Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “multilevel analysis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,207 records · Page 67Linked to original sources
PubMed2003

Emotion regulation in customer service roles: testing a model of emotional labor.

The study used a time-sampling method to test aspects of A. Grandey's (2000) emotion regulation model of emotional labor. Eighteen customer service employees from a call center recorded data on pocket computers every 2 hr at work for 2 weeks. Participants completed ratings of emotion regulation, events, expressed and felt emotions, well-being, and performance on 537 occasions and completed questionnaires containing individual and organizational measures. Multilevel analyses supported many aspects of the model but indicated that it has to be implemented precisely in terms of regulating emotion for organizational goals. Results also showed that deep and surface acting had different consequences for employees. Overall, the study found that emotion regulation is a viable platform for understanding emotional labor.

Adaptation, Psychological↗
PubMed1999

Neighbourhood differences in diet: the Atherosclerosis Risk in Communities (ARIC) Study.

STUDY OBJECTIVE: To investigate whether neighbourhood characteristics are related to dietary patterns independently of individual level variables. DESIGN: A cross sectional analysis of the relation between neighbourhood median household income and food and nutrient intakes, before and after adjustment for individual level variables. SETTING: Four United States communities (Washington Co, MD; Suburban Minneapolis, MN; Forsyth Co, NC, and Jackson, MS). PARTICIPANTS: 13,095 adults aged 45 to 64 years participating in the baseline examination of the Atherosclerosis Risk in Communities (ARIC) Study, a prospective study of atherosclerosis. MEASUREMENTS AND MAIN RESULTS: Information on diet and individual level income was obtained from the baseline examination of the ARIC Study. Diet was assessed using a semi-quantitative food frequency questionnaire. Information on neighbourhood (census defined block groups) median household income was obtained from the 1990 US Census. Multilevel models were used to account for the multilevel structure of the data. Living in lower income neighbourhoods was generally associated with decreased energy adjusted intake of fruits, vegetables, fish, and increased intake of meat. Patterns generally persisted after adjustment for individual level income, but were often not statistically significant. Inconsistent associations were recorded for the intake of saturated fat, polyunsaturated fat, and cholesterol. Overall, individual level income was a more consistent predictor of diet than neighbourhood income. CONCLUSION: Despite limitations in the definition and characterisation of neighbourhoods, this study found consistent (albeit small) differences across neighbourhoods in food intake, suggesting that more in depth research into potential neighbourhood level determinants of diet is warranted.

Arteriosclerosis↗
PubMed2006

Power, control, and intimate partner sexual violence in Haiti.

This study sought to determine how power and control in intimate relationships influenced women's exposure to sexual violence. Multilevel modeling was used to determine the risk of partner sexual violence in the past 12 months among 2240 women aged 15-49 years who were currently married or cohabiting. The data were drawn from the 2000 Haiti Demographic and Health Survey. Strong positive effects on intimate partner sexual violence were found for husband's jealousy and perpetration of controlling behavior and women's endorsement of traditional norms concerning a husband's rights to beat his wife. Female dominance in decision making about purchases for daily household needs was positively associated with intimate partner sexual violence but its effects were mediated by relationship quality. The effect of wife's education on intimate partner violence was nonlinear. The analysis also showed that high community female headship rates were independently associated with higher risks of partner sexual violence. The findings highlight the importance of adopting a multidimensional approach to the measurement of power in sexual relationships and the need for programs to work at multiple levels to address gender-based norms and the structural factors that put women at increased risk of sexual violence.

Adolescent↗
PubMed2005

Dyadic adjustment in chronic illness: does relationship talk matter?

Relationship talk involves talking about the nature and state of one's relationship. To determine the effectiveness of talking about the relationship when one spouse has a chronic illness, the study involved completion of a confidential questionnaire by 182 married couples. Ninety of these were couples in which both partners were healthy, and 92 were couples in which one spouse had a chronic illness. Results of multilevel modeling analyses showed that the association between relationship talk and dyadic adjustment was stronger for women than for men and for couples with an ill spouse than for couples where both spouses were healthy. These findings highlight the importance of taking a relationship perspective and suggest that relationship talk is a potentially useful tool couples can use in their repertoire of relationship-enhancing behaviors during chronic illness.

Adaptation, Psychological↗
PubMedDate not supplied

Ethnicity and the theory of planned behavior in the exercise domain.

