S&o Paulo Med J. - Instructions to authors
online version
INSTRUCTIONS TO AUTHORS
Aim and editorial policy
Indexing and scope
The S&o Paulo Medical Journal/Evidence for Health Care
was founded in 1932. Its articles are indexed in Medline, Lilacs, SciELO,
Science Citation Index Expanded, Journal Citation Reports/Science Edition
(ISI) and EBSCO Publishing.
Published bimonthly by the Associa&&o Paulista de Medicina,
the journal accepts articles in the fields of clinical health science
(internal medicine, gynecology and obstetrics, mental health, surgery,
pediatrics and public health). Articles will be accepted in the form of
original articles (clinical trials, cohort, case-control, prevalence,
incidence, accuracy and cost-effectiveness studies and systematic reviews
with or without meta-analysis), narrative reviews of the literature, case
reports, short communications and letters to the editor. Papers with a
commercial objective will not be accepted.
The Journal's policy and procedures
After receipt of the article by the Scientific Publications Sector, the
authors will be provided with a protocol number. This number serves to
maintain good understanding between the authors and the Scientific Publications
Sector. Following this, the article will be read by the Editor, who will
verify whether it is consonant with the journal's policy and interests,
i.e. whether the research or review is within the fields of health or
public health.
Next, the Scientific Publications Sector will verify whether the text
complies with the journal's Instructions for Authors. If the text is incomplete
or if it is not organized as required, the authors will be asked to resubmit
their text after resolving such problems. When its format is acceptable,
the Scientific Publications Sector will submit the manuscript to closed
review, in which the reviewers will not sign their verdict and will not
know the names of the authors. Each paper will be reviewed by at least
three reviewers: one expert in the field, one associate editor (who will
evaluate the article from the reader's perspective and one ad hoc
editorial advisor (who will assess methodological aspects of the study).
The authors will then receive the reviewers' evaluation and will be asked
to resolve all the problems that have been pointed out. Once the Scientific
Publications Sector receives the manuscript again, the text will be sent
to the scientific editor and the proofreader, who will point out problems
with sentence construction, spelling, grammar, bibliographical references
and other matters. The authors should then provide all further information
requiredand corrections requested and should mark in the text all the
points at which modifications have been made, using different colors or
electronic text marking systems, so that these modifications are easy
When the text is considered acceptable for publication, and only then,
it will enter the queue for publication and the author will receive a
letter of acceptance of the article. The Scientific Publications Sector
will provide a proof, including any tables and figures, for the authors
to approve. No article is published without this last procedure.
The manuscript and types of articles
General guidelines: for all types of articles
Texts must be submitted exclusively through the internet, using the electronic
submission system, which is available at .
Submissions sent by e-mail or through the post will not be accepted.
The manuscript must be submitted in English. Nonetheless, it must also
include a summary and five key words both in Portuguese and in English.
The key words must be selected from the DeCS and MeSH lists only, as explained
in detail below (no other key words will be accepted).
Papers submitted must be original and therefore all the authors need
to declare that the text has not and will not be submitted for publication
in any other journal. Papers involving human beings (individually or collectively,
directly or indirectly, totally or partially, including the management
of information and materials) must be accompanied by a copy of the authorization
from the Research Ethics Committee of the institution in which the experiment
was performed.
All articles submitted must comply with the editorial standards established
in the Vancouver Convention (Uniform Requirements for Manuscripts Submitted
to Biomedical Journals)1 and the specific quality guidelines
for papers reporting on clinical trials (CONSORT),2 systematic
reviews and meta-analyses (PRISMA),3,4 observational studies
(STROBE).5,6 and accuracy studies on diagnostic tests (STARD).7,8
The style known as the "Vancouver Style" is to be used not only
for the format of the references, but also for the whole text. The Editors
recommend that authors should familiarize themselves with this style by
accessing .
Abbreviations must not be used, even those in common use. Drugs or medications
must be referred to using their generic names, avoid&ing unnecessary
mention of commercial or brand names, and should be followed by the dosage
and posology. Any prod&uct cited in the Methods section, such as diagnostic
or therapeutic equipment, tests, reagents, instruments, utensils, prostheses,
orthoses and intraopera&tive devices must be described together with
the manufacturer's name and place (city and country) of manufacture
in parentheses.
