MT S BT CP KHI NG DNG THNG K V TIN HC

TRONG NGHIN CU Y HC
Lu Ngc Hot
M U
Ngy nay vi s bng n ca khoa hc, k thut v cng ngh trong khm cha
bnh, ngi thy thuc trc khi ra quyt nh chn on hoc iu tr mt bnh no
cn phi tng hp v cn nhc cc thng tin lin quan t cc ngun khc nhau,
c bit l t cc xt nghim, kt qu chn on hnh nh, thm do chc nng, t cc
nghin cu, th nghim lm sng, ch khng ch n thun l cc triu chng lm
sng nh trc y, do vy khi nim y hc da vo kinh nghim lm sng ca
ngi thy thuc c thay th bi khi nim y hc da vo bng chng.
Vi cc nh qun l v hoch nh chnh th khi nim lp k hoch, qun l v
hoch nh chnh sch da vo bng chng cng tr nn rt ph bin v ngy nay
cc nc pht trin hu ht cc quyt nh, chnh sch u phi xy dng, trin
khai v nh gi da theo mt quy trnh nghim ngt, trong bng chng c
cung cp t nhiu ngun khc nhau nh trnh by trong s di y

Cc thng tin m nh qun l cn

khi lp k hoch, qun l hoc hoch
nh chnh sch:
o Thng tin y t, sc khe
o Thng tin ti chnh, kinh t
o Thng tin v chnh sch, vn
ha, x hi...
o Cc thng tin khc

Tiu chun ca thng tin

cho cc nh qun l:
Hp dn, ngn gn,
chnh xc
Phi trnh by di
dng cc bng chng

Cc thng tin thiu ht cn

thu thp thm:
o T th vin, Internet
o T iu tra, nghin
cu b sung

So snh

Cc thng tin c sn
ti a phng

Bng chng cho

LKH v QL

S 1: Vai tr ca cc ngun thng tin khc nhau trong lp k hoch, qun l

v hoch nh chnh sch
Do vy vi xu th pht trin ca y hc da vo bng chng, lp k hoch, qun l v
hoch nh chnh sch da vo bng chng hin nay v trong tng lai, vai tr ca
1

thng k, tin hc ng dng ngy cng c m rng, khng ch trong nghin cu

khoa hc m cn c trong tm kim, tham kho tng hp, phn tch s liu c sn v
cc thng tin trn mng. Bng di y c th cho thy thng k v tin hc ngy nay
khc g vi thng k v tin hc khi m my vi tnh v phn mm cha c ph cp:
Bng 1: Cc thao tc v k nng m ngi nghin cu cn hc v thng k v tin
hc trc y v ngy nay
Giai on

Thao tc ca cn b
lm nghin cu

K nng sinh vin cn c sau khi

hc mn thng k-tin hc

1. Trc khi c my vi tnh (computer)

Thit k cng c thu
thp s liu, nhp
liu

Th cng bng vit

tay hay nh my;

Cch thit k cng c v lp bng

tng hp nhp s liu

Tnh c mu, tng

Th cng hoc c s
hp s liu, tnh ton
h tr ca bn tnh,
cc test thng k
my tnh tay
(calculator);

Chn ng cng thc v tnh ton

theo cc cng thc
Cch dng bn tnh v my tnh tay
tnh ton

Tham kho thng tin: Ch yu t sch, tp

ch, bo co c in
n v lu di dng
n phm (hard copy);

Cch c, ghi chp, lu gi v s

dng cc ti liu tham kho t cc
n phm;

Trch dn v sp xp
ti liu tham kho

Cch trch dn v sp xp ti liu

tham kho theo quy nh

Theo cch th cng

2. Khi my vi tnh v cc phn mm ph bin

Thit k cng c thu
thp s liu, nhp
liu

S dng cc phn
mm thch hp (EPI
Info, EPI Table...)

Cch thit k, m ha cng c, x

l v nhp liu bng phn mm
my vi tnh;

Tnh c mu, tng

Thng qua cc phn
hp s liu, tnh ton
mm nh EPI Info,
cc test thng k
STATA, SPSS...

Cch chuyn dng s liu, tnh c

mu, tng hp, tnh ton s liu,
cc test bng phn mm

Tham kho thng tin: T cc n phm trong

th vin,
T th vin in t,
a v c bit l t
Internet

Cch tm v lu gi thng tin t n

phm vo my tnh hoc phn mm
Cch tra cu ti liu trn Internet
Tng hp s liu c h thng
(Systermatic review, Meta-analysis)

Trch dn v sp xp
ti liu tham kho

Cch sp xp ti liu tham kho;

Cch s dng phn mm tm
kim, lu gi v sp xp ti liu
tham kho

S dng cc phn
mm nh Reference
Manager, Endnote...

Vi nhng l do nu trn, ging dy thng k v tin hc ng dng trong y sinh hc

hin nay trong cc trng i hc y cn phi cp nht v thay i.
Ngoi ra, do cc cn b y t v nhiu nh nghin cu trong lnh vc y t cng cha
c o to, cp nht v thng k v tin hc y hc nn h cn gp nhiu kh khn
v sai st trong vic ng dng cc kin thc v k nng v thng k v tin hc trong
nghin cu khoa hc, cng l mt trong nhng l do lm cho cht lng ca
nhiu nghin cu cn thp v cha c nhiu bi bo khoa hc c ng ti trn cc
tp ch th gii.
tm hiu thc trng ca nhng bt cp trong ng dng thng k v tin hc y hc
trong nghin cu khoa hc, nhm cn b ging dy ca B mn Thng k, Tin hc
Y hc ca Vin o to Y hc D phng v Y t cng cng, Trng i hc Y H
Ni trin khai mt s nghin cu tm hiu cc li thng gp khi cn b y t p
dng thng k, tin hc trong nghin cu khoa hc thng qua vic r sot hng trm
bi bo ng ti trong mt s tp ch c uy tn ca Vit Nam (350 bi nm 2003 v
201 bi nm 2009) v thng qua xem xt cc bo co thng k, cc lun vn, lun n
tt nghip ca sinh vin v hc vin, cc ti nghin cu cc cp. Kt qu nghin
cu cho tht cc cn b y t v nh nghin cu y hc Vit Nam thng gp phi mt
s li sau y:
1. Li lin quan n phn i cng thng k v bin s:
Khng phn bit c thng k m t v thng k suy lun
Khng phn bit c mi lin quan gia tn ti, mc tiu nghin cu v
bin s
Xc nh tha hoc thiu bin s trong nghin cu
Chuyn bin nh lng sang dng nh tnh khi thit k cng c thu thp s
liu khng ng
Khng hiu r v phn b chun v vai tr ca phn b chun trong thng k
Cha phn bit c loi nghin cu c lp v ghp cp
Nhng thng tin no cn phi cp trong phn i tng v phng php
nghin cu?
2. Li lin quan n loi thit k nghin cu
Cha phn bit c loi thit k nghin cu nh nghin cu ngang v dc; hi
cu hay tin cu; m t, phn tch hay can thip; nh tnh hay nh lng;
Cha phn bit c nghin cu ngang (cross-sectional study) v iu tra ct
ngang (cross-sectional survey);
Cha bit cch trnh by mc thit k nghin cu trong phn i tng v
phng php ca mt bo co nghin cu
3. Li lin quan n chn mu v tnh ton c mu
Chn khng ng cng thc tnh c mu v cc thnh phn trong cng thc
tnh c mu
3

