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PubMedDate not supplied

[The structure of financial planning of public health in Ukraine during the transitional period].

Based on the newly developed concept of multilevel functional system of primary health care which is to replace the current multicomponent system, the author discusses the computer-aided realization of the system for estimation and analysis of the integral model of outpatient and inpatient medical care of the population of the Ukraine. This system is intended to solve the problems associated with intensification of the resources of the public health system of the Republic (district).

Health Care Reform↗
PubMed2005

A multilevel examination of the relationships among training outcomes, mediating regulatory processes, and adaptive performance.

This study examined whether cognitive, affective-motivational, and behavioral training outcomes relate to posttraining regulatory processes and adaptive performance similarly at the individual and team levels of analysis. Longitudinal data were collected from 156 individuals composing 78 teams who were trained on and then performed a simulated flight task. Results showed that posttraining regulation processes related similarly to adaptive performance across levels. Also, regulation processes fully mediated the influences of self- and collective efficacy beliefs on individual and team adaptive performance. Finally, knowledge and skill more strongly and directly related to adaptive performance at the individual than the team level of analysis. Implications to theory and practice, limitations, and future directions are discussed.

Adaptation, Psychological↗
PubMed2003

[Multi-media computer-based chart: modern tool of clinical record keeping].

AIM: To design the program of computer multimedia case history (MCH) for collection, storage and analysis of information about the patient including diagnostic images; to test MCH for application in telemedical consulting and control over valid conduction of the treatment protocol. MATERIAL AND METHODS: Brief representation of information is reached by integrated multilevel placement of the data on common time axis. Dynamics of the selected parameters is represented as normalized diagrams in the same system axes. Electron tables are filled either by hand or import of the data from individual electron file of all the information about the patient. Diagnostic images and conclusions are obtained from local computer bases of the diagnostic units. Inexpensive commonly used computers allows one to input digital micro- and macrophotos, x-ray images, etc. Monitor information is available from the universal computer net directly from the monitors Geolink-M. RESULTS: MCH was tested in the Hematological Research Center of RAMS. In cooperation with Bryansk diagnostic center N 1 telemedical consulting and some data bases were perfected. The MCH system joints routine activity of the clinic without any problems raising quality of the patients management, facilitating the access to therapeutic and diagnostic information and its analysis. On-line breaking the limits of the controlled parameters and protocols is detected automatically. These events are emphasized by "blocking questions" which must be worked out by the user. The information on the patient can be fully stored on CD-ROM in line with the MCH program providing organization of the data. CONCLUSION: The system is introduced which collects medical information from various sourses and builds up comprehensive representation of the data on the same time axis. The system provides control over implimintation of the protocols of the patients' management, gives a convenient access to medical information, ensures its reliable storage and availability in case of the patients transfer to other medical institutions, facilitates analysis of clinical cases, conduction of medical consulting.

Computer Communication Networks↗
PubMed2005

Tongue base suspension combined with UPPP in severe OSA patients.

OBJECTIVE: Tongue base surgery in the severe OSA patients may improve the success of uvulopalatopharyngoplasty (UPPP) as the collapse is multilevel. The aim of this study was to evaluate the long-term objective and subjective effectiveness of the minimally invasive tongue base suspension combined with UPPP in severe OSA patients. STUDY DESIGN AND SETTING: We conducted a retrospective analysis of 22 OSA patients undergoing UPPP and the tongue base suspension for the treatment of severe OSA. RESULTS: Twenty-two men who had their preoperative and postoperative polysomnography had a 54% reduction in the preoperative Respiratory Disturbance Index (RDI), from 47.50 +/- 15.74 to a level of 17.31 +/- 14.17. The standard surgical cure rate which is a >50% reduction in the RDI and a postoperative RDI of <20 events/hour was 81.81%. All patients had some degree of subjective improvement in their snoring, daytime sleepiness, and the Epworth sleepiness scale. CONCLUSIONS: The tongue base suspension combined with UPPP has been shown to reduce RDI better than UPPP alone. This minimally invasive technique is highly successful at 81.81% when combined with UPPP in the severe OSA patients with multilevel airway collapse. SIGNIFICANCE: This study shows the benefits of minimally invasive tongue base suspension combined with UPPP in severe obstructive sleep apnea syndrome.