Grants, bursaries and any other financial support for studies must be
mentioned separately after the references, in a section named "Acknowledgements",
along with any other acknowledgements to individuals or professionals
who have helped in producing the study but whose contribution does not
constitute authorship (we recommend that the item "Authorship"
at http://www.icmje.org should be read to obtain clarifications regarding
the criteria for authorship).
For any type of study, all statements in the text that are not results
from the study presented for publication in the S&o Paulo Medical
Journal/Evi&dence for Health Care, but are data from other studies
already published elsewhere must be accompanied by citations of the pertinent
literature. Thus, statements about the incidence or prevalence of diseases,
costs, frequency of use of certain therapies and epidemiological data
in general should be followed by the references for the surveys that generated
this information, even if the data come from government institutions or
databases, given that these are data from other studies.
First page (cover page)
The first page must contain:
1) the type of paper (original article, review or updating article,
short communication or letter to the editor);
2) the title of the paper in English and Portuguese (or Spanish), which
3) the full name of each author (do not abbreviate), his/ her academic
titles (abbreviated in English), in the order obtained (for example: "MD
for medical doctor, MSc for holders of a master's title, PhD for
holders of a doctorate" or "BSc for bachelor of science, such
as in biology"), and the positions currently held (for example, Doctoral
Stu&dent, Attending Physician, Adjunct Professor, Associate Professor,
Head of Department, etc.), in the department and institution where he/she
4) the place where the work was developed.
Second page: abstract (English and Portuguese) and key words
The second page must include the title and an abstract (English and Portuguese,
maximum of 250 words each) structured in
parts in five items:
2) design (type of study) and setting (place where the study was developed);
3) methods (described in detail);
5) conclusions.
The abstract (both in English and in Portuguese) should contain five key
words. The English terms must be chosen from the Medical Subject Headings
(MeSH) list of Index Medicus, which are available on the internet ().10
The Portuguese terms must be chosen from the Descritores em Ci&n&cias
da Sa&de (DeCS), developed by Bireme, which are available on the
internet ().11
References
The list of references (in the "Vancouver style", as indicated by the
International Committee of Medical Journal Editors, ICMJE) should be laid
out in the final part of the article, after the conclusions and before
the tables and figures. In the text, the references must be numbered according
to the order of citation. The citation numbers must be inserted after
periods/full stops or commas in sentences (see examples in the preceding
section), and must be in superscripts form (without using parentheses
or square brackets). References cited in the legends of tables and figures
must maintain sequence with the references cited in the text.
In the list of references, all the authors must be listed if there are
up to and in if there are six or more, the first
three should be cited, followed by the expression "et al." For books, the city of publication
and the name of the publishing house are mandatory. For books, the city
of publication and the name of the publishing house are mandatory. For
texts published on the internet, the complete uniform resource locator
(URL) or address is necessary (not only the main home page of a website
or link), so that by copying the complete address into their computer
internet browsers, the journal's readers will be taken to the exact
document cited, and not to a general website. The following are some examples
of the most common types of references:
Article in journal
- Hurt AC, Hardie K, Wilson NJ, et al. Community transmission of oseltamivir-resistant
A(H1N1)pdm09 influenza. N Engl J Med. ):2541-2.
Chapter of book
- Miller WI, Achernabb JC, Fluck CE. The adrenal cortex and its disorder.
In: Sperling M. Pediatric endocrinology. 3rd ed. Elservier Health S
2008. p. 444-511.
Text on the internet
- Centers for Disease Control and Prevention. Children's food environment
State Indicator Report, 2011. Availablbre from: .
Accessed in 2012 (Mar 7).
The last page must contain:
1) the date and place of the event at which the paper was presented,
if applicable, such as congresses or dissertation or
2) sources of support in the forms of finance for the project, study bursaries
or funding for purchasing equip&ment or drugs. The protocol number
for the fundi
3) description of any conflicts of interest held by the authors. We recommend
that the item "Conflicts of interest" at
should be read to obtain clarifications regarding what may or may not
be considered to be a
4) the complete postal address, e-mail address and telephone number of
the author to be contacted in relation to the publication process in the
Journal. The author should also indicate a postal address, e-mail address
and telephone number that can be published together with the article.
Figures and tables
Images must have good resolution (minimum of 300 DPI) and be recorded
in ".jpg" or ".tif" format. Do not attach images inside Microsoft PowerPoint
documents. If photographs are inserted in a Microsoft Word file, the images
should also be sent separately. Graphs must be prepared in Microsoft Excel
(do not send them in image formats) and must be accompanied by the tables
of data from which they have been generated. The number of illustrations
must not exceed the total number of pages minus one.
