn OK tip tc.
Kt qu c trnh by nh sau:
. regress tlsosinh tuoithai
161
Source | SS df MS Number of obs = 641
---------+------------------------------ F( 1, 639) = 762.25
Model | 148354317 1 148354317 Prob > F = 0.0000
Residual | 124365805 639 194625.673 R-squared = 0.5440
---------+------------------------------ Adj R-squared = 0.5433
Total | 272720122 640 426125.19 Root MSE = 441.16
tlsosinh | Coef. Std. Err. t P>|t| [95% Conf. Interval]
---------+--------------------------------------------------------------------
tuoithai | 206.6412 7.484572 27.609 0.000 191.9439 221.3386
_cons | -4865.245 290.0814 -16.772 0.000 -5434.873 -4295.617
Tr li: H s tng quan bnh phng R-squared = 0.544 = 54.4% ni ln tui thai c th gii
thch cho 54.4% s thay i v trng lng s sinh. Bng ANOVA cho bit c tng cc sai lch
ca bnh phng trng lng s sinh 272.720.122 (272.7 triu) m phng trnh hi quy c th
gii thch cho 148.3 triu ca s sai lch ny (nh vy cn 124.4 triu tng bnh phng sai lch
cha c gii thch gi l Residual Sum of Square v gi tr 0.45 chnh l gi tr 148.3/272.7).
Mc ngha c trnh by trong bng ANOVA cho bit mc ngha ca phng trnh.
Da vo bng cc h s chng ta c th xy dng phng trnh hi quy nh sau:
Trng lng s sinh = -4865.245 + 206.641 x tui thai (tnh theo tun).
Mc ngha (P-value) ca bin s tui thai (Gestational age) l kt qu ca kim nh ngha
ca bin s ny trong phng trnh c thc s khc khng hay khng.
H s (coefficient) ca bin s c lp ni ln s thay i ca bin s ph thuc khi bin s
c lp thay i mt n v. Trong phng trnh ny (vi bin s c lp l TUOITHAI v bin
s ph thuc l TLSOSINH) chng ta c th l gii nu a tr ln hn 1 tun tui trng lng
lc sanh ca n s tng thm 206.641 gram.
12. Hy xy dng phng trnh hi quy ca trng lng thai theo tui thai, gii tnh ca tr v
huyt p cao ca m.
Hng dn: S dng phng php hi quy n bng cch nhp vo menu "Statistics :: Linear
regression and related :: Linear regression" hin ra hp thoi regress Linear regression
Nhp tn bin s ph thuc (tlsosinh) vo hp Dpendent variable v tn cc bin s c lp
(tuoithai gioi tang_ha) vo hp Idependent variables, ri nhn OK tip tc. Khi hp thoi
162
chn on s hin ra. Tuy nhin nu chng ta khng quan tm n vic chn on cc vn
trong phng trnh hi quy chng ta hy nhp vo nt Cancel.
. regress tlsosinh tuoithai gioi tang_ha
Source | SS df MS Number of obs = 641
-------------+------------------------------ F( 3, 637) = 275.43
Model | 153998584 3 51332861.4 Prob > F = 0.0000
Residual | 118721538 637 186376.04 R-squared = 0.5647
-------------+------------------------------ Adj R-squared = 0.5626
Total | 272720122 640 426125.19 Root MSE = 431.71
------------------------------------------------------------------------------
tlsosinh | Coef. Std. Err. t P>|t| [95% Conf. Interval]
-------------+----------------------------------------------------------------
tuoithai | 201.4248 7.541441 26.71 0.000 186.6157 216.2339
gioi | 167.8167 34.17884 4.91 0.000 100.6999 234.9335
tang_ha | -142.14 50.8685 -2.79 0.005 -242.0302 -42.24979
_cons | -4729.048 294.1447 -16.08 0.000 -5306.659 -4151.438
------------------------------------------------------------------------------
Tr li: Chng ta tm c r
2
(R-squared) l 0.5647 cho thy phng trnh hi quy gii thch
c 56.47% s bin thin ca trng lng thai v iu ny cho thy m hnh c c gii tnh v
tng huyt p gii thch tt hn so vi m hnh ch c tui thai (r
2
=0.54).
Chng ta cng c th vit c phng trnh hi quy theo kt qu trn:
Trng lng thai = -4729.048 + tui thai x 201.425 - tng huyt p x 142.14 + gii x 167.817
10. Bn c gi g trnh by phng trnh hi quy mt cch d hiu hn i vi ngi khng
chuyn v thng k.