Adult↗
PubMed2006

Measuring and modeling the social and geographic context of trauma: a multilevel modeling approach.

Increasingly it is recognized that health and illness are products of individual level risk and protective factors, as well as forces operating at contextual levels. In this article, we present the motivation and rationale for understanding trauma within its context. We use the example of the concept of social capital to illustrate the relevance of the contextual approach for trauma research and outline a multilevel modeling approach to examining contextual influences on trauma outcomes.

Disasters↗
PubMed2001

Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment.

Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.

Adult↗
PubMed2005

Selective effects of emotion on the phenomenal characteristics of autobiographical memories.

The present study investigates the emotional determinants of the phenomenal characteristics of autobiographical memories. A total of 84 participants completed the Memory Characteristics Questionnaire (MCQ, Johnson, Foley, Suengas, & Raye, 1988) after retrieving and orally describing a negative, a positive, and a neutral autobiographical memory. In addition, self-report and physiological measures of emotional state at retrieval were recorded. Results suggest that recall of perceptual, sensory, and semantic elements is better for emotional memories than for neutral ones. This difference is not significant for contextual and temporal aspects, suggesting that emotional memories are more vivid but no more specific than are neutral ones. In addition, positive memories yielded higher MCQ ratings than did negative memories for sensory, temporal, and contextual aspects. Finally, correlations suggest a positive relation between emotional state at retrieval and level of phenomenal detail of retrieved memories. Results are interpreted in terms of multilevel models of emotion and of Conway and Pleydell-Pearce's (2000) model.

Adolescent↗
PubMed2004

Static conductivity imaging using variational gradient Bz algorithm in magnetic resonance electrical impedance tomography.

A new image reconstruction algorithm is proposed to visualize static conductivity images of a subject in magnetic resonance electrical impedance tomography (MREIT). Injecting electrical current into the subject through surface electrodes, we can measure the induced internal magnetic flux density B = (Bx, By, Bz) using an MRI scanner. In this paper, we assume that only the z-component Bz is measurable due to a practical limitation of the measurement technique in MREIT. Under this circumstance, a constructive MREIT imaging technique called the harmonic Bz algorithm was recently developed to produce high-resolution conductivity images. The algorithm is based on the relation between inverted delta2Bz and the conductivity requiring the computation of inverted delta2Bz. Since twice differentiations of noisy Bz data tend to amplify the noise, the performance of the harmonic Bz algorithm is deteriorated when the signal-to-noise ratio in measured Bz data is not high enough. Therefore, it is highly desirable to develop a new algorithm reducing the number of differentiations. In this work, we propose the variational gradient Bz algorithm where Bz is differentiated only once. Numerical simulations with added random noise confirmed its ability to reconstruct static conductivity images in MREIT. We also found that it outperforms the harmonic Bz algorithm in terms of noise tolerance. From a careful analysis of the performance of the variational gradient Bz algorithm, we suggest several methods to further improve the image quality including a better choice of basis functions, regularization technique and multilevel approach. The proposed variational framework utilizing only Bz will lead to different versions of improved algorithms.

Algorithms↗
PubMed1999

Impact of the Working Well Trial on the worksite smoking and nutrition environment.

This article reports the effect of a worksite cancer control intervention on aspects of the physical and social environment related to dietary and smoking behaviors of employees. Data are from 111 intervention and control worksites that participated in the Working Well Trial. Employee surveys and interviews with key organizational informants assessed environmental and normative changes relevant to nutrition and tobacco use. Results indicated significant effects of the intervention on all nutrition outcomes: access to healthy food, nutritional information at work, and social norms regarding dietary choice. Significant benefits were not found for smoking norms or smoking policies. However, changes occurred in both the control and intervention sites on these variables. This first large analysis of environmental and normative effects of a worksite intervention is consistent with the employee behavior change findings for the trial and serves as a model for future analyses of multilevel worksite health promotion programs.

Adult↗
PubMed2002

[Decompression and internal fixation in the treatment of thoracolumbar spine and spinal cord injury: report of 166 cases].

