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DCH TE HOC MO TA

Bai giang ai hoc


Bo mon Dch te
DCH TE HOC MO TA
Quan iem cua DTH :
Benh khong xuat hien ngau nhien ma
luon luon la hau qua t nguyen
nhan nao o

Nghien cu mo ta ?
- Nghien cu hnh thai xuat hien benh
va mo ta s lien quan cua benh vi
ngi, ni chon, thi gian
- Trnh bay co he thong cac so lieu
ve:
MUC CH

1. Mo ta
Tnh trang sc khoe cua mot dan
so
Xu the benh trong cong ong
2. Cung cap d kien e :
Lap ke hoach y te
anh gia hieu qua
3. Hnh thanh gia thuyet ve s xuat
hien, nguyen nhan cua mot benh
TA
NGHIEN CU TNG QUAN (NC SINH
THAI)

Mo ta moi lien quan gia benh va


yeu to quan tam
S dung d kien cua toan bo dan
so e mo ta moi lien quan
n v quan sat la dan so
Bien so o lng: tr so trung bnh cua
toan dan so
Lap gia thuyet ve moi lien he
da vao he so tng quan (-1< r <+1)
Nghien cu tng quan:
Ty suat chet benh MV/1.000/10 nam so vi % calo t
m bao hoa trong khau phan cua dan so trong 7
nc
Nguon: Seven countries: A multivariate Analysis of Death and Coronary Heart Disease.A
Keys.Cambridge.1980
MO TA
NGHIEN CU TNG QUAN (NC SINH
THAI)

u iem:
Bc au xay dng moi lien quan
Nhanh, t ton kem , thong tin san co
Han che:
Khong co kha nang suy dien, lien ket
benh vi tng ca the, kho ket luan du
he so r cho thay lien quan
Khong kiem soat c yeu to gay nhieu
So lieu ch bieu th cho ca dan so,
khong mo ta c mc tiep xuc cua
tng ca nhan
BAO CAO TNG CA, HANG LOAT
CA

n v nghien cu la ca the
Mo ta:
Benh trang, ac iem cua mot benh mi
Cac yeu to lien quan hoac hau qua cua
mot tiep xuc
- Mo ta mot trng hp benh ac biet: bao
cao tng ca, bc au tien giup nhan dien
ac iem mot benh mi hay hau qua co hai
- Mo ta mot nhom benh co cung chan oan
xay ra trong mot thi khoang ngan: bao cao
hang loat ca
S O THIET KE BAO CAO
MOT CA

Ai ?

GIA
MOT
THUYET
CA au ?
NGHIEN
BEN
H CU

Khi nao?
S O THIET KE BAO CAO HANG
LOAT CA

AC IEM A 1
AC IEM B1
AC IEM C1

AC IEM A 2
MO TA
NHIEU AC IEM B2 CHUNG VA
CA AC IEM C2 AT GIA
BENH THUYET
NGHIEN
CU
AC IEM A 3
AC IEM B3
AC IEM C3
BAO CAO TNG CA, HANG LOAT
CA

u iem:
Nhan biet benh mi
Hnh thanh gia thuyet lien quan en
cac yeu to nguy c.
Xac nh bung phat dch
Han che:
Khong kiem nh gia thuyet c v
thieu nhom chng e so sanh
NGHIEN CU CAT NGANG

Loai nghien cu mo ta thng dung


(khao sat, ieu tra) thc hien tren mot
dan so
So o e mo ta la ty le
Hai yeu to benh" va tiep xuc (phi
nhiem) cung c ghi nhan cung mot luc
Mo ta s phan bo benh tat va cac yeu
to quyet nh sc khoe trong dan so
Co the khao sat moi lien quan gia hien
tng sc khoe va yeu to tiep xuc
S O THIET KE NGHIEN CU CAT
NGANG

DAN SO NGHIEN CU
Chon dan
so

Chon mau

MAU NGHIEN CU

Thu thap d
kien

PN + PN + PN - PN -
Phan tch d
B+ B- B+ B-
kien
NGHIEN CU CAT NGANG

u iem:
Mo ta tnh hnh sc khoe trong cong ong

Hnh thanh gia thuyet

t ton thi gian, chi ph

Neu yeu to phi nhiem bat bien hay xac

nh xuat hien trc, co the ket luan ve


quan he nhan qua
Han che:
Khong xac nh c trnh t thi gian gia

phi nhiem va hau qua nen khong the ket


luan ve quan he nhan qua
NGHIEN CU CAT NGANG
Cac bc tien hanh

1. Xac nh muc tieu :


Mo ta yeu to g ?
Tm hieu moi lien quan nao ?
2. Xac nh dan so nghien cu:
ac iem ve ngi, thi gian, a
iem
3. c lng c mau va chon mau:
u c mau, mau can co tnh ai dien
NGHIEN CU CAT NGANG
Cac bc tien hanh