Hng dn: Bi v ngi khng chuyn v thng k hay ngi cha c lm quen vi phng
php m ho s khng bit lm sao nhn tng huyt p vi 142.14 hay gii vi 167,817.
Chng ta nh li quy c ca tp tin ny:
Bin tng huyt p (tang_ha) c gi tr =0 nu m khng b tng huyt p
Bin gii tnh (gioi) c gi tr =0 nu tr l tr gi
a) Do phng trnh hi quy i vi tr gi c m khng tng huyt p l:
Trng lng thai = -4729.048 + tui thai x 201.425 (a)
b) tr trai vi m khng tng huyt p, trng bin s ph thuc ca phng trnh hi quy s
tng ln 167,817 gram nn phng trnh hi quy s l
Trng lng thai = -4561.23 + tui thai x 201.425 (b)
c) tr gi vi m b tng huyt p, trng bin s ph thuc ca phng trnh hi quy s s
gim i 142,14 gram so vi phng trnh (a) nn phng trnh hi quy cho nhm ny l
Trng lng thai = -4871.19 + tui thai x 201.425
d) tr trai vi m b tng huyt p, trng bin s ph thuc ca phng trnh hi quy s s
gim i 142,14 gram so vi phng trnh (b) nn phng trnh hi quy cho nhm ny l
Trng lng thai = -4703.37 + tui thai x 201.425
Do cc mc ngha (p-value) ca bin s u nh hn 0.05 nn tt c cc bin s c lp ca
m hnh u c ngha thng k v khng nn loi b khi m hnh.
13. Xt hai m hnh
trng lng thai = tui thai + tng huyt p m + gii tnh (cho h s ca bin s tui t hai l
201.4) trong khi m hnh
trng lng thai = tui thai (choh s ca bin s tui thai l 206.6). H s trong m hnh no l
ph hp hn nh gi s tng trng ca trng lng thai.
Tr li:
Chng ta c th gi nh yu t tng huyt p ca m l yu t gy nhiu. Do tng huyt p ca
m c th lm gim trng lng ca con v trong tng huyt p ca m ph bin hn nhm
163
sanh thiu thng nn a tr sinh sm 1 tun b mt trng lng l 206.6 gram nhng iu ny
l c do tc ng ca sanh non v c tc ng do tng huyt p mt s b m. Tuy nhin
nhm khng b tng huyt p tr sanh non mt tun ch b mt c 201.4 gram v do con s
201.4 l ph hp hn nh gi s tng trng ca trng lng thai.
Trn thc tin do con s 201.4 rt gn vi con s 206.6 nn c th b qua tc ng gy nhiu
ca tng huyt p ca m ln tc pht trin thai.
14. S dng kim nh t chng ta pht hin trng lng tr con cc b m b tng huyt p thp
hn con nhng ngi khng tng huyt p l 449.37 gram. Trong khi m hnh ca trng lng
sinh theo tui thai, tng huyt p m v gii tnh cho h s ca bin tng huyt p l 142.14
gram. Hy l gii nhng s liu ny?
Tr li: C hai con s 449.37 v 142.14 u ni ln s khc bit do tnh trng tng huyt p ca
m nhng con s 449.37 l con s khc bit th v con s 142.14 l con s khc bit c hiu
chnh theo thng tui v gii tnh. Da vo nhn xt trn ta c gii thch nhng con s ny nh
sau:
con cc b m b tng huyt p c trng lng nh con nhng ngi khng tng huyt p l
449.37 gram v iu ny do tc ng ca c tng huyt p, tui thai (v c tc ng ca gii
tnh nhng gi s chng ta bit rng tc ng gy nhiu cao gii tnh l khng ng k).
con cc b m b tng huyt p c trng lng nh con nhng ngi khng tng huyt p l
142.14 gram v iu ny do tc ng ca c tng huyt p khi khng xt n tc ng ca
tui thai. Nh vy tc ng do sinh thiu thng l 449.37-142.14 = 307.23 g
C a o h u y e t
a p m e
T r o n g
l n g c o n
S i n h t h i e u
t h a n g
C c h e
k h a c
1 4 2 . 1 4 g
4 4 9 . 3 7 g
Nh vy % tc ng do c ch sinh thiu thng trong tng s tc ng ca tng huyt p m ln
trng lng ca con l:
% 68 68 . 0
37 . 449
22 . 307
37 . 449
14 . 142 37 . 449


tho ong tac
chnh hieu ong tac - tho ong tac

Chng ta c th xem xt tc ng ca c ch sinh thiu thng trong khi so snh trng lng s
sinh ca 2 nhm m tng huyt p v m khng tng huyt p bng cch so snh tui thai trung
bnh gia 2 nhm. Nhm c m b tng huyt p c tui thai trung bnh l 37.3 tun trong khi
nhm m khng b tng huyt p c tui thai trung bnh l 38.9 v s khc bit v tui thai l 1.6
tun. S khc bit v tui thai s gii thch cho khong 200 gram/tun x 1.6 =320 gram trng
lng s sinh.
164

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