 Khng bit cch tnh c mu t kt qu ca cc nghin cu th

Khng bit r u, nhc im ca tng phng php chn mu chn ng
cch chn mu cho mt nghin cu c th
iu chnh c mu vi h s thit k khng ng
Khng bit p dng cng thc tnh c mu thch hp vi cc loi thit k
nghin cu;
Khng bit cch tnh ton c mu trong nghin cu nh tnh
4. Thng k m t
Khng phn bit c khi no c th o lng tp trung ca b s liu nh
lng bng dng gi tr trung bnh, khi no phi dng trung v, khi no c th
o lng phn tn ca b s liu bng lch chun, khi no phi dng
khong phn trm, phn mi, phn t
Khng bit chuyn b s liu t dng khng chun sang phn b chun c
th p dng cch tng hp v phn tch vi b s liu chun
Khng chn ng bng, biu th trnh by b s liu
5. Thng k suy lun
Khng nhn thc ng c vai tr ca thng k suy lun trong nghin cu
khoa hc
Khng phn bit c ch nh v gi tr ca c lng im, c lng
khong v kim nh gi thuyt
Khng phn bit c gi tr Alpha (sai lm loi 1), Beta (sai lm loi 2), gi
tr p trong thng k suy lun;
Khng phn bit c s khc bit trong kim nh s khc nhau v s tng
quan
Khng phn bit c cc test trong nghin cu ghp cp, khng ghp cp, test
tham s v phi tham s
Cha hiu ng khi nim sai s, nhiu v s cn thit phi khng ch sai s v
nhiu trong nghin cu
Khng nh gi ng tnh cn thit v gi tr ca phn tch a bin trong khng
ch nhiu
Phn tch hi quy khi cha quan st tng quan
So snh trc sau can thip khi c nhm chng nhng nhm chng v nhm
can thip cha tng thch
6. Bt cp lin quan n vic tm kim, tham kho, lu gi ti liu tham kho
trn Internet
Cha bit cch tm cc trang web cha nhng thng tin cn thit tham kho
trong nghin cu, c bit l cc trang web m cc nc ang pht trin c th
truy cp min ph;
4

 Cha bit cch s dng cc phn mm tm kim, tham kho, lu gi v sp xp

ti liu tham kho;
Cha bit trin khai nhng loi hnh nghin cu mi s dng s liu c sn
trn Internet nh vic tng hp s liu c h thng (systermatic review) v
phn tch Meta (meta-analysis);
7. Bt cp trong ng dng tin hc trong thu thp, x l v phn tch s liu
Cha bit s dng phn mm thng k trong chn mu, thit k cng c thu
thp s liu, nhp liu, lm sch s liu v phn tch s liu;
Cha phn bit c im mnh, yu ca tng phn mm thng k;
Cha s dng c cc phn mm chuyn b s liu u vo c th p dng
vi nhiu phn mm khc nhau hoc chuyn dng s liu t phn b khng
chun sang phn b chun s dng cc test tham s thay th cho cc test phi
tham s.
Cha tip cn c vi mt s loi hnh nghin cu mi nh nghin cu khng
gian, nghin cu theo H thng tin a l (Geographic Information System
GIS)...
NI DUNG
Thc trng nu trn v nhu cu hc tp mn thng k, tin hc y hc cng nh cc
bt cp trong ng dng mn hc ny trong nghin cu khoa hc t ra mt yu
cu cp bch cho vic phi i mi ni dung ging dy mn thng k v tin hc y
hc trong cc trng i hc y. Vn ny s c tho lun chi tit trong mt cuc
hi tho vo thng 4/2011 vi s tham gia ca cc ging vin tham gia ging dy
mn thng k, tin hc y hc trong tm Trng i hc Y trong khun kh h tr
ca D n Tng cng nng lc ging dy bc s y hc d phng trong tm Trng
i hc Y Vit Nam, do T chc Nuffic, H Lan h tr.
V cc bt cp m cn b y t thng gp khi p dng thng k v tin hc y hc
trong nghin cu khoa hc th vi phm vi ti liu ny, chng ti ch cung cp c
nhng kin thc chung nht lin quan n nhng bt cp ny, chi tit s c trnh
by trong b ti liu m hin B mn Thng k v Tin hc Y hc Trng i hc Y
H Ni ang bin son. Di y l mt s kin thc c bn v thng k v tin hc
y hc c tng hp, s ha v c trnh by di dng tr li cc cu hi
gip cho cc nh nghin cu c th gii p cc vng mc ca mnh khi tin hnh
mt ti nghin cu khoa hc c th.
1. Mi lin quan gia qun th v mu nghin cu, gia thng k m t v
thng k suy lun trong nghin cu nh th no?
Trong nghin cu, c bit l vi cc nghin cu cng ng trn mt din rng th
ngi nghin cu thng khng th no iu tra c tt c cc c th trong mt
qun th nghin cu m thng ch iu qua thng qua mt mu nghin cu c
rt ra t qun th theo cc cch khc nhau (xc sut hoc khng xc sut). S
di y trnh by mi lin quan gia nhiu yu t trong mt qu trnh nghin cu:
5

QUN TH CH
Kt lun ngoi suy

La chn

Tham s
qun th
( , , P...)

QUN TH
NGHIN CU
Mu xc sut
- Ngu nhin n
- Ngu nhin h thng
- Mu phn tng
- Mu chm
- Mu nhiu bc
Mu khng xc sut
- Mu kinh nghim
- Mu thun tin
- Mu ch tiu
- Mu c mc ch.
Cc khi nim:
- Khung chn mu
- n v quan st
- n v mu
- Bin nghin cu
- Cc ch s

Chn loi
thit k v
chn mu
nghin cu

c lng
- im
- khong

Suy lun thng

k (Ch p
dng cho mu
xc sut vi c
mu ln)
(Thng k suy
lun)

Mu

Kim nh
gi thuyt
Tham s mu

Bin s

s, p...)

M t cc tham s mu
(trnh by kt qu nghin cu)
(Thng k m t)

Gi tr p
Cc test
thng k

S 2: Mi lin quan gia qun th, mu, thng k m t v thng k suy lun
trong nghin cu
R rng rng khi nghin cu theo mu, ngi nghin cu khng mun kt lun ca
mnh ch p dng vi mu nghin cu (thng k m t) m mun kt lun cho c
qun th nghin cu v qun th ch. lm c iu ny th h phi p dng
thng k suy lun vi 2 phng php c lng hoc kim nh vi cc test thng
k thch hp. Tuy nhin qu trnh ngoi suy ny ch c th c thc hin khi mu
c chn theo phng php xc sut (tc l chn ngu nhin c tnh i din cao)
vi c mu ln.
2. Mi lin quan gia tn ti, mc tiu chung v mc tiu c th ca nghin
cu nh th no?
Nhiu ngi nghin cu thng khng n mi lin quan ca 3 yu t ny nn
khi xut chng thng phm phi sai lm kh c th chp nhn c. Hai v d
di y th hin r s bt cp ny
6

