HLA-NET population data questionnaire

1. Institution providing the sample

1.1 Name of the Institution: _

1.2 Contact person (e.g. principal investigator):

  • Name: _
  • Telephone number: _
  • E-mail address: _

2. Samples tested

(Please fill one full questionnaire per sample)

2.1 Type of study:

  • Field study in a well-defined population: YES / NO
  • If NO, please indicate which type of sample:
    - blood donors: YES / NO
    - stem cell donors (registries): YES / NO
    - organ donors: YES / NO
    - cord blood donors: YES / NO
    - healthy controls for disease studies: YES / NO
    - patients: YES / NO
    - other, please specify: YES / NO
  • Date of sampling:
  • Does the sample include first degree relatives? YES / NO / UNKNOWN
  • Is the information on relatedness available? YES / NO

2.2 Name of the population and any alternative names known (if necessary use Ethnologue):

  • Main name (s): _
  • Other possible name(s): _
  • Other specific characterization that would help to differentiate this population to any other (e.g., specific cultural trait like endogamy, specific religion, isolated location, etc): _

2.3 Geographic location of the population

Is the location of the sample the same as the location of the population? YES / NO

  • If YES, fill the questionnaire only for the sample (2.3.1).
  • If NO (e.g. answer “NO” for Chinese living in US, etc), please fill the corresponding information for both the sample (2.3.1) and the population (2.3.2) from where the sampling was made.

2.3.1. Sample:

  • Name of country: _
  • Name of region(s): _
  • Name of town(s) or village (s): _
  • Geographic coordinates (useful link to find coordinates)
    Latitude (decimals, North or South): _
    Longitude (decimals, East or West): _
  • Altitude / environment (if relevant): _
  • Please attach a map if possible. Map included: YES / NO

2.3.2. Population:

  • Name of country: _
  • Name of region(s): _
  • Name of town(s) or village (s): _
  • Geographic coordinates (useful link to find coordinates)
    Latitude (decimals, North or South): _
    Longitude (decimals, East or West): _
  • Altitude / environment (if relevant): _
  • Please attach a map if possible. Map included: YES / NO

2.3.3. Size of the population where the individuals were sampled (if known): _

2.3.4. Other relevant information: _

2.4 Language spoken by the population (please use Ethnologue)

  • Most specific language name (s): _
  • Linguistic family: _

2.5 Other useful information about the general population
(e.g. specific disease(s),demographic information, social structure, religion(s), etc (add pages if necessary): _

  • Useful references: _

3. Source of DNA & HLA typing

3.1 Origin of DNA

  • Blood / mouth swabs / other (please underline the correct answer)
  • If other please specify: _

3.2 Loci typed and Methodology used for typing

Include a table with 5 columns and as many lines as you need:

  • Nb of individuals
    Number of individuals typed for each locus
  • Locus typed
    Locus options: A / B / C / DPA1 / DPB1 / DQA1 / DQB1 / DRB1 / DRB3 / DRB4 / DRB5 / MICA / KIR / OTHER
  • Method
    Method options: SSO / SSP / mono-allelic SBT / bi-allelic SBT. For SSO and SBT specify exon(s) typed
  • Resolution Level
    Resolution level options: LOW / INTERMEDIATE / HIGH / ALLELIC
  • Reference date
    Reference date IMGT/HLA-database version used to assign HLA Types

4. Ethical considerations

4.1 Informed consent

• Was informed consent obtained at time of sampling YES / NO
• If yes, did this include
o Transfer of data for analysis to third parties? YES / NO
o Storage of data in third party databases? YES / NO
• If no or unknown:
o Is ethical review of the proposed data transfer necessary? YES / NO

4.2 Data

• Was data anonymised? YES / NO
• Was an ethics checklist completed prior to sample collection? YES / NO

wg1/population_questionnaire.txt · Last modified: 2012/03/13 19:30 by sanchezmazas
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