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Analysis of irrigation systems using sustainability-related criteria.

Sustainable agricultural development as a desired goal in irrigation management is a result of recent public awareness of the scarcity of water for food production. In order to incorporate sustainability-related criteria in the analysis of irrigation systems, the present study aims at introducing environmental indices that represent irrigation water conservation and satisfactory production and income for farmers under stress conditions. An experiment was conducted in Chania, Greece, during the irrigation periods of 1989 and 1990. The irrigation water delivered to 40 experimental plots and the relevant soil moisture content at the root zone were recorded. The data, collected in real time, were used for the calculation of the corresponding environmental indices. The variation of indices in time and space was high, and demonstrated that up to 13% of water was delivered to crops, 82% was yield loss, and 84% was economic return. The study indicated that environmental indices could be easily computed by means of routinely collected data, and could also be incorporated into decision-making approaches, such as compromise programming, in order to develop policies for irrigation water allocation.

Agriculture↗

Quantitative reviewing: the literature review as scientific inquiry.

The literature review process is conceptualized as a form of scientific inquiry that involves methodological requirements and inferences similar to those employed in primary research. Five stages of quantitative reviewing that parallel stages in primary investigation are identified and briefly described. They include problem formation, data collection, data evaluation, analysis and interpretation, and reporting the results. The first two stages provide information and guidelines relevant to reviewers' employing traditional narrative procedures or conducting reviews of qualitative research literature. The final three stages relate specifically to the methodology of quantitative reviewing. The argument is made that quantitative reviewing procedures represent a paradigm shift that can assist researchers and clinicians in occupational therapy to establish a scientific data base that will serve to guide theory development and validate clinical practice.

Data Collection↗

No exit? The effect of health status on dissatisfaction and disenrollment from health plans.

OBJECTIVE: To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE: A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed competition, with substantial enrollment in four types of health plans: fee-for-service, prepaid group practice, independent practice associations, and point-of-service plans. STUDY DESIGN: A set of logistic regression models are estimated to determine the probability of disenrollment, if dissatisfied, controlling for the influence on satisfaction and disenrollment of age, race, education, family income and size, gender, marital status, mental health status, pregnancy, duration of employment and enrollment in the plan, number of alternative plans, and HMO penetration in the local market. Separate coefficients are estimated for enrollees with and without significant physical health problems. Additional models are estimated to test for the influence of selection effects as well as alternative measures of dissatisfaction and health problems. DATA COLLECTION: Data were collected through a mailed survey with a response rate of 63.5 percent; comparisons to a subsample administered by telephone showed few differences. PRINCIPAL FINDINGS: In group/staff model HMOs and point-of-service plans, only 12-17 percent of the chronically ill enrollees who were so dissatisfied when surveyed that they intended to disenroll actually left their plan in the next open enrollment period. This compared to 25-29 percent of the healthy enrollees in these same plans, who reported this level of dissatisfaction and 58-63 percent of the enrollees under fee-for-service insurance. CONCLUSIONS: Switching plans appears to be significantly limited for enrollees with serious health problems, the very enrollees who will be best informed about the ability of their health plan to provide adequate medical care. These effects are most pronounced in plans that have exclusive contracts with providers. We conclude that disenrollment provides only weak safeguards on quality for the sickest enrollees and that reported levels of dissatisfaction and disenrollment represent inaccurate signals of plan performance.

Adult↗

The use of monetary incentives in a community survey: impact on response rates, data quality, and cost.

OBJECTIVES: To assess the effect of incentive size on response rates, data quality, and cost in a digestive health status mail survey of a community sample of health plan enrollees. DATA SOURCES/SETTING: The study population was selected from a database of enrollees in various health plans obligated to receive care at Park Nicollet Clinic-HealthSystem Minnesota, a large, multispecialty group in Minneapolis, Minnesota, and the nearby suburbs. STUDY DESIGN: A total of 1,800 HealthSystem Minnesota enrollees were randomly assigned to receive a survey with an incentive of $5 or $2. The response rates for each incentive level were determined. Data quality, as indicated by item nonresponse and scale scores, was measured. Total cost and cost per completed survey were calculated. PRINCIPAL FINDINGS: The response rate among enrollees receiving $5 (74.3 percent) was significantly higher than among those receiving $2 (67.4 percent); differences were more pronounced in the first wave of data collection. Data quality did not differ between the two incentive groups. The total cost per completed survey was higher in the $5 condition than in the $2 condition. CONCLUSIONS: A $5 incentive resulted in a higher response rate among a community patient sample with one mailing than did a $2 incentive. However, the response rates in the $2 condition approached the level of the $5 incentive, and costs were significantly lower when the full follow-up protocol was completed. Response rates were marginally increased by follow-up phone calls. The incentive level did not influence data quality. The results suggest if a survey budget is limited and a timeline is not critical, a $2 incentive provides an affordable means of increasing participation.

