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PubMed2005

General practictioners' management of cancer in England: secondary analysis of data from the National Survey of NHS Patients-Cancer.

Relatively little is understood concerning the exact role of general practice in the cancer patients' pre-diagnostic, and post-diagnostic journey. This paper aims to explore this role using data from the National Survey of NHS Patients-Cancer. Data from 65,192 patients relating to five questions from this survey were analysed in detail with particular relevance to differences between the six cancers [breast, colorectal, lung, ovarian, prostate and non-Hodgkin's lymphoma (NHL)], and socio-demographic variables (age, gender and social class). There were considerable differences between patients with the six cancers, and the role of general practice in the cancer diagnosis, and post-diagnosis management. The vast majority of patients saw their general practitioner (GP) with symptoms prior to being seen in hospital. A significant minority were told their diagnosis by their GP. About half the sample were told to contact their GP post-discharge, and about half did so. Being told to contact the GP post-discharge was strongly associated with actually seeing the GP. Most patients felt that their GP was given enough information about their treatment or condition. In conclusion, this work has quantified the central role of general practice in cancer diagnosis and management in England. There remain considerable resource, educational and research needs to continue to provide high-quality cancer care in primary care.

Aged↗
PubMed2007

Does the UK government's teenage pregnancy strategy deal with the correct risk factors? Findings from a secondary analysis of data from a randomised trial of sex education and their implications for policy.

BACKGROUND: Much of the UK government's 1999 report on teenage pregnancy was by necessity based on rather old or non-longitudinal research. AIM: To examine the associations between risk factors identified in the report and pregnancy at or before age 16 years among young women and partners of young men using the more recent data. RESULTS: Socioeconomic disadvantage, being born to a teenage mother, expectation of being a teenage parent, low educational expectations and various other behaviours are potential risk factors for teenage pregnancy, as suggested by unadjusted analyses. Those who cited school as providing information on sex had a reduced risk of pregnancy at or before age 16 years, as did girls reporting easy communication with parent or guardian at baseline. Various measures of low sexual health knowledge were not associated, in either adjusted or unadjusted analyses, with increased risk of pregnancy at or before age 16 years among boys or girls. CONCLUSIONS: A focus on many of the risk factors identified in the 1999 report is supported herein. It is suggested that knowledge may not be an important determinant, but that relationships with parents and school, as well as expectations for the future, may have important influences on teenage pregnancy. The analysis also provides new insights into risk factors for pregnancies among the partners of young men.

Adolescent↗
PubMed1999

[Income and smoking behavior in Germany--a secondary analysis of data from the 1995 microcensus].

We investigated to what extent two major parameters of the economic situation, namely the household income and the type of the major source of income, are related to smoking behaviour. Study variables are current cigarette smoking and ex-smoking. Databasis is the Public Use File of the "Microcensus 1995", which is a representative survey for Germany, conducted under the auspices of the German Federal Statistical Bureau. Included in the analysis were 185,822 persons aged 18 years and older. 30.9% of males and 18.2% of females are current smokers. 39% of males and 31.2% of females, who had been smokers at any time, stopped smoking. For persons aged 18 to 64 years, we observed strong income-related differences in the smoking prevalence. The higher the income the lower was the rate of smokers. Higher rates for ex-smokers were observed for persons older than 30 years, who had a high household income. For study subjects with a primary income based on unemployment or social welfare payments, we found for both sexes a remarkably higher smoking prevalence. Due to the fact that the underlying causes for the higher prevalence of smoking in the poorer segments of the population are not very well understood, it is rather difficult to establish a comprehensive prevention strategy for this high-risk population group.

Adolescent↗
PubMedDate not supplied

GP visits by health care card holders. A secondary analysis of data from Bettering the Evaluation and Care of Health (BEACH), a national study of general practice activity in Australia.

BACKGROUND: Patients of low socioeconomic status are more likely to hold a commonwealth government health care card. Card holders are recipients of age, disability, unemployment or other low income pensions. OBJECTIVE: To compare the general practice managed morbidity of health care card holders with noncard holders. METHOD: Data from one year of the continuous Australian national survey of general practice activity (comprising 98,000 encounters from 980 general practitioners) were used to compare patient and encounter characteristics and the problems managed for health care card holders and noncard holders. Logistic regression adjusted for patient confounders (age and sex, practice size, comorbidity and measured social factors) to describe morbidity associated with health care card status. RESULTS: Health care card holders were more likely to have respiratory, circulatory, musculoskeletal, psychological, neurological, endocrine, digestive, urinary and social problems managed. They were more likely to have chronic and psychosocial problems managed and to receive prescriptions. Female card holders were less likely to have a genital check up (including Pap smear). CONCLUSION: This analysis supports a relationship between socioeconomic status and health. Those from a low socioeconomic status (health care card holders) experience worse psychosocial health and more chronic health problems, have more medications prescribed and receive less preventive care.