V d 1:
Tn ti: Cao huyt p ca ngi cao tui ti huyn A nm 2010 v mt s yu
t nh hng
Mc tiu chung: Xc nh t l cao huyt p ca ngi cao tui ti huyn A nm
2010 v mt s yu t nh hng
Mc tiu c th:
1. Xc nh t l cao huyt p ca ngi cao tui ti huyn A.
2. Xc nh mt s yu t lin quan n tnh trng cao huyt p.
3. xut (v thm d) mt s gii php can thip cng ng lm gim t l
tng huyt p.
V d 2:
Tn ti: Huyt p ca ngi dn ti huyn A nm 2010 v mt s yu t nh
hng
Mc tiu chung: Xc nh t l cao huyt p ca ngi cao tui ti huyn A nm
2010 v mt s yu t nh hng
Mc tiu c th:
1. Xc nh t l cao huyt p ca ngi cao tui ti huyn A.
2. Xc nh mt s yu t lin quan n tnh trng cao huyt p.
3. nh gi hiu qu ca mt s gii php can thip cng ng lm gim t l
tng huyt p.
R rng l v d 1 th hin r tn ti bao trm mc tiu chung, cn mc tiu
chung li bao trm mc tiu c th v u tp trung vo cng mt vn nghin cu
l cao huyt p, cng mt i tng nghin cu l ngi cao tui, cng mt a d
(khng gian) l huyn A v trong cng mt thi im nghin cu l nm 2010.
Trong khi v d 2 th vn nghin cu (huyt p) v i tng nghin cu
(ngi dn) nu trong tn ti qu rng so vi mc tiu chung (cao huyt p v
ngi cao tui), v 1 trong 3 mc tiu c th (mc tiu 3) li khng h c cp
trong mc tiu chung v tn ti, do vy nu ta hnh tng ha tn ti nh mi
nh, mc tiu chung nh trn nh, cc mc tiu c th nh cc ct nh th vi v d
1 ta s c c hnh mt ngi nh hp l (hnh 1) cn vi v d 2 ta s c hnh mt
ngi nh c mi qu to, trn qu nh v c mt ct nh nm ngoi c trn ln mi
nh (hnh 2)
Tn ti
Mc tiu chung
Mc tiu 3

Mc tiu 2

Mc tiu 1

Hnh 1: Hnh tng ngi nh ng vi v d 1

7

Tn ti
Mc tiu chung
Mc tiu 3

Mc tiu 2

Mc tiu 1

Hnh 2: Hnh tng ngi nh ng vi v d 2

3. Mi lin quan gia mc tiu c th v bin s nh th no? Lm th no
chn ng v bin s cho mt nghin cu?
Nh ta bit, bin s quyt nh bn cht v ni dung ca mi nghin cu v vi
mi mc tiu nghin cu c th th cn cc bin s khc nhau. Nu ta coi cc mc
tiu c th nh nhng ci ct ca ngi nh (hnh 1 v 2) th bin s chnh l cc vt
liu gip ta hnh thnh c tng ci ct nh . S 2 phn trn ch r sau
khi chn mu xong th ngi nghin cu s tin hnh thu thp s liu trn cc i
tng nghin cu da vo cc bin s v sau qu trnh phn tch s liu, vit bo
co cng ch da vo cc bin s ny. Vic xc nh ng v bin s trc khi
trin khai nghin cu l v cng quan trng v nu thiu bin s th s khng c
d liu phn tch v nh vy mc tiu nghin cu c th khng t c (nh
mt ci ct nh thiu nguyn vt liu to ra n). Tuy nhin nu xc nh tha bin
s th cng s rt lng ph thi gian, cng sc v kinh ph thu thp s liu cho cc
bin s tha v n s khng c s dng trong nghin cu. V vy ngi ta
khuyn rng khi xc nh v chn bin s ngi nghin cu cn tr li cc cu hi
sau:
-

Nhng bin s no l cn phi thu thp khi phn tch ta c s liu kt lun
cho tng mc tiu c th?

Nhng bin s no c cp n trong phn d kin trnh by kt qu nghin

cu ca cng nghin cu c ph duyt?

Bng vic tr li 2 cu hi ny, ngi nghin cu s bit c nhng bin s no

c chn tha v bin s no cn thiu (so snh bin c trong trong b cng c thu
thp s liu vi nhng bin c trong phn d kin kt qu nghin cu).
4. Khi no th bin nh lng khng nn (hoc nn) chuyn sang dng nh
tnh thu thp?
Rt nhiu ngi u bit rng bin nh lng l nhng bin c gi tr l cc con s
(nh s o huyt p ca bin huyt p) cn bin nh tnh c gi tr l cc ch vit
hay k hiu (nh tn tnh, huyn, x ca mt bin a d) v bin nh lng c th
c chuyn sang dng nh tnh thu thp s liu (bin tui ngh tnh bng nm
c chuyn thnh cc nhm tui ngh < 5 nm, t 5-10 nm, t 11-15 nm, t 168

20 nm v > 20 nm, nhng c nhiu ngi khng hiu r khi mt bin nh lng
chuyn sang dng nh tnh thu thp s liu, tnh gi tr ca chng b gim i
ng k. Hnh 3 v 4 di y minh ha cho nhn xt ny:
50 tr

A
B

450 tr
2500 gr

50 tr

450 tr

2500 gr
Hnh 3: Hai nhm tr c t l suy dinh dng bo thai nh nhau nhng cn
nng khi trung bnh li rt khc nhau
Nu nhng a tr c cn nng khi < 2.500 gram c coi l suy dinh dng bo
thai th nhm tr A v B u c t l tr suy dinh dng bo thai nh nhau v u l
10% (50 tr c cn nng < 2.500 gram trn tng s 500 tr c iu tra). Tuy nhin
nu nhn s phn b cn nng ca tng tr trn trc s th hai nhm tr ny c s
khc bit rt ng k v chc chn l cn nng trung bnh ca nhm tr A s ln hn
nhiu so vi nhm tr B.
Cng tng t nh vy, tnh trng cao huyt p ca i tng nghin cu thuc hai
nhm C v D biu th trong hnh di y cho thy hai nhm ny c t l i tng
b cao huyt p ti a l nh nhau (40%) v huyt p trung bnh ca hai nhm ny
c th khc bit khng ng k, nhng nu xt v mc phn tn huyt p ca
tng c th th nhm D c phn tn cao hn nhiu so vi nhm C v nh vy
lch chun ca huyt p ti a ca nhm D s cao hn nhm C.
300 ngi

200 ngi

C
140 mmHg
200 ngi

300 ngi
D
140 mmHg

Hnh 4: Hai nhm i tng nghin cu c t l cao huyt p nh nhau, gi tr

huyt p trung bnh khng khc bit nhng lch chun li rt khc nhau
Nh vy, nu cc b s liu trn c chuyn ngay sang dng bin nh phn phn
tch th ta khng th pht hin c s khc bit khi chng di dng nh lng.
Chnh v nhng l do nu trn, ngi ta khuyn l khi thu thp s liu, ta c gng
thu thp chng di dng nh lng.
V d: Cu hi thu thp tui ngh ca cng nhn:
+ Dng bin nh lng (nn):
Anh/Ch lm bao nhiu nm trong ngh ny: . . . . . . . (nm)
9

+ Dng bin nh tnh (khng nn):