OBJECTIVE: To examine the moderating influence of ethnicity on the theory of planned behavior (TPB) in the exercise domain and to generate common and ethnic-specific underlying accessible beliefs. METHODS: 90 Caucasian and 94 African American undergraduate students completed a TPB questionnaire. RESULTS: Multilevel modeling analyses indicated that ethnicity and gender interacted by moderating the relationships between exercise intention and effective (beta = -0.44) and instrumental (betaeta = 0.39) attitudes. Furthermore, common and ethnic-specific underlying accessible beliefs were identified. CONCLUSION: When exercise interventions are developed, ethnicity and gender may need to be considered when dealing with affective and instrumental attitudes.

Adolescent↗
PubMedDate not supplied

Conservative management of tuberculous spondylitis in a developing country.

BACKGROUND: Tuberculous spondylitis is a significant health burden in the Third world. Tuberculosis and its complications are on the increase because of the HIV/AIDS challenge. The aim of this study was to review the patients managed for tuberculous spondylitis at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. METHODS: This was a retrospective study of patients seen at the University of Port Harcourt Teaching Hospital between January 1999 and December 2002 with tuberculosis of the spine. Patients case notes were reviewed after collating out-and-in-patient records. Analysis was done using multiway frequency tables. RESULTS: There were 16 males and 18 females, with a ratio of 1:1.1. Their ages ranged from 3.3 to 82 years with an average of 31.1. Peak ages of occurrence were the 3rd and 4th decades. Eighteen patients (52.9%) presented within the first 6 months of symptoms. The most frequent presenting symptoms were back pain, weight loss, difficulty with walking, low grade fever, and night sweats. The most frequent signs were gibbus and lower limb paralysis. The most common association was pulmonary tuberculous (32.4%). The thoracic spine was mostly affected, followed by the lumbar spine. Wedge collapse of the vertebrae was the common radiological finding. Twenty two patients had multilevel affection. Twenty patients (71%) had a lymphocyte differential of more than 45%, 87% had erythrocyte sedimentation rate of over 20 mm/hr. Westergren, and Mantoux test was positive in 55 percent of the patients. Twelve patients had outpatient treatment and 22 had in-patient treatment. Duration of hospital stay ranged from 7 to 157 days with an average of 62.6 days. All the patients had standard combination antituberculosis therapy. No patient had surgery for tuberculous spondylitis. Outcome of treatment was good (68.2%). Follow up was poor with a high default rate. There were 3 mortalities (8.8%). CONCLUSION: Diagnostic delays partly due to lack of experience makes a high index of suspicion necessary to make a diagnosis. Outcome utilizing conservative methods of treatment is good.

Adolescent↗
PubMed2001

The impact of diabetes on arterial reconstructions for multilevel arterial occlusive disease.

PURPOSE: Critical limb ischemia due to multilevel arterial occlusive disease often may be treated with an inflow procedure alone; however, a subset patients require a subsequent infrainguinal revascularization for persistence of their symptoms. As diabetic patients typically exhibit a pattern of extensive distal arterial disease, we sought to determine if the presence of diabetes mellitus altered the need for an outflow procedure after inflow bypass. METHODS: A total of 504 patients undergoing inflow bypass for occlusive disease and lower extremity ischemia between 1990 and 1998 were entered prospectively into a computerized vascular registry. Inflow bypass procedures performed were as follows: aortofemoral (370; 73%), axillofemoral (56; 11%), femorofemoral (81; 16%). Of these patients, 79 required subsequent outflow bypass for unresolved ischemic symptoms. Multiple logistic regression analysis was used to analyze the effects of diabetes and multiple other risk factors on the need for an additional outflow procedure. RESULTS: The indications for surgery were limb salvage (78%) and disabling claudication (22%). Overall morbidity was 17.7% (hematoma, 3.8%; wound infection, 2.5%; graft occlusion, 1.3%; myocardial infarction, 2.5%; acute renal failure,1.3%; pulmonary failure, 2.5%; pneumonia, 3.8%). Overall mortality was 0%. Diabetic patients comprised a greater proportion of the total number of patients requiring inflow bypass (301 of 504) as well as a greater proportion of patients requiring inflow and outflow procedures (47 of 79). Diabetes was determined not to be an independent risk factor for the need for multiple revascularization procedures by multiple logistic regression analysis (P >0.10). CONCLUSION: Although patients with diabetes are predisposed to the development of distal arterial occlusive disease, in this study the subgroup of diabetic patients who present with aortoiliac occlusive disease were no more likely than patients without diabetes to require multiple levels of revascularization. These findings provide little rationale for simultaneous inflow and outflow procedures based on the presence of diabetes alone.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Rethinking social work service delivery.