Australia↗
PubMed1999

Secondary analysis of survey data: a research method with potential for occupational therapists.

The secondary analysis of previously collected survey data can assist occupational therapists to focus research, make policy decisions and test theory. In this paper the authors outline the process of carrying out a secondary analysis using existing survey data. Steps include selecting the research question, and then locating, appraising, acquiring and analysing the data. To illustrate this process, the authors examined the relationships between accidents and mobility impairments among older adults using data previously collected in the National Population Health Survey. Finally, some further examples of occupational therapy research carried out using secondary analysis of survey data are considered.

Accidents↗
PubMed2006

The association of physical function with agitation and passivity in nursing home residents with dementia.

The purpose of this article is to examine the association of physical function with agitation and passivity in nursing home residents with dementia using direct observational measures. Data were analyzed using mixed model analysis of variance. This study was a secondary data analysis using baseline data yielded from a crossover experimental study. Univariate analyses showed that physical function, cognitive status, and education explained a significant amount of variance in agitation. When controlled for cognitive status and education, physical function lost significance and only explained 2.6% of the variance in agitation. It was found that physical function was not related to passivity. Environmental factors may be more salient antecedents for agitation and passivity in nursing home residents with moderate to severe cognitive impairment.

Activities of Daily Living↗
PubMed1984

Self-care. Substitute, supplement, or stimulus for formal medical care services?

This article examines the relationship between selected self-care practices during an episode of illness and the use of formal medical care. Stimulated by conflicting evidence and assertions, the general question addressed is: "Is self-care a substitute, a supplement, or a stimulus for use of formal medical care services?" Multiple Classification Analysis was used in a secondary data analysis of a 1976 nationwide study on access to medical care. The results suggest that self-care users may visit the physician less often and stay fewer days in the hospital, and thus they are expected to have lower expenditures for hospital and physician services. Therefore, the self-care activities examined appear to be substitutes for, rather than supplements or stimuli to, health services utilization. The results must be viewed with some caution due to limitations in the data. However, the results also argue for a greater research emphasis on self-care.

Adolescent↗
PubMed2002

Measuring the efficiency of dental departments in medical centers: a nonparametric analysis approach.

Data envelopment analysis (DEA), a cross-sectional study design based on secondary data analysis, was used to evaluate the relative operational efficiency of 16 dental departments in medical centers in Taiwan in 1999. The results indicated that 68.7% of all dental departments in medical centers had poor performance in terms of overall efficiency and scale efficiency. All relatively efficient dental departments were in private medical centers. Half of these dental departments were unable to fully utilize available medical resources. 75.0% of public medical centers did not take full advantage of medical resources at their disposal. In the returns to scale, 56.3% of dental departments in medical centers exhibited increasing returns to scale, due to the insufficient scale influencing overall hospital operational efficiency. Public medical centers accounted for 77.8% of the institutions affected. The scale of dental departments in private medical centers was more appropriate than those in public medical centers. In the sensitivity analysis, the numbers of residents, interns, and published papers were used to assess teaching and research. Greater emphasis on teaching and research in medical centers has a large effect on the relative inefficiency of hospital operation. Dental departments in private medical centers had a higher mean overall efficiency score than those in public medical centers, and the overall efficiency of dental departments in non-university hospitals was greater than those in university hospitals. There was no information to evaluate the long-term efficiency of each dental department in all hospitals. A different combination of input and output variables, using common multipliers for efficiency value measurements in DEA, may help establish different pioneering dental departments in hospitals.

Cross-Sectional Studies↗
PubMed2002

A tribute to John Gibbon.

This article provides an overview of the published research of John Gibbon. It describes his experimental research on scalar timing and his development of scalar timing theory. It also describes his methods of research which included mathematical analysis, conditioning methods, psychophysical methods and secondary data analysis. Finally, it describes his application of scalar timing theory to avoidance and punishment, autoshaping, temporal perception and timed behavior, foraging, circadian rhythms, human timing, and the effect of drugs on timed perception and timed performance of Parkinson's patients. The research of Gibbon has shown the essential role of timing in perception, classical conditioning, instrumental learning, behavior in natural environments and in neuropsychology.

Journal Article↗
PubMed2004

The importance of degree versus type of maltreatment: a cluster analysis of child abuse types.