Anh/Ch lm bao nhiu nm trong ngh ny (nh du vo thch hp)
[ ] < 5 nm
[ ] 5 - 10 nm
[ ] 11 - 15 nm
[ ] > 15 nm
Tuy nhin trong mt s trng hp, ngi ta li khuyn nn chuyn s liu nh
lng sang dng nh tnh thu thp khi ta khng th hoc khng cn thu thp
chng di dng nh lng.
V d: Hi s iu thuc l mt ngi ht trung bnh/ngy, ta ch nn thu thp di
dng nh tnh:
+ Dng bin nh lng (khng nn):
Anh/Ch ht trung bnh bao nhiu iu thuc l trong mt ngy?: . . . . (iu)
+ Dng bin nh tnh (nn):
Anh/Ch ht trung bnh bao nhiu iu thuc l/ngy?(chn thch hp)
[ ] < 5 iu
[ ] 5 - 10 iu
[ ] 11 - 15 iu
[ ] > 15 iu
5. C cc loi thit k nghin cu no v phn bit chng nh th no?
Thit k nghin cu thc cht khng phi l bi hc m thuc mn hc thng k,
nhng n li rt lin quan n thng k v vic chn mu, tnh ton c mu v phn
tch s liu u b nh hng bi loi thit k nghin cu. Do vy trong ti liu ny,
chng ti xin c trnh by mt s s phn loi mt s loi thit k nghin cu
ph bin c lin quan nhiu n thng k.
Hin c nhiu cch phn loi thit k nghin cu nhng c th chia lm 3 nhm
chnh theo cch sau:
1. Theo loi hnh
nghin cu
NC khoa
hc c bn

2. Theo bn cht
nghin cu

3. Theo cch thit k

nghin cu dch t hc
NC ngang

NC nh
tnh

NC quan st
NC ng
dng

NC nh
lng

NC hnh ng

M
t

NC Bnh - Chng

Phn
tch

NC dc
NC can thip
Lm
sng

NC Thun tp

S 3: Phn loi cc nhm thit k nghin cu

10

Cng
ng

Trong :
-

Nghin cu khoa hc c bn l nhng nghin cu c tnh pht minh thng c

lm bi nhng ngi c o to c bn chuyn lm nghin cu;

Nghin cu ng dng (applied research) l loi nghin cu m ngi nghin cu

thng ng dng nhng kt qu nghin cu hoc pht minh ca nhng nh
nghin cu khc vo a phng hoc lnh vc cng tc ca mnh;
Nghin cu hnh ng (action research) l mt loi nghin cu ng dng m
ngi nghin cu cng chnh l ngi s ng dng cc kt qu, kin ngh t
nghin cu vo thc t. Nh vy nghin cu hnh ng trong y hc thng xut
pht t nhu cu thc t ca mt vi cn b y t no c cc kh khn trong vic
thc thi cc cng vic hng ngy v h mun lm nghin cu, hoc mi nh
nghin cu gip h trin khai nghin cu tm gii php cho h ci thin nhng
bt cp trong cng vic hng ngy. V vy loi nghin cu ny thng c tnh
ng dng rt cao v thng c nhiu nh ti tr quan tm h tr.
Loi nghin cu nh tnh v nh lng l hai loi nghin cu c cch tip cn
rt khc nhau nhng li h tr nhau rt nhiu. Bng di y tng hp s khc
bit gia hai loi nghin cu ny v ngha ca chng trong nghin cu:

Bng 2: S khc bit gia nghin cu nh lng v nghin cu nh tnh

Nghin cu nh lng

Nghin cu nh tnh

Cch tip
cn

- Theo phng php quy np

- Theo phng php ngoi suy
(inductive)
(deductive)
- Vn NC l hin hu (c tht) v S hin hu ca vn NC ch l
mc ch ca NC l quan st v o tng i v mi ngi c th c
cch nhn nhn khc nhau v s
lng tm c ca vn NC,
- NC thng bt u bng vic hnh tn ti v ln ca vn ny.
thnh gi thuyt sau chng minh - Mc ch ca NC l pht hin
nhng nhn thc khc nhau ny
gi thuyt bng cc test thng k.
- Nhng g khng th quan st v o v l gii ti sao c s khc bit.
lng trc tip th khng thch hp - Hnh thnh kt lun, gi thuyt t
cc pht hin ny
vi cch ny (nh xc cm).

nh
ngha

- o lng kch thc, ln, s

phn b, kt hp ca cc bin s

- Xc nh, thm d mt s yu s
gip ta hiu su sc v bn cht,
nguyn nhn, cc yu t nh
hng ca vn

Cu hi

- Bao nhiu? Bng no?

- Ci g? Ti sao? Nh th no?

u im

- chnh xc c th cao hn do c
cc cng c o lng chun xc
- C cc phng php phn tch
chun, do c v thuyt phc hn

- Thng p dng cho cc nghin

cu, nh gi c s tham gia ca
cng ng, do vy nghin cu
thng st thc t hn.
- Thng l bc thm d cho
nghin cu nh lng, hoc kt
hp vi nghin cu nh lng.

11

Nhc
im

- Phc tp cn phi chn mu ngu

nhin, c mu i din

- Chn mu v c mu khng quan

trng lm nu l NC thm d, tuy
nhin phi chn ng i tng.

Loi k
- o lng, thm khm, xt nghim,
thut thu
s liu c sn, dng b cu hi...
thp s liu

- Phng vn su, tho lun nhm,

v bn , quan st, chp nh,
ghi nht k...

Cng c
cn thit

- Phng tin k thut, Bnh n, b

cu hi...
- c thit k chun, thng c cu
trc sn

- Phiu hi, bng hng dn tho

lun, my nh, my ghi m.....
- Ch thit k chnh, ngi thu
thp s liu da vo khai
thc s liu

Ngi thu
thp s
liu

- C th s dng ngi t c kinh

nghim nghin cu sau tp hun
v gim st tt.

- Phi l ngi c kinh nghim thu

thp s liu nh tnh do phi c
kh nng iu hnh tho lun,
phng vn v khai thc thng tin.

Loi nghin cu theo cch tip cn dch t hc: li c phn ra hai cch phn
loi, l cch phn loi da vo yu t thi gian (nghin cu ngang khi cc
i tng nghin cu ch c thu thp s liu mt ln v nghin cu dc khi
cc i tng c thu thp s liu nhiu ln ti cc khong thi gian khc
nhau) v phn loi theo bn cht tc ng ca ngi nghin cu n i tng
nghin cu (nghin cu quan st hay can thip) nh trong s di y:
Thit k nghin cu dch t hc
NC can thip

