DPPH Seminar, Mänttä
11.04.2008
HOW TO WRITE A SUMMARY
OF A DISSERTATION
Prof. Eero Lahelma
University of Helsinki
Department of Public Health
Background 1
 Ongoing debate on doctoral studies
 Too many doctors?
 Quality of theses?
 Supervision, substudies/articles
 Good to look at doctoral work
 How it’s being done
 What are the expectations from students, supervisors,
universities etc.
 How can we respond to the expectations
 How to avoid pitfalls, keep time schedules etc.
 Challenges for doctoral students and supervisors
 Statutes, guidelines, assessment, examples
 Experience from graduate schools – DPPH, VTE
 University of Helsinki as example
Background 2
 Writing a thesis
 Long process, serious effort, much research work
 Collaboration, supervision
 Reporting, writing, revising
 Thesis format
 Thesis based on articles + summary
 Monograph thesis
 Summary in focus
 No uniform guidelines
 Sometimes difficult, sometimes less so
 But it is summary! not another monograph
 Great variation between (even within) universities,
faculties, departments
 Concentrate on (public) health sciences + related social
and behavioural sciences
What is a doctoral degree?
Government decree on doctoral degrees 19.8.2004/794
22§ Passing a doctoral degree
 Tohtorin tutkinnon suorittamiseksi jatkokoulutukseen otetun
opiskelijan tulee:
 1) suorittaa jatkokoulutuksen opinnot;
 2) osoittaa tutkimusalallaan itsenäistä ja kriittistä ajattelua; sekä
 3) laatia väitöskirja ja puolustaa sitä julkisesti.
 …
 Väitöskirjaksi voidaan hyväksyä myös yliopiston riittäväksi katsoma
määrä samaa ongelmakokonaisuutta käsitteleviä tieteellisiä
julkaisuja tai julkaistaviksi hyväksyttyjä käsikirjoituksia ja niistä
laadittu yhteenveto taikka muu vastaavat tieteelliset kriteerit täyttävä
työ. Julkaisuihin voi kuulua myös yhteisjulkaisuja, jos tekijän
itsenäinen osuus on niissä osoitettavissa.
What is a doctoral thesis?
- Faculty guidelines 1
 Faculty of Social Sciences, Univ Helsinki (Väittelijän opas §1
7.11.2007):
 ”Väitöskirja on tieteellinen, itsenäiseen tutkimukseen
perustuva monografia tai artikkeliväitöskirja, jossa
esitetään uutta tietoa.”
 Faculty of Medicine, Univ Helsinki (Tieteellinen
jatkokoulutusopas, yleiset määräykset väitöskirjasta):
 ”Väitöskirjan voi esittää joko osajulkaisuväitöskirjana,
jossa on yhteenveto-osa ja liitteenä osajulkaisut tai
monografiaväitöskirjana.”
Write a thesis on substudies or write a monograph?
 Thesis based on substudies
 Sub-questions – many substudies
 Article format - typically in English
 Publishing – requires effort
 Broader audience – summary?
 Feedback - research community
 Joint work – except summary
 Monograph
 Unpublished ms – no articles
 One question, one data source
 Theoretical or qualititative emphasis
 In Finnish – national significance
 One (heavy) work process
What is a doctoral thesis?
- Faculty guidelines 2
Faculty of Medicine, Univ Helsinki
Doctor of Philosophy, Doctor of medicine
Re: Doctoral thesis based on substudies
 A thesis contains several substudies following a coherent theme plus a
summary by the doctoral student which is the proper thesis. The student
has to have a clear independent contribution in joint substudies.
 Substudies have to be published (or accepted) in high quality scientific
series or journals, except one which can be unpublished.
 Summary can include unpublished results.
What is a manuscript?
Faculty guidelines
Faculty of Medicine, Univ Helsinki
The following parts are included in a doctoral thesis
 Abstract, 1–2 pages on the doctoral work and its main results
 Analytic literature review, which shows the knowledge within the field,
its development and current status
(I = Introduction)
 Research questions of the study.
 A presentation of data and methods.
(M = Methods)
 Results of own study and their discussion.
(R = Results)
(A = And)
 General discussion where own results are critically compared with
previous studies.
 Summary and conclusions.
 List of references.
(D = Discussion)
”IMRAD”
How are manuscripts assessed?
- Faculty guidelines for reviewers of doctoral theses
(pre-examiners) Faculty of Medicine, Univ Helsinki
Following points should be apparent from the review:
 1. Originality of the research, basic idea and previous work
in the field.
 2. Planning the research to follow rules of science.
 3. Reliability of methods.
 4. The way results are reported.
 5. Brief presentation results achieved.
 6. Adequacy of discussion (without unnecessary
speculation).
 7. The structure of the work, title and subtitles.
 8. Knowledge of literature of own field.
 9. Coherence formed by substudies. Own contribution by
the doctoral student in palnning and accomplishment of the
study.
How does the extent of summary vary?