Adult↗

[Required procedure for nominal data files processing in biomedical research].

To date, biomedical research using nominal data files for the data collection, data acquisition or data processing has had to comply with 2 French laws (Law of December, 20, 1988, modified, relating to the protection of patients participating in biomedical research, and the Law of January, 6, 1978, completed by the Law of July 1, 1994 n degrees 94-548, chapter V bis). This later law dictates rules not only for the establishment of nominal data files, but also confer individual rights to filed persons. These regulations concern epidemiological research, clinical trials, drug watch studies and economic health research. In this note, we describe the obligations and specific general and simplified procedure required for conducting biomedical research. Included in the requirements are an information and authorization procedure with the local and national consultative committees on data processing in biomedical research (CCTIRS, Comité Consultatif sur le Traitement de l'Information en Recherche Biomédicale, and CNIL, Commission Nationale Informatique et Libertés).

Clinical Trials as Topic↗

Development of a scale to measure patients' trust in health insurers.

OBJECTIVE: To develop a scale to measure patients' trust in health insurers, including public and private insurers and both indemnity and managed care. A scale was developed based on our conceptual model of insurer trust. The scale was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. DATA SOURCES/STUDY SETTING: The scale was developed and validated on a random national sample (n = 410) of subjects with any type of insurance and further validated and used in a regional random sample of members of an HMO in North Carolina (n = 1152). STUDY DESIGN: Factor analysis was used to uncover the underlying dimensions of the scale. Internal consistency was assessed by Cronbach's alpha. Construct validity was established by Pearson or Spearman correlations and t tests. DATA COLLECTION: Data were collected via telephone interviews. PRINCIPAL FINDINGS: The 11-item scale has good internal consistency (alpha = 0.92/ 0.89) and response variability (range = 11-55, M = 36.5/37.0, SD = 7.8/7.0). Insurer trust is a unidimensional construct and is related to trust in physicians, satisfaction with care and with insurer, having enough choice in selecting health insurer, no prior disputes with health insurer, type of insurer, and desire to remain with insurer. CONCLUSIONS: Trust in health insurers can be validly and reliably measured. Additional studies are required to learn more about what factors affect insurer trust and whether differences and changes in insurer trust affect actual behaviors and other outcomes of interest.

Adult↗

Utilising field assignments in survey methodology course at Ziauddin Medical University, Karachi.

OBJECTIVE: To describe the teaching-learning strategy employed in the module of Survey Methodology for undergraduate medical students at Ziauddin Medical University. SETTING: Medical students of Ziauddin Medical University, Clifton, Karachi. METHODS: The objectives of the Survey Methodology course were developed so that a student would be able to design and conduct a small survey independently. For this purpose the students were required to participate in a census survey of a squatter settlement. The questionnaire for the survey was developed with the students, which included the demographic information of the households. It was discussed and pretested with the medical students. The students edited and entered the data on computer using Epi-Info. They were trained in sampling methods, data collection, data editing and entry through lectures and small group sessions. At the end of the course, students filled the course evaluation form. RESULTS: Out of 117 students who responded, 63% found the course to be useful. Small group sessions were regarded as the most helpful teaching strategy by 91% of the students. Majority (74%) of the students recommended that field visits should be a part of teaching strategy. CONCLUSION: The Survey Methodology course reinforces the importance and practical application of research methods. The students appreciate the course especially the small group sessions and the field visits.

Adult↗

Development of health surveillance in Togo, west Africa.