NC quan st

Phng
bnh

NC M t

Thng tin
qun th

Thng tin
c th
Bnh
him

NC
tng quan

Ca bnh
him

Lm
sng

NC
phn tch
Bnh
ph bin

Chm bnh
him

Th
nghim

Bnh
chng
Lot
bnh

NC
ct ngang

Thun
tp
Hi
cu

S 4: Phn loi cc loi thit k dch t hc

12

Cng
ng

Tng
lai

6. Nhng yu t no cn cn nhc khi tnh c mu cho mt nghin cu?

6.1. Nguyn tc tnh ton c mu:
Nh trnh by trong s 2, c mu nghin cu l mt trong hai iu kin quan
trng gip cho qua trnh ngoi suy kt qu t mt mu ra qun th nghin cu c th
thc hin c
Loi thit k nghin cu: C cc cch tnh c mu khc nhau vi mi loi thit
k nghin cu tuy nhin c th c mt s nguyn tc chung sau:
- Cc loi nghin cu dc (longitudinal) thng yu cu c mu cao hn loi
nghin cu ngang (cross-sectional study) v t l b cuc trong nghin cu
dc thng cao hn.
- Nghin cu nh lng thng phi tnh ton c mu theo cng thc thch
hp vi tng loi nghin cu, trong khi nghin cu nh tnh thng tnh ton
c mu theo nguyn tc thu thp thng tin cho n khi khng thu c cc
thng tin mi na th dng
- Trong cc nghin cu m qu trnh ngoi suy ra qun th khng c hoc
khoong cn thit (nh nghin cu chm bnh, ca bnh hoc nghin cu thm
d), th c mu nhiu khi khng phi l vn quan trng v nghin cu ch
kt lun cho mu nghin cu;
Loi phng php chn mu: Chn mu chm yu cu c mu ln hn cc
cch chn mu ngu nhin khc (phi nhn c mu vi h s thit k) do cch
chn chm lm gim tnh i din ca mu.
Mc ph bin ca vn c nghin cu: S kin nghin cu cng him
th c mu cng phi cao (cho cc bin nh tnh).
c tnh bin thin ca tham s nghin cu: S khc nhau ca tham s ny
gia cc c th trong qun th cng ln th c mu cng phi nhiu.
Mc sai lch mong mun gia tham s mu v tham s qun th: Do nghin
cu thng ch c tin hnh vi mu nhng ngi nghin cu li mun kt
lun cho qun th m t mu c rt ra nn nu ngi nghin cu mong
mun nghin cu ca mnh pht hin c s khc bit nh gia tham s mu
v tham s qun th th c mu phi ln.
K hoch phn tch s liu: Phn tch s liu a bin (multivariate) yu cu c
mu ln hn phn tch n bin (univariate). Phn tch tng yu cu c mu ln
hn phn tch th.
C mu cn ty thuc vo s bin ph thuc ca nghin cu: Nu ngi nghin
cu mun kho st nhiu bin s u ra (bin ph thuc) trong cng mt nghin
cu th c mu phi c xc nh ring vi tng bin sau la chn c mu
ln nht.
Kh nng thc thi ca nghin cu: y l tiu ch quan trng trong vic chn
c mu nh: kinh ph hin c, nhn lc (s v cht lng), vic i li, thi gian
13

dnh cho nghin cu... Nhiu khi do tiu ch ny m cht lng nghin cu b
gim xung.
6.2. Mt s im cn lu trong tnh ton c mu:
Cn phi chn ng cng thc tnh c mu v cc thnh phn trong cng thc
tnh c mu. Trong trng hp kt qu ca nghin cu tng t trc khng
c sn tham kho th nn lm nghin cu th c s liu a vo tnh c
mu do s liu ca mu nghin cu th sau ny c th gp vo vi s liu ca
nghin cu tht tnh ton nu c 4 iu kin sau:
- a im ly mu th cng chnh l a im m nghin cu tht s din ra;
- Mu ca nghin cu th cng c chn theo ng phng php m nghin
cu tht s chn;
- Phng php thu thp s liu ca nghin cu th cng ging nh nghin cu
tht;
- Vi nhng vn nghin cu c thay i theo thi gian (nh bnh theo ma)
th thi im trin khai nghin cu th phi khng qu xa nghin cu tht
m bo yu t thi gian khng lm nh hng n c mu.
Khi dng cng thc n = Z 21 / 2

p(1 p)
tnh c mu cho mt t l m khng
2

tm c thng tin no v gi tr ca p t nghin cu trc v cng khng

th lm c nghin cu th ly gi tr p a vo tnh c mu th ngi
nghin cu c th c tnh t l p ca hin tng sc khe trong qun th
nghin cu thng qua kinh nghim ca mnh ch khng nn chn p = 0,5 nh
mt s sch thng k thng kin ngh do khi chn p = 0,5 th ng l tch p(1p) = 0,5 (1-0,5) s l ln nht nhng nu khng c kinh nghim chn m u
chn bng 0,05 th c mu ca mi nghin cu khi chn theo cch ny vi
=0,05 lun bng 384. iu ny l khng th chp nhn c v theo nguyn tc
tnh c mu, vn nghin cu cng him th c mu cng ln, cn vn
nghin cu cng ph bin th c mu cng nh.
Ngoi ra, trch trng hp chn khng thch hp, ngi ta khuyn nn p
dng cng thc tnh c mu m c tnh gin tip qua p v theo cng thc
p(1 p)
1 p
sau: n = Z 21 / 2
.
= Z 21 / 2
2
( p. )
p 2
7. Tng phng php chn mu ngu nhin c nhng u, nhc im g?
Chn mu i din cho qun th nghin cu l mt khu v cng quan trng khi
trin khai nghin cu v nu mu khng i din th kt qu thu c t mu s
khng th ngoi suy ra ngoi qun th (s 2). mu c th i din c cho
qun th th cn phi p dng cc phng php chn mu ngu nhin m mi
phng php u c nhng u, nhc im m ngi nghin cu cn phi bit. Ta
c th chia chn mu ngu nhin trong nghin cu nh lng ra lm 2 nhm:
14

Nhm 1: Mu c chn rt ngu nhin v i din nhng cc i tng nghin

cu thng b phn tn, ri rc trong qun th dn n qu trnh thu thp s liu
phi i li nhiu gy tn km. Thuc nhm ny c cch chn mu ngu nhin
n, mu ngu nhin h thng v mu ngu nhin phn tng.
Nhm 2: Mu c chn t phn tn hn m tp trung ch yu vo cc chm
(hoc cm) c chn vo mu. Thuc nhm ny c cch chm mu chm
hoc chn theo phng php PPS (probability proportionate to size). Nh vy
vi phng php chn mu ny, ngi nghin cu s phi i li nhiu khi
thu thp s liu nhng ngc li tnh i din ca mu s gim i. khc phc
nhc im ny ngi ta khuyn cn phi tng c mu ln v mc tng ty
thuc vo h s thit k (design effect) c tnh ton theo mt cng thc kh
phc tp. Trong trng hp khng bit cch tnh h s ny, ngi ta khuyn
nhn nn c mu ln gp i cho mi ln chn mu chm hoc PPS.
8. C nhng im no cn lu khi tng hp v trnh by s liu?
Tng hp v trnh by s liu l cc thao tc chnh trong thng k m t (s 2).
y l phn tng i d hiu nhng cng c nhiu sai st xy ra. Sau y l mt s
im cn lu :
Trc khi tng hp mt b s liu nh lng (o lng tp trung v phn
tn ca b s liu) th cn phi xem b s liu c c phn b chun hay
khng? Nu b s liu c phn b chun ta mi c th dng gi tr trung bnh
v lch chun tng hp, cn nu phn b khng chun th phi dng gi
tr trung v v khong phn trm (hoc phn mi, phn t) tng hp;
Khi mt b s liu c gi tr trung bnh, trung v v mt c xp x bng nhau th
l cch n gin nht kt lun b s liu c phn b chun. Ngoi ra
ta c th dng mt s phn mm thng k v biu ct lin tc ca b s
liu kt hp ng cong kim tra xem b s liu c c phn b chun
khng nh biu di y:

Frequency

29

0
709

bwt

4990

Biu 1: Biu kim tra b s liu c c phn b chun khng

Trong mt s trng hp khi b s liu nh lng c phn b khng chun,
ngi ta c th chuyn dng thnh b s liu chun tng hp v p dng cc
15

test thng k vi phn b chun (test tham s). Qu trnh ny c th d dng

trin khai vi mt s phn mm thng k nh STATA:
30

Frequency

Frequency

34

0
14

45
1.83177

age

B s liu trc khi chuyn dng

BC(age,-.2959)

2.28396

B s liu sau khi chuyn dng

Khi trnh by cc kt qu nghin cu di dng biu , th th mi loi s

liu thch hp vi cc cch trnh by khc nhau theo m t trong bng sau:
Bng 3: Chc nng ca tng loi biu
Loi biu

Chc nng biu

Ct ri (hoc
thanh) ng
hoc ngang
(bar chart)

So snh cc tn s, t l gia cc nhm, loi ca mt bin nh tnh (danh

mc hoc th hng), hoc gi tr trung bnh ca cc bin nh lng. C
th kt hp hai n ba bin trn mt biu , khi s to ra cc nhm
ct. Gia cc nhm ct lun c mt khong cch.