OBJECTIVE: To evaluate the therapeutic effect of several internal fixation methods in the surgical treatment of thoracolumbar spine and spinal cord injury (SSI-TL). METHODS: In the 166 SSI-TL cases included in this retrospective analysis, 37 had vertebral body burst fracture, 109 had vertebral body compression fracture (with compression to a degree over 50%),14 had vertebral body fracture and dislocation and 6 had multilevel vertebral fractures or jumping fracture. In view of the spinal cord injury 59 belonged to Frankel grade A, 46 grade B, 42 grade C and 19 grade D. Posterior decompression, reduction and internal fixation were performed in 122 patients and the other 44 underwent anterior decompression, reduction and ilium bone grafting. RESULTS: Follow-up study for 3 to 18 month was conducted in 123 cases, in which RF screws cracking occurred in 4 cases, Harrington upper hook dislocation in 5 cases and Harrington rod cracking in 6, while the rest cases were free of theses incidents. In terms of the function recovery of the spinal cord, 88 cases showed improvement of the spinal cord and cauda equina of 1 to 3 Frankel grades, leaving only 35 lingering in grade A. CONCLUSION: Decompression should be performed at early stages of SSI-TL, and employment of various internal fixation instrument helps maintain and enhance spinal stability, preventing secondary lesion of the spinal cord and promoting the function recovery of the injured spinal cord.

Adolescent↗
PubMedDate not supplied

[System of distributed storage and analysis of genomic information].

A distributed computing system is developed to search and analyze genetic databases using parallel computing technologies. Queries are processed by a local network PC cluster. A universal task and data exchange format is developed for effective query processing. A multilevel hierarchic task batching procedure is elaborated to generate multiple subtasks and distribute them over cluster units under dynamic priority levels and with dynamic distribution of replicated source data subbases. Primary source data preparation and generation of annotation word indices are used to significantly reduce query processing time.

Databases, Genetic↗
PubMed1995

Psychiatric morbidity: a multilevel approach to regional variations in the UK.

STUDY OBJECTIVE: To establish whether regional variations in psychiatric morbidity in Britain constitute a distinctive geography of mental health arising from factors that are context-specific at area level or whether these variations are an artifact generated by sampling fluctuations and differing population compositions in areas. DESIGN: Multilevel modelling techniques were applied to data from the 1984-85 health and lifestyle survey. The outcome was the prevalence of psychiatric morbidity as recorded by the application of the general health questionnaire in this survey. SETTING: The analysis was undertaken simultaneously at the individual level, electoral ward level, and regional level for England, Wales, and Scotland. PARTICIPANTS: A total of 6572 adults were selected from the electoral register. MAIN RESULTS: Regional variations were detected in crude aggregate general health questionnaire scores but these were found to be the result of sampling fluctuations and varying regional population compositions rather than higher level contextual effects. There was certainly no evidence of a clear north-south distinction in psychiatric morbidity as was suggested by earlier work. In addition, the local neighbourhood did not seem to have any importance beyond the type of people who lived there. A number of individual characteristics was shown to be associated with mental wellbeing but a large degree of individual variation remained unexplained. CONCLUSIONS: In terms of low level psychiatric disturbance it seems that the characteristics of individuals have greater importance than the characteristics of areas, although the latter may still operate as important mediating factors. Multilevel modelling represents a robust statistical method of examining area variations in health outcomes and further work needs to be conducted, particularly on more serious psychiatric conditions.

Adult↗
PubMed2002

Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea.

OBJECTIVE: To evaluate the usefulness of uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea syndrome (OSAS). DESIGN: Prospective study of 20 consecutive patients with OSAS. SETTING: University medical center. PATIENTS AND INTERVENTIONS: Twenty OSAS patients with multilevel upper airway obstruction who refused continuous positive airway pressure treatment. All patients were evaluated before and 6 months after surgery by clinical history, the Epworth Sleepiness Scale, physical examination, fiberoptic nasopharyngoscopy combined with the Müller maneuver, cephalometric analysis, nocturnal polysomnography, and a second-night polysomnography with upper airway pressure recording during sleep. Surgery procedures were uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement. Surgical successful outcome was defined as an apnea-hypopnea index (AHI) lower than 20 plus subjective resolution of daytime symptoms. MAIN OUTCOME MEASURE: Surgical success rate. RESULTS: Mean +/- SD AHI decreased from 60.5 +/- 16.5 to 44.6 +/- 27(P =.007), and CT90 (percentage of time with oxyhemoglobin saturation below 90%) decreased from 39.5% +/- 26% to 25.1% +/- 26.4% (P =.002). The overall surgical success rate was 35% but increased to 57% in patients with moderate OSAS (AHI, 41-60) and to 100% in mild OSAS (AHI, 21-40). In the group of severe OSAS, the success rate was 9%. Predictors of surgical outcome success were the AHI, CT90, stages 2 and 3-4 sleep percentages, and the cephalometric ANB angle (angle formed from the deepest point on the maxillary outer contour to the nasion to the deepest point on the outer mandibular contour). CONCLUSION: Patients with mild and moderate OSAS and multilevel obstruction in the upper airway may benefit from uvulopalatopharyngoplasty plus genioglossus and hyoid advancement.