Since 1988, the Ministry of Health (MOH) of Togo, with technical assistance from CDC, has systematically adapted and strengthened its health information system (HIS) to enable improved monitoring of trends in diseases. The previous system had been hampered by complicated, lengthy reporting forms; incomplete and delayed receipt of reporting forms; absence of mortality reporting; slow, cumbersome manual compilation and analysis methods; and lack of standard case definitions. To simplify the adaptation process, the system was divided into three main activities: data collection, data compilation and analysis, and dissemination of reports and follow-up action. Public health authorities in Togo have built on existing strengths and successfully adapted the HIS to focus on national morbidity and mortality prevention priorities.

Communicable Disease Control↗

Effects of a task failure exercise on the peroneus longus and brevis during perturbed gait.

Ankle inversion injuries represent the most common trauma sustained by athletes. Muscle fatigue from activity may contribute to a delay in the response of the ankle proprioceptors and dynamic restraints during unexpected inversion. The purpose of this investigation was to determine changes in peroneal average EMG, peak EMG, and time to peak EMG following a task failure exercise. Thirty-two subjects (age 20+/-1.43 yrs; 21 male, 11 female) with no lower extremity injuries reported for data collection. Data were collected from each subject's dominant leg using surface electromyography (EMG). EMG electrodes were applied over the peroneus longus (PL) and brevis (PB) using a standard protocol Subjects walked at a fixed pace on a 6.1 m runway with one section that could be unexpectedly dropped into 30 degrees of inversion upon foot contact. Trials with perturbed and unperturbed gait were randomized to reduce prediction of the unexpected inversion. Once 3 trials of perturbed gait were recorded, subjects completed an isotonic activity that isolated the peroneals. The task was completed to failure. Immediately following the task failure exercise, subjects walked on the perturbation runway once again until 3 trials of perturbed gait were recorded. Analysis revealed no significant differences with regard to average muscle activity between pre- and post-task failure exercise for the PL (F1,31 = 0.133; p = 0.718) or for the PB (F1,31 = 0.795; p = 0.380). There was also no significant difference in peak muscle activity pre- to post-task failure for the PL (F1,31 = 0.032; p = 0.859) or the PB (F1,31 = 0.156; p = 0.695). Finally, there was no significant difference in time-to-peak muscle activity pre- to post-task failure for the PL (F1,31 = 0.830; p = 0.369) or the PB (F1,31 = 1.037; p = 0.316). We concluded that the task failure exercise did not contribute to changes in peroneal activity during perturbed gait. These results indicate that peroneal fatigue does not play a significant role in the incidence of inversion ankle sprains.

Adult↗

Use of a disease reporting system in a large beef feedlot.

A large commercial beef feedlot in northeastern Colorado was selected by stratified random process for inclusion in the National Animal Health Monitoring System pilot data collection project. Various records in the feedlot were used to collect data related to animal health conditions and to their costs. A total of 57,727 cattle were processed during the 12-month period of the study. Rates were used to adjust for the number of cattle in the feedlot during that period. The disease incidence, culling rate, and death rate were presented by each month in the study. The monthly mean number of cattle was the denominator for these rates. During the 12 months, 72 diseases or abnormal conditions were recorded. The total cost of the 10 most prevalent diseases (itemized by dead, culled, treatment, and income from selling dead animals) accounted for approximately 77% of the total cost of disease in the feedlot. The total cost of lower respiratory tract diseases contributed approximately 46% of the total disease cost, and 60% of the cost of the 10 most prevalent diseases. In order to consider the reporting methods reliable, a separate study was undertaken to validate a reported disease or condition in the feedlot.

Animals↗

Public health surveillance: historical origins, methods and evaluation.

In the last three decades, disease surveillance has grown into a complete discipline, quite distinct from epidemiology. This expansion into a separate scientific area within public health has not been accompanied by parallel growth in the literature about its principles and methods. The development of the fundamental concepts of surveillance systems provides a basis on which to build a better understanding of the subject. In addition, the concepts have practical value as they can be used in designing new systems as well as understanding or evaluating currently operating systems. This article reviews the principles of surveillance, beginning with a historical survey of the roots and evolution of surveillance, and discusses the goals of public health surveillance. Methods for data collection, data analysis, interpretation, and dissemination are presented, together with proposed procedures for evaluating and improving a surveillance system. Finally, some points to be considered in establishing a new surveillance system are presented.

Communicable Disease Control↗

Mammography in women > or = 50 years of age. Predisposing and enabling characteristics.