4. Quyet nh thong tin can thu thap:


nh ngha cac bien so
Phng phap o lng
Cong cu thu thap so lieu
5. Nghien cu th
6. Nghien cu chnh thc (can co ty
le tham gia cao)
NGHIEN CU CAT NGANG
7.Trnh bay so lieu

BENH BENH (-) TONG


(+)
TIEP XUC a b a+b
(+)
TIEP XUC c d c+d
(-)
TONG a+c b+d N
NGHIEN CU CAT NGANG
7.Trnh bay so lieu

TANG TANG TONG


H/A (+) H/A (-)

BEO PH 50 150 200


(+)
BEO PH (-) 100 700 800
TONG 150 850 1.000
NGHIEN CU CAT NGANG
S lc phng phap phan tch

Tnh va mo ta cac ty le
1. Ty le benh trong dan so khao sat : a+c/N
2. Tnh ty le phi nhiem trong dan so: a+b/N
3. Tnh ty le va mo ta s phan bo cua cac
nhom:
Ty le benh nhom phi nhiem (+): a/(a+b)
Ty le benh nhom phi nhiem (-) : c/(c+d)
Ty le phi nhiem nhom benh (+): a/(a+c)
Ty le phi nhiem nhom benh (-) : b/(b+d)
NGHIEN CU CAT NGANG
S lc phng phap phan tch

So sanh
Ty le benh nhom phi nhiem(+)/ phi nhiem(-)
a/(a+b) so vi c/(c+d)
Ty le phi nhiem nhom benh (+) va benh (-)
a/(a+c) so vi b/(b+d)
Cac so o moi lien quan gia benh va phi nhiem :
Ty so ty le hien mac (prevalence ratio PR):
PR = a/(a+b) : c/(c+d)
Ty so so chenh (prevalence odd ratio POR):
POR = ad/bc
lc luc con nho
Nguon : Mac Millan va CS 1999

TNH:
Ty le ngi nghien ru trong dan so khao
sat ?
Ty le ngi thng xuyen b oi x bao lc
luc con nho trong dan so?
Ty le cua cac nhom trong dan so, ty so so
chenh ?

B OI X BAO NGHIEN NGHIEN TONG


LC LUC NHO RU (+) RU (-)
KHONG CO/ 309 3140 3449
HIEM
THNG XUYEN 190 1247 1437
TONG 499 4387 4886
CAC AC TRNG CAN
MO TA
MO TA VE NGI:
ai mac benh?, ho co ac
iem g?

Cac yeu to can mo ta ve ngi


1.TUOI : anh hng manh, tuy vao
Kha nang mien dch
Tnh nhay cam vi tac nhan gay benh
Thi gian tiep xuc tch luy
Thay oi tnh trang sinh ly theo tuoi
ac iem ve loi song, hanh vi sc
khoe
Ty suat mac hoi chng Down theo tuoi
cua me
Thuy ien.1968-1970 va
Jerusalem.1964-1970
Nguon:Hook and Linksjo(1979), Harlap (1974)
Mo ta ac iem ve ngi:
Ty suat gay xng do loang xng phu n,
phan bo theo tuoi
Nguon:Cooper & Melton.1992
Nguy c ung th v theo tui
incidence 1/1.000
SEER (NATIONAL CANCER INSTITUDE 1999)
IEM VE NGI
Ty le Tang huyet ap
theo tuoi va gii

Nguon: Tran Thien Thuan, Tang HA ngi dan TPHCM nam 2005: ty le hien
mac va yeu to nguy c
Cac yeu to can mo ta
ve ngi

2. PHAI TNH: do s khac biet ve


sinh hoc
hoat ong xa hoi, nghe nghiep
ac iem tam ly

3. TNH TRANG HON NHAN


vai tro tch cc cua hon nhan
anh hng cua tiep xuc gii
tnh.
co thai, cho con bu
Mo ta ac iem ve ngi:
Ty suat MT(+) phan bo theo tuoi va gii.Viet Nam
2002
Nguon: Global Tuberculosis Control. WHO REPORT 2005
Cac yeu to can mo ta
ve ngi
4. GIA NH VA CAC YEU TO LIEN QUAN
chung toc
so ngi trong gia nh, th t sinh
tuoi va cac ac iem cua cha me
cac tnh chat di truyen