Hnh trn (pie

chart)

So snh cc t l khc nhau gia cc loi trong mt nhm ca mt bin

nh tnh. Tng cc t l ny phi bng 100%.

Ct chng
nhau

Biu hnh trn ch thch hp khi biu th cho mt qun th. Khi mun
so snh bin gia hai hoc ba qun th khc nhau th biu ct chng
l thch hp nht.

Ct lin tc
(histogram)

Khi mt bin nh lng c phn ra cc nhm khc nhau, n s tr

thnh mt bin nh tnh (bao gm nhiu nhm xp k tip nhau). Trong
trng hp ny biu lin tc l thch hp nht.

a gic
(polygon)

L mt dng c bit ca biu ct lin tc khi im gia ca cc ct

ny c ni vi nhau theo nguyn tc din tch cc ct bng din tch a
gic. Khc vi biu ng thng, hai u mt ca biu a gic lun
lun tip xc vi trc honh, to ra mt a gic vi trc honh.

ng thng
(line)

Ch ra s bin thin ca mt loi s liu no theo thi gian. C th

ghp nhiu biu ng thng trn cng mt trc s tin so snh.

Biu chm
(scatter)

Ch ra s tng quan gia hai bin nh lng. Da vo biu ny ta c

th bit c hng v mc tng quan gia hai bin nh lng ny.

Bn (map)

Phn b ca mt bnh, mt hin tng sc khe no theo a d.

Trong trng hp ny ngi ta quan tm n s ngi mc bnh trong
cc vng khc nhau ch khng quan tm n t l mc.
16

9. C nhng im no cn lu khi ngoi suy kt qu nghin cu t mt mu

ra qun th m t mu c rt ra?
Vic nghin cu theo mu nhng vn c th ngoi suy v kt lun cho mt qun th
l mt u im ni tri trong nghin cu theo mu, tuy nhin c nhiu yu t nh
hng n vic b s liu c th ngoi suy c hay khng cng nh cht lng v
tnh chnh xc ca qu trnh ngoi suy. Di y l mt s im cn lu :
1. Ch nhng nghin cu vi mu c rt ra t qun th nghin cu mt cch
ngu nhin vi c mu ln mi c th ngoi suy ra qun th c (s 2).
Do vy khng nn lm dng cc test thng k ngoi suy nu mu c chn
khng p ng hai yu cu trn. Khi ch nn p dng thng k m t vi mu
nghin cu (tng hp v trnh by kt qu nghin cu);
2. Cn phi phn bit c khi no th dng c lng im, khong, khi no dng
kim nh gi thuyt ngoi suy kt qu nghin cu t mu ra qun th nghin
cu. c lng im v khong dng c tnh tham s qun th t tham s
mu. Tham s mu c th l gi tr trung bnh, t l, gi tr OR, RR... c tnh
ton t b s liu ca mu, trong khi kim nh gi thuyt thng c p
dng khi c s so snh gia cc tham s mu ca hai hay nhiu mu nghin cu
bng cc test thng k t kim nh xem kt qu khc bit t mu c ging
nh trong qun th m t mu c rt ra hay khng.
3. Cn phi phn bit cc loi test thng k p dng cho cc b s liu khc nhau.
Cc bng di y cho thy vic chn test ty thuc vo rt nhiu yu t nh:
Phn b ca b s liu (c chun hay khng?); Loi s liu (nh tnh hay nh
lng?); S nhm (mt, hai hay nhiu nhm?); Ghp cp hay c lp? Nu b s
liu c phn b chun th c th p dng c cc test tham s (parametric test)
cn nu khng th phi p dng cc test phi tham s (non-parametric test), hoc
chuyn b s liu sang dng chun p dng cc test tham s tnh ton.
Bng 4: Ch nh p dng mt s test phi tham s thng dng
Test phi tham s
Ch nh
Test tham s tng ng
- Kim nh du hiu (sign Dng n gin ca kim nh
test)
du hiu v tr Wilcoxon
- Kim nh du hiu v tr
Wilcoxon

Kim nh s khc nhau gia Kim nh t cp

cc quan st cp

- Kim nh tng, v tr
Wilcoxon

So snh hai nhm

- Kim nh MannWhitney U v Kendalls

Tng t nh kim nh tng Kim nh t hai mu

v tr Wilcoxon
c lp

Kim nh t hai mu
c lp

- Phn tch phng sai mt So snh nhiu nhm

chiu Kruskal-Wallis

Phng sai mt chiu

(one way ANOVA)

- Phn tch phng sai hai

chiu Friedman
- Tng quan du hiu

Phng sai hai chiu

(two ways ANOVA)

So snh cc nhm bng cc

gi tr ca n trn hai bin
o s tng quan gia hai
17

H s tng quan (r)

Spearmans

bin

- Tng quan du hiu

Kendalls

Tng t nh tng quan

du hiu Spearmans

- Test khi bnh phng

goodness

So snh s phn b quan st

c vi l thuyt

- Kim nh mt mu
Kolmogorov-Smirnov

Tng t vi khi bnh

phng

- Kim nh hai mu
Kolmogorov-Smirnov

So snh phn b tn s

S liu nh
lng c
phn b
chun (test
tham s)
Phn tch
s khc
nhau

S liu th
hng hoc
nh lng
khng chun
(phi tham s)