Adult↗
PubMed1999

Multilevel mediation modeling in group-based intervention studies.

This article proposes and evaluates a method to test for mediation in multilevel data sets formed when an intervention administered to intact groups is designed to produce change in individual mediator and outcome variables. Simulated data of this form were used to compare ordinary least squares (OLS) and two multilevel estimators of the mediated effect. OLS and multilevel standard error approximations were also evaluated and recommendations given for optimal estimator choice. These methods were applied to data from an existing substance use intervention to show the impact multilevel mediation modeling can have on the conclusions drawn from real-world evaluation studies.

Analysis of Variance↗
PubMed2005

Local neighbourhood and mental health: evidence from the UK.

This paper examines the association between neighbourhood and levels and changes in common mental disorders. Using data from a large scale nationally representative survey of individuals and households (the British Household Panel Survey), it locates individuals in their local neighbourhoods. These are defined as the nearest 500-800 persons centered around each individual in the survey. These 'bespoke' neighbourhoods are characterised according to five dimensions--disadvantage, mobility, age, ethnicity and urbanness--derived from factor analysis of the census characteristics of the residents of neighbourhoods in 1991. These dimensions measure characteristics of place that have been argued to be associated with mental ill health. The paper estimates multilevel models of the level and 5-year changes of common mental disorders (measured by the twelve item version of the General Health Questionnaire). Three and two level models are estimated, all of which allow for individual and household characteristics that may act as confounders of any neighbourhood effect. The results show the extent of association between neighbourhood and both levels and changes in mental health is limited. Less than one percent of the variance across individuals is at the neighbourhood level. The neighbourhood characteristics are not generally statistically associated with levels or changes in mental ill health. There is some evidence of interaction between neighbourhood characteristics and gender and ethnicity, but while statistically significant these interactions are small in size compared to the main effects of individual and household characteristics. What appears to be important for levels of common mental disorders are the observed characteristics of individuals and their households, not of place.

Adult↗
PubMed2004

[Environmental quality assessment of regional agro-ecosystem in Loess Plateau].

Based on the detection and analysis of the contamination status of agro-ecosystem with apple-crops intercropping as the dominant cropping model in Loess Plateau, the individual factor and comprehensive environmental quality were assessed by multilevel fuzzy synthetic evaluation model, analytical hierarchy process(AHP), and improved standard weight deciding method. The results showed that the quality of soil, water and agricultural products was grade I, the social economical environmental quality was grade II, the ecological environmental quality was grade III, and the comprehensive environmental quality was grade I. The regional agro-ecosystem dominated by apple-crops intercropping was not the best model for the ecological benefits, but had the better social economical benefits.

Agriculture↗
PubMed2000

Making a difference: the social ecology of social transformation.

A multidisciplinary and multilevel framework for social transformation is proposed, encompassing four foundational goals: capacity-building, group empowerment, relational community-building, and culture-challenge. Intervention approaches related to each goal are presented at the setting, geographic community, and societal levels. Four exemplars of social transformation work are then discussed: the Accelerated Schools Project, Meyerhoff Program, ManKind Project, and women's movement. These examples illustrate the synergistic relationship among the four transformational goals, within and across levels of analysis, which is at the heart of the social transformation process. The paper concludes with three challenges to guide our efforts as we enter the new century: (1) to move social transformation to the center of our consciousness as a field; (2) to articulate jointly with allied disciplines, organizations, and citizen groups an encompassing, multidisciplinary, and multilevel framework for social transformation; and (3) to do the above with heart, soul, and humility.

Culture↗