The author conducted secondary data analysis of 3 previously reported studies (D. J. Higgins & M.P. McCabe, 1998, 2000b, 2003) to examine whether respondents are best classified according to their experience of separate maltreatment types (sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence) or whether their experience reflects a single unifying concept: child maltreatment. The author conducted a cluster analysis of the combined dataset followed by a confirmatory discriminant function analysis. Finally, the differences in psychological adjustment between those classified into the 3 different clusters were examined as a test of the 3-cluster solution. The best cluster analysis solution grouped individuals according to the degree to which maltreatment behaviors were reported. Individuals classified into the high maltreatment cluster had significantly more adjustment problems than those in either the moderate or the low maltreatment clusters. The results showed that it may be more meaningful to talk about the degree of maltreatment (frequency and/or severity) experienced by the child rather than about the type.

Adult↗
PubMed2005

Ontological analysis of gene expression data: current tools, limitations, and open problems.

Independent of the platform and the analysis methods used, the result of a microarray experiment is, in most cases, a list of differentially expressed genes. An automatic ontological analysis approach has been recently proposed to help with the biological interpretation of such results. Currently, this approach is the de facto standard for the secondary analysis of high throughput experiments and a large number of tools have been developed for this purpose. We present a detailed comparison of 14 such tools using the following criteria: scope of the analysis, visualization capabilities, statistical model(s) used, correction for multiple comparisons, reference microarrays available, installation issues and sources of annotation data. This detailed analysis of the capabilities of these tools will help researchers choose the most appropriate tool for a given type of analysis. More importantly, in spite of the fact that this type of analysis has been generally adopted, this approach has several important intrinsic drawbacks. These drawbacks are associated with all tools discussed and represent conceptual limitations of the current state-of-the-art in ontological analysis. We propose these as challenges for the next generation of secondary data analysis tools.

Algorithms↗
PubMed2002

Association between overweight or obesity and household income and parental body mass index in Australian youth: analysis of the Australian National Nutrition Survey, 1995.

This study is a secondary data analysis based on the 1995 Australian National Nutrition Survey (NNS). A random subsample of 1581 school children aged 7-15 years old from the NNS was studied. The results show the prevalence of overweight, obesity and combined overweight and obesity was 10.6-20.9%, 3.7-7.2% and 15.6-25.7%, respectively. The odds ratio of overweight or obese boys with highest household income was significantly smaller than those with the lowest household income. The proportion of combined overweight and obesity in children whose parents were overweight or obese was significantly greater compared with those whose parents were not. The trend of increasing prevalence of overweight or obesity among children with increasing parental body mass index (BMI) was significant after adjusting for age except the trend of father's BMI for boys. This study provided baseline data on the recent prevalence of overweight or obesity of Australian school children using new international absolute BMI cut-off points. It indicated that young school girls (7-9 years) were more likely to be overweight or obese compared with boys, the prevalence rates of overweight or obesity in older boys (13-15 year) was significantly greater than in other age groups while in girls it was the opposite. The boys with lowest household income ($0-17 500) were more likely to be overweight or obese compared with those with the highest household income (greater than $67 500). Having parents especially mothers who were overweight or obese may increase the risk of children being overweight or obese.

Adolescent↗
PubMed2005

Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer.

The aim of this paper is to describe and compare components of diagnostic delay (patient, primary care, referral, secondary care) for six cancers (breast, colorectal, lung, ovarian, prostate and non-Hodgkin's lymphoma), and to compare delays in patients who saw their GP prior to diagnosis with those who did not. Secondary data analysis of The National Survey of NHS Patients: Cancer was undertaken (65 192 patients). Breast cancer patients experienced the shortest total delays (mean 55.2 days), followed by lung (88.5), ovarian (90.3), non-Hodgkin's lymphoma (102.8), colorectal (125.7) and prostate (148.5). Trends were similar for all components of delay. Compared with patient and primary care delays, referral delays and secondary care delays were much shorter. Patients who saw their GP prior to diagnosis experienced considerably longer total diagnostic delays than those who did not. There were significant differences in all components of delay between the six cancers. Reducing diagnostic delays with the intention of increasing the proportion of early stage cancers may improve cancer survival in the UK, which is poorer than most other European countries. Interventions aimed at reducing patient and primary care delays need to be developed and their effect on diagnostic stage and psychological distress evaluated.

Female↗
PubMedDate not supplied

Cigarette smoking and the disenfranchisement of adolescent girls: a discourse of resistance?