- Public health, Univ Helsinki
 38 theses in 1998-2007 (medicine-other fifty-fifty)
 Summary + 3-7 substudies
 Gross number of pages in summary
 Range 41-131
 Over 100
10
 75-99
14
 50-74
13
 Below 50
1
 Average
89
 Theses with over 100 pages increasing?
 Layout (1 or 2 columns), tables/figures, literature,
appendices affect the length
What is the nature of summary and its contents? 1
”Yhteenvetoon väitöskirja tuskin koskaan kaatuu” (Isohanni 2000)
 No clear rules - a summary of the substudies
 Article, report, summary, something else?
 Guidelines for exminers, previous works within own field
 Own work as part of current research – what’s the contribution
 Extent ca. One substudy or + 15-20% - good ≠ long
 Publishing, language
 Nature of summary – disciplinen and their traditions
 ”Coherent theme” – framework
 Independent text – do not copypaste!
 Summary tables/figures: literature review + results
 Possible additional results (not in substudies)
 Critical, analytic, summarising, broader, more abstract
perspective than in single substudies, esp. discussion
 Quality and extent
 At best deepens the theme and the interpetation of results
 High quality substudies – less empahsis on summary,
modest substudies – more emphasis on summary (?)
 Good summary may produce a review article
What is the nature of summary and its contents? 2
Summary of pitfalls
 Start too late
 Too concise – too long
 Problems of structure






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No framework vs. too broad scope?
Literature review - too broad, lack critical/analytic approach
Methods inadequately presented
Results directly copied from articles?
Discussion copied from substudies
Discussion over the whole work lacking
Unbalanced
 Problems of text




Copypaste from articles
Tables, figures?
Discussion
Independent text – copyright
What do reviewers empasise in their comments on
summaries?
 Review typically follows
 The structure of the work (IMRAD) or faculty guidelines
 Emphasis on summary as a description of the work done
 Research questions and themes, importance and novelty
 Adequacy of accomplishment of research and results
 Quality of summary with regard to substudies
 Structure of work = substudies as a coherent whole
 Coherence, ”logical wholeness”
 Significant findings and novelty important
 Literature review
 Extent, boundaries rajat, systematic
 Concepts/framework
 Knowledge of own field, ”critical”
 Methods
 ”Adequacy”
 Discussion
 Interpretation, ”maturity”, avoiding speculation
Jaana Lindström: Prevention of type 2 diabetes with lifestyle
intervention – emphasis on dietary composition and
identification of high-risk individuals. (2006)
LIST OF ORIGINAL PUBLICATIONS.............................................................................11
ABBREVIATIONS.............................................................................................................12
1 INTRODUCTION ....................................................................................................13
2 REVIEW OF THE LITERATURE ..........................................................................15
2.1 Definition of type 2 diabetes and other categories of glucose intolerance................15
2.2 Epidemiology and pathophysiology of type 2 diabetes ............................................18
2.3 Risk factors for type 2 diabetes.................................................................................19
2.3.1 Obesity ......................................................................................................20
2.3.2 Diet composition .......................................................................................26
2.3.3 Physical inactivity .....................................................................................32
2.3.4 Other lifestyle factors................................................................................32
2.4 Previous lifestyle intervention studies to prevent type 2 diabetes ............................32
2.4.1 The Malmö feasibility study .....................................................................33
2.4.2 The Da Qing IGT and Diabetes Study ......................................................33
2.5 Identification of target groups for intervention.........................................................35
2.5.1 Rationale for screening .............................................................................35
2.5.2 Methods for screening...............................................................................38
3 AIMS OF THE STUDY ...........................................................................................41
4 POPULATIONS AND METHODS .........................................................................42
4.1 Diabetes Prevention Study (Papers I - IV)................................................................42
4.1.1 Population and design ...............................................................................42
4.1.2 Lifestyle intervention ................................................................................45
4.1.3 Assessment of dietary intake.....................................................................46
4.1.4 Assessment of physical activity ................................................................47
4.1.5 Assessment of compliance with the intervention goals.............................47
4.1.6 Clinical examinations................................................................................47
4.1.7 Laboratory analyses ..................................................................................47
4.1.8 Assessment of the end-points....................................................................48
4.1.9 Statistical methods ....................................................................................48
4.1.10 Project organisation...................................................................................49
4.2 Diabetes risk score (Paper V) ...................................................................................50
4.2.1 Populations and design..............................................................................50
4.2.2 Assessment of the end-points....................................................................50
4.2.3 Statistical methods ....................................................................................51
Jaana Lindström (2)
5 RESULTS.................................................................................................................52
5.1 Diabetes Prevention Study (Papers I - IV)................................................................52
5.1.1 Baseline results .........................................................................................52
5.1.2 Intervention results....................................................................................54
5.1.3 Post-intervention follow-up results ...........................................................64
5.2 Diabetes risk score (Paper V) ...................................................................................69
5.2.1 Model development...................................................................................69
5.2.2 Model validation .......................................................................................69
5.2.3 The Finnish Diabetes Risk Score FINDRISC ...........................................72
5.3 FINDRISC in the DPS population............................................................................73
6 DISCUSSION...........................................................................................................75
6.1 Prevention of type 2 diabetes....................................................................................75
6.1.1 Diabetes incidence ....................................................................................75
6.1.2 Changes in lifestyle...................................................................................77
6.1.3 Changes in body weight and clinical variables .........................................77
6.1.4 Determinants of changes in body weight and type 2 diabetes risk............78
6.1.5 Limitations ................................................................................................83
6.2 Identification of high-risk individuals.......................................................................85
6.3 Practical implementation of the findings ..................................................................88
7 CONCLUSIONS ......................................................................................................91
ACKNOWLEDGEMENTS.................................................................................................92
REFERENCES ....................................................................................................................94
APPENDIX
ORIGINAL PUBLICATIONS
Yht. 125 s.