Hai
mu

Hai
mu

Hai
mu

Hai
mu

Loi phn
tch

Phn tch
mi tng
quan

Bin danh
mc hoc
nh phn

H s tng quan (r)

c lp

Test t student

Ghp cp

Test t ghp cp

c lp

ANOVA 1-2 chiu

Ghp cp

ANOVA ghp cp

c lp

Mann-Whitney U test
Mc Nemar test

Ghp cp
c lp

Kruskal-Wallis test

Ghp cp

Friedman test

Hai mu c lp
Hai mu ghp cp

hoc Fisher test

Friedman/Kendall
test

S liu nh lng c
phn b chun

H s tng quan (r)

ca Pearson

S liu th hng hoc

nh lng khng chun

H s tng quan ca
Spearman

Bin danh mc hoc nh

phn

H s tng quan
Phi/Cramer

S 5: La chn test tham s hoc phi tham s ty cc loi s liu

18

10. Cha hiu ng khi nim sai s, nhiu v s cn thit phi khng ch sai
s v nhiu trong nghin cu
Khi nim qun l s liu (data management) v tng cng cht lng s liu (data
quality) v khng ch sai s, nhiu (bias and confounding control) trong nghin cu
hin cn cha c quan tm ng mc Vit Nam. Nhiu nh nghin cu cha
hiu c rng c b s liu c cht lng, khch quan phc v cho mc tiu
nghin cu th ngi nghin cu phi lm tt t khu thit k, chn mu, thu thp s
liu, x l, lm sch, phn tch s liu v vit bo co. Ngay c khi c b s liu
tt nhng khi phn tch khng ng th b s liu cng c th cho kt qu sai dn
n kt lun sai lm. Di y l mt s lu :
10.1. Cn phi phn bit r sai s ngu nhin, sai s h thng v bit cch loi tr
chng ngay t khi thit k nghin cu:
Nu mt ngi c o huyt p tm trng bng cch lun mt ng thng vo
ng mch v kt qu c c bng my th kt qu thng l rt chnh xc v t
c dao ng gia cc ln o cng nh ngi o. iu ny tng ng vi trng hp
A trong s di y. Tuy nhin trn thc t ta thng o huyt p mt cch gin
tip thng qua mt s cng c v do ngi o. chnh xc ca cch o ny ty
thuc vo cc yu t sau:
chnh xc ca cc cng c o lng;
Ngi o khc nhau c th cho kt qu khc nhau ngay c khi s dng cng
mt dng c o;
Din bin c im sinh hc ca ngi c o, t th lc o;
Do cc yu t khc khng th gii thch c.
iu c th pht sinh ra mt s loi sai s sau y:
a/ Sai s h thng
Khi s dng mt dng c o lng thiu chnh xc (v d lun cho kt qu cao hn
gi tr thc) th ta thng thu c kt qu cao hn mt cch c h thng so vi gi
tr thc (trng hp B s di). Trong mt s trng hp khc, mc d my o
huyt p chnh xc nhng do ngi o khc nhau cng c th cho kt qu khc
nhau, c ngi thng cho kt qu lun cao hn ngi khc (ty thuc thnh gic,
trnh v kinh nghim), iu cng c th dn n sai s h thng.
b/ Sai s ngu nhin
Cn gi l sai s do may ri, trong trng hp ny ngay c mt ngi o, s dng
cng mt dng c, trn cng mt bnh nhn v cng t th nhng vn c th cho
kt qu huyt p khc nhau, iu ny c th do may ri, do yu t thn kinh, tm l
ca ngi c o huyt p. Tuy nhin, nu s o lng c lp li nhiu ln th ta
thng thy kt qu mi ln o dao ng xung quanh mt gi tr no v nu tnh
gi tr trung bnh ta s c kt qu trung bnh gn vi gi th thc (nu khng c sai
s h thng kt hp). Trong s di y, do sai s h thng nn gi tr trung bnh
19

ca cc ln o l bng vi gi tr m sai s h thng gy ra (bng 90 mmHg, trong

khi gi tr thc l 80 mmHg).
Mt v d d hiu hn v sai s do may ri l vic tung ng xu. V l thuyt th c
hi gp ng xu vi mt sp v nga l bng nhau v bng 50%, tuy nhin do may
ri t l ny nhiu khi khng nh l thuyt, nht l khi s ln tung khng nhiu.
Ngi ta thy rng khi s ln tung tng ln, t l nhn c mt sp hoc nga s
tin dn n t l l thuyt tc l 50% sp hoc nga. y cng l c s l lun ca
vic tng c mu trong nghin cu hn ch sai s ngu nhin.
B (gi tr sai)

A (gi tr ng)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

May ri

Sai s
h thng

oo
oooo
oooooooooo
oooooooooooooooooooooooo
oooooooooo
oooo
oo

80

mmHg
90

Hnh 5: Phn bit khi nim sai s ngu nhin v sai s h thng
10.2. Cn phi hiu nhiu c tc ng nh th no n kt qu nghin cu v lm
th no khng ch nhiu:
Di y l mt v d c in ca Simpson, Julious v Mullee nm 1944 trnh by
vai tr ca yu t nhiu (l yu t tui) trong mt nghin cu thun tp v t vong
do tiu ng lin quan n s l thuc vo insulin:
Bng 5: T vong do tiu ng lin quan n mc l thuc vo insulin
a/ Khi ch c bin Mc l thuc Insulin v Tnh trng sng st c xem xt
Mc l thuc insulin
Tnh trng sng st

Khng

Sng

326

253

Cht

218

105

Tng

544

358

T l cht

40%

29%

20

B/ Khi bin nhm tui c a vo phn tch tng nh mt yu t nhiu

Tng 1: Tui bnh nhn
Tnh
trng
sng st

40

Tng 2: Tui bnh nhn > 40

Mc l thuc
insulin
Khng

Tnh
trng
sng st

Sng

15

129

Cht

Tng
T l cht

Mc l thuc
insulin
Khng

Sng

311

124

Cht

218

104

15

130

Tng

529

228

0%

1%

T l cht

41%

46%

T 3 bng trn ta thy khi bin nhm Tui cha c a vo phn tch cng vi
bin Mc l thuc insulin v Tnh trng sng st, th t l cht trong s bnh
nhn tiu ng c l thuc vo insulin cao hn ng k so vi cc bnh nhn
khng l thuc vo insulin (40% so vi 29%). Tuy nhin khi yu t tui cn nhc
di dng phn tch tng kh nhiu (tng tui 40 v tng tui > 40), t l cht
trong nhm khng l thuc vo insulin li lun cao hn nhm nhm c l thuc vo
insulin. Nh vy, r rng khi yu t tui c a vo phn tch th kt lun v vai
tr ca s l thuc insulin trong t vong ca bnh tiu ng thay i hn. Trong
trng hp ny tui c th c coi l yu t nhiu v bng cch p dng phn tch
tng vi vic xc nh gi tr hiu chnh ca RR hoc OR s cho kt lun chnh xc
hn nh trong v d di y:
Phi nhim
C
Khng
Tng

Bnh
C
200
50
250

Khng
800
950
1,750

Tng
1000
1000
2,000

Bng trn l tng hp s liu t mt nghin cu thun tp c c mu ca nhm phi

nhim l 1.000 v nhm khng phi nhim cng bng 1.000. Khi ch c yu t phi
nhim v bnh c cn nhc th vi b s liu trn ta s tnh c nguy c tng
200 / 1000
i (RR) l RR =
= 4.00 .
50 / 1000
Vi kt qu ny ta c th kt lun c rng nhng ngi phi nhim vi yu t
nguy c c nguy c mc bnh gp 4 ln ngi khng phi nhim. Tuy nhin khi mt
bin s th 3 c em vo phn tch tng, ta c kt qu RR tnh ton c t tng
tng khc vi kt qu thu c t bng trn (bng di y), c th l RR ca tng 1
ch cn l 1,02 cn RR ca tng 2 l 1,86. Nu tnh ton RR hiu chnh (tc l cho
21

php cn nhc cng mt lc tc ng ca yu t nguy c v nhiu) t b s liu trn

ta s c RR hiu chnh ch bng 1,14 v khi ta c th kt lun rng khi yu t
nhiu c em phn tch cng mt lc vi yu t nguy c, nhng ngi phi
nhim ch cn nguy c mc bnh gp 1,14 ln nhng ngi khng phi nhim (ch
khng phi l 4 ln nh khi cha kh yu t nhiu)
Tng 1: C yu t nhiu
Phi
nhim