The purpose of this study was to identify the relationship of selected predisposing and enabling characteristics of women > or = 50 years of age to mammography utilization. Andersen and Aday's theoretical model for health services utilization guided data collection. Data were collected from a convenience sample of 161 women members of four urban churches, using a mailed survey. Results showed that 81% reported at least one mammogram and 24% had followed mammography guidelines for the preceding 3 years. Results of logistic regression analyses with variables having a bivariate significance of p < or = 0.01 showed that higher income was associated with both ever having a mammogram and adherence. Willingness to pay > $50 out of pocket for a mammogram was significant for 3 year adherence. Additionally, the sociodemographic variables of age and religion were associated with adherence, whereas a college education was highly significant (odds ratio = 13.78) for ever having a mammogram. Having a regular place for health care and having yearly Papanicolaou tests were associated with ever having a mammogram, but not adherence. Finally, intending to get a mammogram was associated with ever having a mammogram. In this study, belief and knowledge variables showed no association with utilization, and social influence had bivariate significance only for ever having a mammogram. This study suggests the importance of addressing economic and health-care delivery system factors to promote increased mammography utilization, particularly for older women.

Aged↗

Patient-related risk factors that predict poor outcome after total hip replacement.

OBJECTIVE: To identify factors associated with poor outcome after total hip replacement (THR) surgery. DATA SOURCES: This article is the first to present results from the American Medical Group Association (AMGA) THR consortium. STUDY DESIGN: The outcomes evaluated were pain and physical function. Eight patient risk factors were evaluated. These included the age, sex, race, marital status, and education of the patient; whether the patient had polyarticular disease or other comorbid conditions; and the patient's preoperative pain and physical function score. DATA COLLECTION: Data were collected from patients using AMGA-approved, self-administered questionnaires preoperatively and at six weeks, three months, six months, one year, and two years postoperatively. PRINCIPAL FINDINGS: Of the patient risk factors studied, race, education, number of comorbid conditions, and preoperative Health Status Questionnaire (HSQ) score were found to be associated with poor outcome. These risk factors were found to have an effect on both pain and physical function at six months postoperatively. Patients with higher preoperative scores were found to have higher postoperative scores, but substantially fewer of these patients received any benefit from their surgery. For each 10-point increase in preoperative score, patients could expect at least a 6-point decrease in postoperative improvement. CONCLUSIONS: Our study indicates that preoperative status is an important predictor of outcome for THR.

Activities of Daily Living↗

Does moderate alcohol intake reduce fecundability? A European multicenter study on infertility and subfecundity. European Study Group on Infertility and Subfecundity.

BACKGROUND AND AIM: There are plausible reasons to suggest that heavy alcohol consumption reduces male as well as female fecundability, but only a few epidemiological studies have addressed this issue, and results concerning the effect of a moderate intake are equivocal. The present studies were designed to examine the association between male and female alcohol intake at the start of the waiting time to a planned pregnancy. METHODS: Two types of studies were used-a population-based study of randomly selected women between 25 and 44 years in the different European countries from census registers and electoral rolls, and a pregnancy-based study of consecutive pregnant women (at least 20 weeks pregnant) recruited during prenatal care encounters. More than 4000 couples were included in each study, and 10 different regions in Europe took part in the data collection. Data were collected through personal interviews in all population-based samples and in all but four regions of the pregnancy study. RESULTS: The results showed no strong nor coherent association between alcohol intake and subfecundity. CONCLUSIONS: Should any causal effect be present it is restricted to females with a high intake of alcohol within the range of normal consumption reported in European countries.

Adult↗

The health information system in the City of Bulawayo, Zimbabwe: how good is it?

OBJECTIVE: To evaluate the operations and attributes of the outpatient diseases (OPD) surveillance system in the City of Bulawayo. DESIGN: Cross sectional and descriptive study. The system's attributes were evaluated using Centres for Disease Control and Prevention (CDC) evaluation guidelines. We also held focus group discussions with health personnel regarding the use of collected data. SETTING: 6 of 17 health care clinics in Bulawayo, the second largest city in Zimbabwe. SUBJECTS: 34 health personnel were interviewed. MAIN OUTCOME MEASURES: Knowledge of the system's operations, and attributes of the system. RESULTS: Data providers interviewed and all those who participated in Focus Group Discussions (FGDs) had good knowledge of the system's operations. The system is complex. It reports on 94 health events, of which only six (6%) have standard case definitions. All 17 clinics participated in this surveillance. However, of 54 returns studied, 67% were incomplete, and 69% were sent in after the deadline. The system has no plans on how data should be analyzed, used and disseminated. CONCLUSIONS: The CODROPA system is potentially useful in detecting trends of diseases. However, the long delay between data collection and data analysis does not allow for early detection of epidemics and clusters of diseases may be missed. A simpler and less time consuming surveillance system should be started to improve the system's attributes particularly, timeliness of reporting and acceptability of the system to those who have or need to participate.