All figures and tables must contain legends or titles that precisely
describe their content and the context or sample from which the information
was obtained (i.e. what the results presented are and what the kind of
sample or setting was). The legend or title sentence should be short but
comprehensible without depending on reading the article.
All the figures and tables should be cited in the text.
S&o Paulo Medical Journal/Evidence for Health Care
is for now published in black-and-white in its printed version. Photographs,
photomicrographs, bar and line graphs and any image to be published must
be prepared considering that there will be no color differentiation (any
color information will be discarded). Shades of gray and printing patterns
(dots, stripes and others) should be used instead, with good contrast.
Original articles
Clinical trial, cohort, case-control, prevalence, incidence, accuracy
and cost-effectiveness studies, and systematic reviews with or without
meta-analysis, are considered to original articles.
The S&o Paulo Medical Journal/Evidence for Health Care supports
the clinical trial registration policies of the World Health Organization
(WHO) and the International Committee of Medical Journal Editors (ICMJE)
and recognizes the importance of these initiatives for registra&tion
and international dissemination of information on randomized clin&ical
trials, with open access. Thus, from 2008 onwards, manuscripts on clinical
trials are accepted for publication only if they have received an identifi&cation
number from one of the clinical trial registers that have been vali&dated
in accordance with the criteria established by WHO and ICMJE. Authors
of randomized clinical trials must thus register their studies before
submitting them for publication in the S&o Paulo Medical Journal/Evi&dence
for Health Care. The addresses for these registers are available from
the ICMJE website (http://www.icmje.org/). The identification number should
be declared at the end of the abstract.
Authors will be required to comply with the guidelines for writing each
type of original article, as follows:
Observational articles: STROBE S5,6
Clinical trials: CONSORT S2
Accuracy studies on diagnostic tests: STARD S7,8
Systematic reviews of the literature and meta-analyses: PRISMA4
The S&o Paulo Medical Journal takes the view that these guidelines
not only aid in writing and organizing the content of articles in a standardized
manner, thereby improving their quality and facilitating reading and assessment,
but also these guidelines help to avoid situations in which important
information on the methodology of studies remains outside of the manuscript.
As a partner institution of the Cochrane Collaboration and the Brazilian
Cochrane Center, the Associa&&o Paulista de Medicina considers
that production of articles in accordance with these guidelines also aids
in future production of systematic reviews of the literature and meta-analyses.
Thus, articles submitted for publication that are not in accordance with
these norms may be returned to their authors for readjustment before the
peer review process begins.
Original articles must be structured so as to contain the following parts:
Introduction, Objective, Methods, Results, Discussion and Conclu&sion.
The text must not exceed 5,000 words (excluding tables, figures and references),
from the introduction to the end of the conclusion, and must include a
structured abstract with a maximum of 250 words.9 "Structured
abstract" means that the abstract must contain the following items:
Con&text and objective, Design and setting, Method, Results and Conclusion.
The structure of the document should follow the format laid out below:
1) Title and abstract: the study design and/or the way participants were
allocated to interventions, for example "randomized" or "retrospective"
study, should be mentioned in the title and in the abstract. The abstract
should provide a summary of what was done and what was found.
2) Introduction: specify the reasons for carrying out the study, describing
the present state of knowledge of the topic. Describe the scien&tific
background and "the state of the art". Do not include here any
results or conclusions from the study. Use the last paragraph to specify
the prin&cipal question of the study, and the principal hypothesis
tested, if there is one. Do not include discussions about the literature
the introduction section should be short.
3) Objective: describe briefly what the main objective or question of
the study was. Clearly describe the pre-specified hypotheses.
4) Methods
4.1) Type of study: describe the design of the study and specify, if
appropriate, the type of randomization (the way in which draws were
conducted), the blinding (how this was ensured), the diagnostic test
standards (gold standard or range of normal values) and the time direction
(retrospective or prospective). For example: "ran&domized clinical
trial", "double-blind placebo-controlled clinical trial, "cross-sectional
accu&racy study" ", "retrospective cohort study",
"cross-sectional prevalence study" or "systematic review
of clinical trials".
4.2) Sample, participants or patients: describe the eligibility criteria
for participants (inclusion and exclusion criteria) and the sources
and procedures for selection or recruitment. In case-control studies,
describe the rationale for distributing the subjects as cases
and controls, and the matching criteria. The numbers of patients at
the beginning and end of the study (after exclusions) must be made clear.