Providence Centre is a 577-bed, multilevel, geriatric health facility located in Scarborough, Ontario. This article outlines the transition from a traditional model of social work service delivery to a specialized case referral system. It describes the review process, creation of the alternative service model, implementation strategies, evaluation measures and outcomes of the undertaking. Through these efforts, the centre succeeded in creatively redefining and restructuring its social work service delivery and resource utilization in today's tough economic climate.

Aged↗
PubMed2004

Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study.

The Baltimore Memory Study is a cohort study of the multilevel determinants of cognitive decline in 50-70-year-old randomly selected residents of specific city neighborhoods. Prior studies have demonstrated that cognitive function differs by race/ethnicity, with lower scores in minorities than in whites, but the underlying basis for these differences is not understood. Studies have differed in the rigor with which they evaluated and controlled for such important confounding variables as socioeconomic status (SES), health-related behaviors, comorbid illnesses, and factors in the physical environment. The goal of this study was to describe differences in neurobehavioral test scores by race/ethnicity, before and after control for a four-dimensional measure of SES and health-related behaviors and health conditions, in a cross-sectional analysis of first visit data. Random samples of households in the study area were selected until enrollment goals were reached. Among the 2,351 persons on whom eligibility was determined, 60.8% were scheduled for an enrollment visit; of these, 1,140 (81.3%) were enrolled and tested. These study participants were 34.3% male and 65.7% female and were from 65 Baltimore, Maryland, neighborhoods. After adjustment for age, sex, and testing technician, there were large and statistically significant differences in neurobehavioral test scores by race/ethnicity, with African-American scores lower than those for whites, for both men and women. After adjustment for individual SES (educational status, household income, household assets, and occupational status), the average difference declined by 25.8%. After additional adjustment for SES, health-related behaviors and health conditions, and blood lead, the average difference declined another 10%, but large differences persisted; African Americans had test scores that averaged 0.43 standard deviation lower than those for whites across all neurobehavioral tests. These differences were present in all cognitive domains, including tests that would not be characterized as susceptible to differential item functioning by race/ethnicity, suggesting that the results are not due to race/ethnicity-associated measurement error.

Black or African American↗
PubMed2002

Predicting small area health-related behaviour: a comparison of multilevel synthetic estimation and local survey data.

A recent paper in Social Science and Medicine (Twigg et al. 50 (2000) 1109) outlined an approach to the estimation of prevalences of small-area health-related behaviour using multilevel models. This paper compares results from the application of the multilevel approach with those derived using the more traditional strategy of the local 'lifestyle' survey. Estimations of smoking prevalence and high alcohol consumption are examined and critical assessments made of both estimation approaches. It is concluded that the alternative method is more suited towards the prediction of smoking rates as opposed to unsafe alcohol consumption.

Alcohol Drinking↗
PubMed2007

Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy.

This study evaluated the effects of multilevel botulinum toxin type A (BTX-A) treatments on the gait pattern of children with spastic cerebral palsy (Gross Motor Function Classification System Levels I-III). In this nested case-control design, 30 children (mean age 6y 11mo [SD 1y 5mo]; 21 males, nine females; 19 with hemiplegia, 11 with diplegia) were treated according to best practice guidelines in paediatric orthopaedics, including BTX-A injections. A matched control group of 30 children (mean age 7y 8mo [SD 1y 10mo]; 13 males, 17 females; 19 with hemiplegia, 11 with diplegia) were treated identically, but without BTX-A. Motor development status at 5 to 10 years of age was assessed by means of three-dimensional gait analysis at a mean time of 1 year 10 months (SD 10mo) after the last BTX-A treatment. The control group showed a significantly more pronounced pathological gait pattern than the BTX-A group. Major differences were found for pelvic anterior tilt, maximum hip and knee extension, and internal hip rotation. These results provide evidence for a prolonged effect of BTX-A and suggest that BTX-A injections, in combination with common conservative treatment options, result in a gait pattern that is less defined by secondary problems (e.g. bony deformities) at 5 to 10 years of age, minimizing the need for complex surgery at a later age and enhancing quality of life.

Botulinum Toxins, Type A↗
PubMed2006

Associations between xerostomia and health status indicators in the elderly.

AIMS: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. METHOD: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant's residence. RESULTS: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Self-reported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. CONCLUSION: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.

Aged↗
PubMedDate not supplied

Longitudinal changes in isokinetic leg strength in 10-14-year-olds.