Akseli Aittomäki: Social class inequalities in ill health
– the contribution of physical workload
List of original publications 7
Abstract 8
Tiivistelmä 9
Chapter I
Introduction – the issues of work and class inequalities in ill health 10
Chapter II
Social stratification and class theory 15
Classical Marxism 16
Contradictory class locations – Marxism of Erik Olin Wright 18
Class as market situation in Max Weber’s theory 19
Liberal theories on industrialisation and status attainment 20
Service class versus the labour-contract – John Goldthorpe’s position 22
Operationalising class 23
Chapter III
Social class and public health – from history to explanation 25
Early social medicine and class 26
Official statistics and class 29
Social stratification in epidemiology today – comments on Lynch and Kaplan 30
Explanations to inequalities in health 32
The structural framework of explanation 33
Materialistic explanations 34
Psychosocial explanations 36
Lifestyle explanations 38
Selection and mobility 39
Emerging complexity – and a simple strategy 41
Chapter IV
Concepts of health and illness 43
Health as a variant of goodness – the philosophy of Georg Henrik von Wright 44
Disease as a medical concept 45
The Parsonian sick role as an approach to social meaning of illness 47
Medical, experienced and social dimensions of health – the three model approach 48
Measuring illness and morbidity 49
Functioning as a quantity of illness 51
Chapter V
Conceptualising workload 52
A model of mechanical exposure 53
Description of physical workload as a pathway 54
Relationship to stressor-strain concept 56
Demands and decision latitude – the model by Robert Karasek 57
Chapter VI
Previous research – a review of relevant empirical studies 59
Class inequalities in overall physical morbidity 59
Socioeconomic inequalities in major disease groups 61
Work disability and social class 64
Social class inequalities in functioning 66
Physical workload in the population 67
Physical workload as a determinant of musculoskeletal disorders 70
Decision latitude as determinant of ill health and class inequalities in ill health 73
Physical workload as an explanation for class inequalities in ill health 75
Chapter VII
Scope and objectives of the study 82
Chapter VIII
Methods used in the study 84
On the City of Helsinki 84
Mail questionnaires 85
Health examinations 86
Personnel registers and combined data 87
Social classification 88
Measures of ill health and functioning 89
Measures of physical work conditions 92
Other measures 95
Statistical methods 95
Elaboration of effect mediation 97
Chapter IX
Results of the study – statistical models of effects of social class and work conditions on ill health 99
Dependence on gender, age and decision latitude of the effect of
physical workload on limited functioning 101
The contribution of physical workload to class inequalities in ill health and limited functioning 102
Chapter X
Discussion on the findings and methods 106
Contribution of physical work load to social class inequalities in ill health 107
Interaction of physical demands with decision latitude, age and gender 110
Causality of the observed effects and potential influences from selection 111
Issues of social classification 113
Measures of work conditions 115
Measures of ill health 117
Data collection and statistical methods 120
Generalisability of the findings 122
Conclusions 124
Acknowledgements 126
Bibliography 128
Original publications 146
Literature, statutes, guidelines
Eco Umberto. Oppineisuuden osoittaminen eli miten tutkielma
tehdään. Vastapaino, Tampere 1989
Isohanni Matti. Monografia vai osajulkaisuväitöskirja? Duodecim
1998:114:376-378
Isohanni Matti. Väitöskirjan yhteenveto-osa – väkisin väännetty
vai työn kruunaus. Suomen Lääkärilehti 2000:55:3366-3369
Patja Kristiina ym. (toim.). Kohti karonkkaa. Kustannus Oy
Duodecim 1999
HY:n lääketieteellinen tiedekunta:
www.med.helsinki.fi/opiskelu/tieteellinen jatkokoulutus/opintoopas
Valtioneuvoston asetus yliopistojen tutkinnoista 19.8.2004/794:
www.edilex.fi/saadokset/lainsaadanto/20040794
Valtiotieteellinen tiedekunta:
www.valt.helsinki.fi/jatko-opinnot/väittelijän opas