A flow diagram showing the initial recruitment, the exclusions and the
final sample of patients included should be produced and inserted in
the article.
4.3) Setting: indicate the place where the study was carried out, including
the type of healthcare provide (i.e. whether and
whether in a private or in a public hospital). Avoid stating the name
of the institution where the study was developed (for blinding purposes
in the peer review). Only the type of institution should be made clear,
for example: "public university hospital" or "private
4.4) Procedures (intervention, diagnostic test or exposure): describe
the principal characteristics of any intervention, including the method,
the timing and the duration of its administration or of data col&lection.
Describe the differences in interventions administered to each group
(if the study is controlled). Detail the procedures in such a way that
other researchers will be able to repeat them in other localities.
4.5) Main measurements, variables and outcome: state what the primary
and secondary outcomes analyzed in the study are. Describe the method
of measuring the primary result, in the way in which it was planned
before data collection. For each variable of interest, detail the assessment
methods. If the hypothesis of the study was formulated during or after
data collection (and not before), this needs to be declared. Describe
the methods used to enhance the quality of measurements (for example,
multiple observers, training, etc.) and to avoid bias. Explain how quantitative
variables were handled in the analyses.
4.6) Sample size and statistical analysis: describe the sample size
cal&culation method, or the study period in the event that patients
were consecutively admitted over a period. Readers need to understand
why a given number of patients was used. The planned statistical analysis,
the statistical tests used and their significance levels, along with
any post hoc analyses, should be presented in this section. Describe
the methods used to control for confounding factors and variables, and
explain how missing data and cases lost from the follow-up were dealt
4.7) Randomization: describe the method used to implement the ran&dom
allocation sequence (for example, sealed envelopes containing random
sequences of numbers or software for generating random numbers). If appropriate,
report that the study used "quasi-randomization".12
In addition, describe who generated the random sequence, who assigned
the participants to each group (in the case of controlled trials) and
who recruited the participants.
5) Results: describe the main findings. If possible, these should be
accompanied by their 95% confidence intervals and the exact level of sta&tistical
significance (it is not enough to write "P & 0.05": the exact
P value should be supplied). For comparative studies, the confidence interval
must be stated for the differences between the groups.
5.1) Participant flow diagram: describe the flow of participants through
each stage of the study (inclusions and exclusions) and the follow-up
period and the number of participants completing the study (or lost
from the fol&low-up). Use a flow diagram to demonstrate the numbers
of patients, from the initial recruitment to the end of the study, and
the reasons for exclusions. If there was any "intention-to-treat"
analysis, describe it.
5.2) Deviations: if there was any deviation from the protocol, away
from what was initially planned, describe it and the reasons for it.
5.3) Adverse events: describe any side effect, adverse event or complication.
6) Discussion: provide an interpretation of the results, taking into
account the study hypotheses and conclusions. Emphasize the new and important
factors encountered in the study, which will form part of the conclusion.
Do not repeat data presented in the introduction or results in detail.
Mention any limitations of the findings that should be noted and any possible
implications for future research. Describe any potential bias. Report
any relevant findings from other studies: it is important to review the
recent literature to seek new evidence that may have been published, which
needs to be discussed. State whether the findings can be generalized to
populations (i.e. whether the findings have external validity). It is
recommended that the last two paragraphs should contain implications for
practice and for further research.
7) Conclusions: specify only the conclusions that can be sustained by
the results, together with their clinical significance (avoiding excessive
generalization). Draw conclusions based on the objectives and hypotheses
of the study. The same emphasis should be placed on studies with positive
and negative results.
Systematic reviews with or without meta-analyses should comply with the
same publication norms established for original articles, and be produced
in accordance with PRISMA4 and the Cochrane Collaboration's
systematic review Handbook.13 The text should not exceed 5,000
words (excluding tables, figures and references).
Short communications, case reports or case series
Short communications and case reports must be limited to 3,000 words
(from the introduction to the end of the conclusion). Short communications
are reports on the results from ongoing studies or studies that have recently
been concluded for which urgent publication is important. They should
be structured thus: Introduction, Objective, Methods, Results, Dis&cussion
and Conclusion, like in original articles. Individual case reports should
contain: Introduction, Case Report, Discussion and Conclusion. Reports
on case series constitute observational studies and these should be structured
in accordance with the norms of the STROBE Statement.5
Both short communications and case reports must be submitted with abstracts
and key words. The abstracts in short communications should be structured
with Context and Objective, Design and Setting, Meth&ods, Results,
Discussion and Conclusion, as for original articles. The abstracts in
case reports and case series should contain Context and Case Report (with
a description of the case and a pertinent discussion) and Conclusion.