The consequences of smoking for women are of particular concern in light of recent observations that more adolescent females than males are taking up smoking. To date, few studies have explored gender differences in depth, but we do know that males and females smoke for different reasons and that current smoking prevention programs may be differentially effective depending on gender. Recent evidence suggests that the school environment may have an important influence on smoking. The purpose of this study, therefore, was to explore gender differences in the relationships between cigarette smoking and adolescents' experiences of school climate and their relationships with the school and significant adults in their lives. A secondary data analysis was done using a data set derived from a student survey conducted in 20 secondary schools in British Columbia (BC), Canada, which included 8,179 students in grades 8 to 12. Analyses were primarily descriptive. The results demonstrated that adolescent girls who smoke are more likely than either males or nonsmoking females to experience powerlessness in their school environment and to feel considerably less attachment to the school. Female smokers are more likely than males or female nonsmokers to be engaged in oppositional, distanced, and unsatisfactory relationships with important adults in their lives, particularly those who are in positions of relative power and authority. These findings are discussed in relation to critical and feminist perspectives that suggest smoking is part of a larger discourse of resistance within schools. The implications for health practitioners are discussed.

Adolescent↗
PubMed1995

Recreational exercise participation and aerobic fitness in men and women: analysis of data from a national survey.

We compared the relationship between predicted VO2 max (ml kg-1min-1) and recreational exercise patterns, using secondary data analysis of a comprehensive national survey (18,293 subjects aged 15-69 years). Exercise participation and predicted VO2 max data were available for about 50% of this sample (4933 females, 4738 males). As expected, VO2 max was significantly lower in the females than in the males at any age (P < 0.0001). Age was the most significant predictor of VO2 max (r = -0.71 for males, r = -0.73 for females). Adjusting the data for the body mass index (BMI) increased this relationship only slightly in the males (R = 0.75) and females (R = 0.79). The simultaneous inclusion of exercise participation data (intensity, duration, energy expenditure) did not increase the predictions meaningfully (R = 0.78 for the males, R = 0.81 for the females). These exercise participation parameters concomitantly accounted for only a very slight amount of the variance of VO2 max in both the females (3.0%) and males (4.5%). To minimize the effects of age, the data were analysed using 5-year intervals. Again, the exercise participation parameters accounted for only a small part of the variance in VO2 max (< 10%), except in the 15- to 19-year-old males (24%). These data suggest that VO2 max is not associated with participation in recreational exercise.

Adolescent↗
PubMed1996

Case record analysis: biopsied lesions in a high-risk white and African American Community.

OBJECTIVES: The purpose of this secondary data analysis was to characterize biopsied intraoral lesions documented from neighborhood health center records in a lower socioeconomic biracial community over an eight year period, (1982-1989.) METHODS: A thorough intraoral examination, which included radiographs, was completed by either a general dentist or an oral surgeon. Questionable lesions were referred to and biopsied in the Department of Pathology at Johns Hopkins Medical Center. Biopsied lesions were classified into three groups for analysis: benign, malignant/premalignant, and dental-related. RESULTS: Of 13,317 recorded dental visits, 10,819 (81.2%) visits were made by African Americans. There were 341 lesions biopsied, representing 69 different histologic diagnoses. Of identified lesions, 76.5% were in African Americans; 41.6% were in males, ranging in age from 41 to 94 years old (a mean age of 73 +/- 7 years). Approximately 50% of identified lesions in African American and Whites were benign. Among African Americans, 11.9% of the lesions were malignant premalignant, while 16.3% were among Whites. Within the malignant/premalignant category, squamous cell carcinoma was the most frequently identified malignant lesion. Hyperkeratosis was the most common premalignant lesion type. CONCLUSIONS: Neighborhood health centers can provide a valuable screening service identifying intraoral lesions in vulnerable communities. Future research should explore how socioeconomic factors affect differences in the prevalence of intraoral pathologies among White and African American subgroups as well as other subpopulations.

Adult↗
PubMed1988

HMO enrollment and Medicaid. Survival analysis with a Weibull function.

This paper analyzes the length of enrollment in Health Maintenance Organizations (HMOs) by performing secondary data analysis. It estimates a Weibull survival function using only simple regression. For middle-class enrollees in one HMO, the hazard rate (the disenrollment rate for the remaining members of a cohort) falls sharply with the length of enrollment. For medicaid beneficiaries allowed to remain in the fee-for-service sector, the hazard rate in another HMO is much greater but falls less sharply. Limiting the choice of Medicaid beneficiaries to HMOs would increase their length of enrollment, lowering a major barrier to HMOs' participation in Medicaid.

Epidemiologic Methods↗