Tng 2: Khng c yu t nhiu

Bnh

Tng

C
Khng

C
194
21

Khng
706
79

900
100

Tng

215

785

1000

RR1 =

Phi
nhim

Bnh

Tng

C
Khng

C
6
29

Khng
94
871

100
900

Tng

35

965

1000

194 / 900
= 1.02
21 / 100

RR2 =

6 / 100
= 1.86
29 / 900

Ngoi ra, tc ng tng h gia cc tng trong phn tch tng kh nhiu cng l
vn cn phi cn nhc. Bng di y gip ta phn bit c khi nim v nhiu
v tc ng tng h:
Bng 6: Phn bit cc loi yu t nhiu v tc ng tng h
Loi nghin cu

Gi tr chung v theo tng

Tng 1

Tng 2

Chung 2 tng

Nhn xt

1
2
3

Thun tp (RR)
Thun tp (RR)
Bnh chng (OR)

1,02
1,74
0,96

1,86
3,00
0,45

4,00
1,00
1,83

Nhiu v c tc
ng tng h
gia cc tng

4
5
6

Thun tp (RR)
Thun tp (RR)
Bnh chng (OR)

4,00
1,00
1,83

4,00
1,00
1,83

4,00
1,00
1,83

Khng nhiu v
khng c tc
ng tng h

7
8
9

Thun tp (RR)
Thun tp (RR)
Bnh chng (OR)

1,01
3,00
0,83

1,01
3,00
0,83

4,00
1,00
1,83

Nhiu v khng
c tc ng
tng h

10
11
12

Thun tp (RR)
Thun tp (RR)
Bnh chng (OR)

1,07
3,00
0,36

9,40
0,33
6,00

4,00
1,00
1,83

Tc ng tng
h rt ln
lm lu m nhiu

T cc v d nu trn ta thy nu ch da vo cc phn tch n bin (tc l ch xem

xt nh hng ca mt yu t nguy c trn bnh) th mi lin quan tnh ton c c
th s khng chnh xc do tc ng ca cc yu t nhiu cha c khng ch.
22

10.3. Cc bin php khng ch nhiu:

Khc vi sai s (ch c th loi b trong giai on thit k), nhiu c th c khng
ch c giai on thit k ln giai on phn tch s liu
a/ Kh nhiu trong giai on thit k nghin cu:
-

Chn ngu nhin v phn b ngu nhin: Vi mt c mu ln th ngi ta

hy vng rng chn ngu nhin c th phn phi u cc yu t nhiu (k c cc
yu t bit, khng bit n hoc khng ngh n) trong cc nhm nghin cu.
Tuy nhin, do vai tr ca yu t may, ri, iu ny khng phi lc no cng
ng. Trong mt s th nghim lm sng, chc chn yu t nhiu c phn
b u trong nhm nghin cu v nhm chng, ngi ta c th p dng k thut
phn b ngu nhin phn tng hoc phn b khi.

Thu hp phm vi nghin cu: V d ch chn nghin cu mt gii loi yu t

gii, chn mt nhm tui nht nh, chn ch nhng ngi c ht thuc l...

Bin php ghp cp: Ghp cp thng dng trong nghin cu bnh chng, th
nghim lm sng, i khi trong thun tp vi quy m nh. Ngoi ra nh gi
trc v sau can thip cng l 1 dng ghp cp, cn gi l t i chiu. Tiu thc
c la chn ghp cp chnh l bin nhiu chng ta mun loi b. V d nu
ta mun loi b yu t nhiu l tui, gii v ngh nghip, th khi c mt c th
bnh c chn, ta phi chn mt c th chng c cng gii, xp x tui v c
ngh nghip tng t vi c th bnh chn to ra mt cp nghin cu. Khi
vic phn tch s liu s i theo cp ch khng i theo cc c th nh trong
nghin cu khng ghp cp.

b/ Kh nhiu trong giai on phn tch s liu:

-

Phn tch tng kh nhiu: Nh cp trong phn trn, nhiu l yu t c

th lm thay i ln v ngha ca mi tng quan gia phi nhim v bnh.
S thay i ny c th c pht hin trong giai on phn tch s liu v phn
tch tng l mt trong cc bin php hu hiu pht hin nhiu v kh nhiu.
Tuy nhin bin php ny ch p ng c vi bin nhiu l cc bin nh tnh
(c th chia nhm hnh thnh cc tng) v cng ch khng ch c 1-2 yu t
nhiu cng mt lc.

Kh nhiu bng phn tch a bin: y l gii php l tng nht kh nhiu
v c th kh nhiu bin nhiu cng mt lc v c th kh c cc yu t nhiu l
cc bin nh lng. Ty theo bn cht ca bin ph thuc m ngi ta chn
phng php phn tch a bin khc nhau. Nu bin ph thuc l bin nh lng
th ngi ta p dng phn tch hi quy a bin, cn nu bin ph thuc l bin
nh phn th ngi ta p dng phn tch hi quy logistics.

23

KT LUN:
Thng k l mt mn hc c lch s rt lu i nhng kh kh v tru tng,
nn nhiu nh nghin cu lun cm thy kh khn khi ng dng chng trong
nghin cu. Trong khi , tin hc li l mt lnh vc kh mi m v mc d n
thuc mt phm tr khc vi thng k nhng n li c mi lin quan mt thit
vi thng k v c th h tr rt nhiu cho vic ng dng thng k trong nghin
cu khoa hc. Trc y khi tin hc cha pht trin, nhng ngi lm nghin
cu khoa hc gp rt nhiu kh khn trong thit k cng c nghin cu, thu
thp, x l, phn tch s liu, tham kho v sp xp cc ti liu nghin cu.
Ngy nay vi s bng n ca cng ngh thng tin, ngi nghin cu c rt
nhiu cng c hu hiu thc hin cc cng vic trn, tuy nhin Vit Nam,
vic ging dy v thng k, tin hc trong y hc cha c i mi theo ng
tc pht trin ca hai mn hc ny.
Vi ti liu ny, chng ti mong mun nu ln tnh cn thit v cp bch trong
vic phi i mi ging dy thng k v tin hc y hc trong cc trng i hc
y v tng hp nhng sai st thng gp ca cn b y t khi p dng thng k
trong nghin cu khoa hc, cng nh tm tt nhng phn kin thc c lin quan
ngi c c th tham kho.
Ti liu tham kho:
1. Lu Ngc Hot, Phm Ngn Giang, L Vn Hi. Thng k c bn trong y sinh
hc, Nh xut bn Y hc, 2010.
2. Lu Ngc Hot v cng s: ng dng thng k y sinh hc trong cc bi bo
khoa hc y hc, Kha lun tt nghip c nhn YTCC H Y H Ni, nm 2009
3. Lu Ngc Hot. Thng k v tin hc ng dng trong Nghin cu y hc, Nh
xut bn Y hc, 2008.
4. Pamela Wright, Peter Mason, Lu Ngc Hot. Vit v xut bn bi bo khoa
hc Quc t (bn ting Vit & ting Anh). Nh xut bn Y hc, 2008.
5. Luu Ngc Hoat et al: A desk study on reviewing articles published in several
common Vietnamese medical journals in 2002, study supported by MCNV,
2003

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