Ambulatory Care↗

Questions to ask: implementing a system for clinical pathway variance analysis.

Although it is agreed that there is a need for clinical pathway variance analysis, methods for creating a system are less well defined. To help others down this path, we have developed a list of questions around four core issues: data collection, data entry and analysis, data reporting, and organizational support. Our goal is to identify key questions related to variance management and provide a framework for clinical pathway variance analysis.

Analysis of Variance↗

Provider choice and use of mental health care: implications for gatekeeper models.

OBJECTIVE: To examine the ways in which the costs of nonresidential mental health care depend on (1) the type of provider who initiates the treatment episode and (2) the level of cost sharing imposed on the patient. STUDY SETTING: The 1987 National Medical Expenditure Survey, a national probability sample of the U.S. civilian, noninstitutionalized population. DATA COLLECTION: Data were collected during four personal interviews conducted during 1987 and 1988. Key variables include the type of provider contacted at the beginning of treatment (psychiatrist, other physician, nonmedical mental health care specialist) and the cost (total actual payments from all sources) for the treatment episode. METHODS OF ANALYSIS: An episodic model of demand for mental health care is estimated using a two-step procedure. Multinomial probit analysis is first used to determine the factors that influence the choice of initial provider type. Right-censored Tobit analysis is used to determine the factors that affect the costs of care, including the type of provider who initiates the care episode. PRINCIPAL FINDINGS: Results indicate that out-of-pocket price does significantly (p < .05) affect the patient's initial choice of provider type but that, after controlling for the endogeneity of provider choice, price is no longer significant in explaining overall treatment costs. After controlling for selection effects, care episodes initiated by nonspecialist physicians are found to be as expensive as those initiated by psychiatrists and significantly more expensive than episodes initiated by nonphysicians. CONCLUSIONS: The results suggest that nonmedical mental health care specialists may be more effective than physicians in controlling costs when used as case managers in the care of persons with mental illnesses.

Adult↗

The Wisconsin outcomes experience: baseline outcomes of the WISCVPR Web-based Outcomes Project.

PURPOSE: The measurement of outpatient cardiac rehabilitation (OCR) outcomes is now considered common practice. Unfortunately, because of the costs involved in purchasing outcomes tracking software, many programs are not able to participate in pooled outcomes analysis and benchmarking. The purpose of this report is to describe the current OCR outcomes data in the state of Wisconsin using a web-based model for outcomes data collection, data pooling, and benchmarking. METHODS: Participating OCR programs collected individual patient outcomes according to protocols developed by the Wisconsin Society for Cardiovascular and Pulmonary Rehabilitation's Outcomes Committee. Programs analyzed their data quarterly and submitted the values to a database via an Internet web site. Aggregate outcomes data from 34 programs were collected over a 27-month period. RESULTS: Aggregate data representing 5235 OCR patients are presented. The mean age for the men was 64 +/- 5 years (N = 3612; 69% of the sample). The mean age for the women was 67 +/- 6 years (N = 1623; 31% of the sample). The completion rate for the group was 89% (95%CI, 86-91). The average number of OCR sessions per patient was 22 +/- 6 over 9 +/- 3 weeks. The clinical and behavioral outcomes for this sample ranged from a median value of 88% for the percentage of patients meeting the blood pressure goal (95%CI, 87-91) to less than 5% for the percentage of patients receiving formal psychosocial counseling (95%CI, 0). The major cardiovascular event rate was 0.17 per 10,000 patient-hours. CONCLUSION: This report describes the baseline OCR outcomes obtained via a state affiliate-sponsored outcomes management program. These data show that this model of OCR outcomes measurement, collection, and interprogram analysis produces data that are comparable with those of published, controlled studies. Determining baseline characteristics of OCR outcomes data will be important in the development of benchmarks and best practice guidelines.

Aged↗