The S&o Paulo Medical Journal/Evidence for Health Care is interested
in publishing rare or instructive case reports, accompanied by a systematic
search of the litera&ture, in which relevant studies found (based
on their level of evidence) are presented and discussed.14
The results from the systematic search of the main databases - Medline
(via PubMed), Embase, Lilacs and Cochrane Library - should be presented
in a table with the search strategy for each database and the number of
articles obtained.
Narrative review
Narrative reviews may be accepted by the S&o Paulo Medical
Journal/Evidence for Health Care and should be structured with: Introduction,
Objectives, Methods, Results, Discussion and Conclusions. The abstract
must be structured with: Context and objective, Design and setting, Methods,
Results and Conclusions, like in original articles. The manuscript must
comply with the norms of the Vancouver style1 and must include
a systematic search in the main databases: Medline , Embase, Lilacs and
Cochrane Library. The search strategy for each data&base and the number
of articles obtained from each database should be presented in a table.
The access route to the electronic databases used should be stated (for
example, PubMed, OVID, Elsevier or Bireme). For the search strategies,
MeSH terms must be use for Medline, LILACS and Cochrane Library. DeCS
terms must be used for LILACS. EMTREE terms must be used for Embase. Also,
for LILACS, search strategy must be performed, at the same time, with
English (MeSH), Spanish (DeCS) and Portuguese (DeCS) terms. The search
strategies must be presented exactly as they were used during the search,
including parentheses, quotation marks and Boolean operators (AND, OR,
Letters to the editor
Letters to the editor may address articles published in the S&o
Paulo Medical Journal/Evidence for Health Care publication or may deal
with health issues of interest. Case reports must not be submitted as
letters. In the category of letters to the editor, the text has a free
format, but must not exceed 500 words and five references.
Documents cited
1. International Committee of Medical Journal Editors. Uniform requirements
for manuscripts submitted to biomedical journals writ&ing and editing
for biomedical publications. Available from: .
Accessed in 2012 (Aug 6).
2. The CONSORT statement. Available from: .
Accessed in 2012 (Aug 6).
3. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving
the quality of reports of meta-analyses of randomised con&trolled
trials: the QUOROM statement. Lancet. 3):. Available
Accessed in 2012 (Aug 6).
4. PRISMA. Transparent Reporting of Systematic Reviews and Meta-Analyses.
Available from: .
Accessed in 2012 (Aug 6).
5. STROBE Statement. Strengthening the reporting of observational studies
in epidemiology. What is STROBE? Avaliable from: .
Accessed in 2012 (Aug 6).
6. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting
of Observational Studies in Epidemiology (STROBE) statement: guidelines
for reporting observational studies. J Clin Epidemiol. ):344-9.
7. STARD Statement. STAndards for the Reporting of Diagnostic accuracy
studies. Available from: .
Accessed in 2012 (Aug 6).
8. Rennie D. Improving reports of studies of diagnostic tests: the STARD
initiative. JAMA. ):89-90.
9. Haynes RB, Mulrow CD, Huth EJ, Altman DG, Gardner MJ. More informative
abstracts revisited. Ann Intern Med. ):69-76.
10. National Library of Medicine. Medical Subject Headings: annotated
alphabetic list. Bethesda: NLM; 1998. Available from: . Accessed in 2012 (Aug 6).
11. BVS Biblioteca Virtual em Sa&de. Descritores em Ci&ncias
da Sa&de. Available from: .
Accessed in 2012 (Aug 6).
12. Reeves BC, Deeks JJ, Higgins JPT, Wells GA. Including non-randomized
studies. In: Cochrane Non-Randomised Studies Methods Group. The Cochrane
Book Series. England: John Wiley & S 2008. Available from: .
Accessed in 2012 (Aug 6).
13. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews
of Interventions. Available from: .
Accessed in 2012 (Aug 6).
14. Phillips B, Ball C, Sackett D, et al. Oxford Centre for Evidence-
Based Medicine Levels of Evidence (May 2001). Available from: .
Accessed in 2012 (Aug 6).
All the content of the journal, except where otherwise noted, is licensed under a
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