5. YEU TO VAN HOA XA HOI:


ton giao va ac iem dan toc
ac iem xa hoi: thu nhap, v tr xa
hoi, hoc van, nghe nghiep. . .
ac iem van hoa: tap quan, loi
song . . .
Mo ta ac iem ve ngi:
TY LE AI THAO NG NGI > 20 TUOI
PHAN BO THEO THU NHAP AN O.2000
(WHO.2002)
Nguon:The Atlas of Heart disease and Stroke.J. Mackay va G.A. Mensah. 2004
Mo ta ac iem ve ngi:
Ty le cao huyet ap theo trnh o hoc van
(nhom >15 tuoi, HA > 160/95. Nam Phi.1998)
Nguon:The Atlas of Heart disease and Stroke.J. Mackay va G.A. Mensah. 2004
Tuoi sinh sinh hoat tnh duc lan au
phan bo theo trnh o hoc van
Swaziland, 2007
( Nguon : Central Statistical Office & Macro International. 2008
VE NGI
Mc o uong ru va
Tang huyet ap

Nguon: Tran Thien Thuan, Tang HA ngi dan TPHCM nam 2005: ty le hien mac
va yeu to nguy c
Mo ta ve kien thc ve lay truyen
HIV trong gii mai dam Karachi va
Lahore, Pakistan
(Nguon Bokhari et al. 2007)
NI CHON: benh xay ra au, ni
nao co ty suat mac benh cao
nhat, thap nhat?

1.Tren pham vi toan cau, mo ta


s phan bo benh va dac iem
ve ni chon:

at gia thuyet ve s xuat hien benh


lien quan en chung toc, yeu to moi
trng
anh gia hieu qua cua chnh sach y
te khi so sanh theo quoc gia
Mo ta xu the benh tren toan cau
Mo ta theo ni chon:
Phan bo SARS theo quoc gia
Nguon:SARS report.WHO.
2003
NI CHON: benh xay ra au?
ni nao co ty suat mac benh
cao nhat, thap nhat?

2. Tren pham vi quoc gia: mo ta s


phan bo benh theo cac ac iem
a ly, kh hau
Moi trng thien nhien va xa hoi
Dinh dng
giup xay dung gia thuyet ve nguyen
nhan va yeu to nguy c cho s xuat hien
benh
Mo ta ni chon
Cac ca benh cum gia
cam phan bo theo a
phng. Viet Nam

Nguon: Avian Influenza A (H5N1) in 10


patients in Viet Nam, NEJM. Vol 350
Mar.2004
NI CHON: benh xay ra
au?, ni nao co ty suat mac
benh cao nhat, thap nhat?

3. Mo ta vu dch: ban o dch cho


biet

Ty suat mac benh tng vung


Cac yeu to moi trng, sinh thai co
lien quan en s xuat hien benh
Benh t au ti

Giup at gia thuyet ve nguyen nhan, cac


yeu to nguy c, cach lay, hng lan truyen
cua vu bung phat dch
CAC AC TRNG CAN MO TA
S lan tran
benh (dch)

39
MO TA
THEO NI
CHON

BAN O
CAC GIENG
NC B
NHIEM
ARSENIC TAI
LANG
RAJAPUR.
(TAY BENGAL)

NGUON: WHO
BULLETIN.VOL 83, JAN
2005
41
THI GIAN : benh xay ra khi nao?
tang hay giam so vi
trc ay?
Mo ta bien oi ty suat mac benh theo
thi gian cho biet
Xu the cua mot van e sc khoe
Tnh chat va s phan phoi benh theo mua
Khao sat s bung phat va cac giai oan
dch
Theo doi qua trnh tiep xuc vi yeu to
nguy c
Dien tien cua benh man tnh
Khao sat hieu ng oan he theo tuoi e
ly giai moi lien he nhan qua.
Mo ta theo thi gian (Xu the benh)
So ca nhiem trung vung chau Anh va X
Wales 1956-1986

Nguon:OXFORD TEXTBOOB OF PUBLIC HEALTH


So ca sot xuat huyet tai cac tnh pha Nam.1975-
1988
Nguon: Phong Dich te, Vien Pasteur
THHCM
Mo ta theo thi gian (ng cong dch)
So ca benh mi / tuan trong vu dch SARS 2002-
2003
Nguon:SARS report WHO.2003
Figure 7. Percentage of adults aged 18-64 years who lacked health insurance
coverage at the time of interview, for at least part of the past year, or for more than
a year: United States, 1997- 2009 (CDC)
Ty suat mac Lao - so ca/100.000.Viet Nam,
Myanmar, Han quoc,
Thai Lan.1980-2003
Nguon: Global Tuberculosis Control. WHO
Report .2005
Tom lai:

Cac nghien cu mo ta:


cung cap so lieu cho xay dng ke
hoach Y te va anh gia hieu qua
phat hien benh, mo ta tnh hnh
sc khoe va benh tat tren ca
nhan va cong ong.
a cac thong tin c ban e at gia
thuyet ve nguyen nhan-hau qua