This study used multilevel regression modelling to longitudinally investigate the influences of age, sex, body size, skinfold thicknesses and maturity on the development of isokinetic knee extension and flexion on eight occasions over a 4-year period. Forty-one subjects (20 boys and 21 girls) were measured and 295 isokinetic leg strength tests and associated measures were successfully completed. Subjects were aged 10.0 +/- 0.3 years at the onset of the study. Stature, body mass, triceps and subscapular skinfold thicknesses, and sexual maturation (according to pubic hair development) were assessed at each test occasion. Isokinetic concentric knee extension and flexion of the dominant leg were determined to elicit maximal peak extension (PET) and flexion torque (PFT). Statistical significance was accepted at p < 0.05. Multilevel regression modelling indicated that stature and mass were significant predictors of both PET and PFT. Age and maturity were non-significant explanatory variables once stature and mass had been accounted for. Skinfold thickness exerted a significant negative effect independent of mass and stature on PFT but not PET. At test occasion 8, cross-sectional areas (CSAs) of the knee extensors (ExCSA) and flexors (FlexCSA) were determined using magnetic resonance imaging on 23 boys and 14 girls and examined as predictors of isokinetic leg strength. There were no significant sex-related differences in PET or PFT. Pearson product moment correlation coefficients indicated a significant relationship between ExCSA and PET and FlexCSA and PFT for both boys and girls. Analysis of covariance (ANCOVA) demonstrated that ExCSA and FlexCSA were significant explanatory variables for PET and PFT, respectively, but became non-significant once stature and mass had been introduced into the analysis. To conclude, there were no significant sex differences in PET or PFT between the ages of 10 and 14 years and the development of PET and PFT could be accounted for by the increase in stature and mass. Age, maturity and thigh muscle CSA were all non-explanatory variables in the production of PET and PFT once body size had been controlled for.

Adolescent↗
PubMed2005

Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy.

OBJECT: The authors conducted a study to investigate the long-term results and postoperative complications of a new surgical technique, fibular strut graft-assisted anterior corpectomy and fusion for multilevel (> four) cervical myelopathy. Multilevel anterior corpectomy and subsequent strut graft placement is considered a challenging procedure because of complications relating to graft dislodgment, pseudarthrosis, greater operative duration, and increased blood loss. METHODS: The study comprised 100 patients with cervical myelopathy who underwent anterior corpectomy and fusion and fibular strut graft placement at more than four disc space levels between 1989 and 1998. Single-screw fixation was used in conjunction with the autologous strut graft. Preoperative and postoperative plain radiographs, computerized tomography myelograms, and magnetic resonance images were obtained for assessment of fusion status. All complications and outcomes were analyzed based on clinical records to evaluate the results of the technique. There were no cases of graft dislodgment. The graft union rate was 85%. Analysis of clinical data showed that pseudarthrosis had no adverse effect on the clinical results. Adjacent-level disc degeneration occurred in 12% of patients, but in all cases the patients were asymptomatic. In 9% of cases C-5 palsy was observed but it recovered spontaneously. There were no infections and no case of neurological deterioration. CONCLUSIONS: With this new graft technique, graft dislodgment, the major complication associated with strut graft surgery, was resolved completely. This simple technique involving single-screw fixation provided good results when used in conjunction with anterior decompression and strut graft fixation with a very low incidence of complications.

Aged↗
PubMed2004

Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM.

INTRODUCTION: The present study was designed to develop a dedicated oesophagogastric model for the prediction of risk-adjusted postoperative mortality in upper gastrointestinal surgery (O-POSSUM). METHODS: Using 1042 patients undergoing oesophageal (n = 538) or gastric (n = 504) surgery between 1994 and 2000 the Portsmouth predictor equation for mortality (P-POSSUM) scoring system was compared with a standard logistic regression O-POSSUM model and a multilevel O-POSSUM model using the following independent factors: age, physiological status, mode of surgery, type of surgery and histological stage. RESULTS: The overall mortality rate was 12.0 per cent (elective mortality rate 9.4 per cent and emergency mortality rate 26.9 per cent). P-POSSUM overpredicted mortality (14.5 per cent), particularly in the elective group of patients. The multilevel model offered higher discrimination than the single-level O-POSSUM and P-POSSUM models (area under receiver-operator characteristic curve 79.7 versus 74.6 and 74.3 per cent). When observed to expected outcomes were evaluated, the multilevel O-POSSUM model was found to offer better calibration (Hosmer-Lemeshow chi(2) statistic 10.15 versus 10.52 and 28.80). CONCLUSION: The multilevel O-POSSUM model provided an accurate risk-adjusted prediction of death from oesophageal and gastric surgery for individual patients. In conjunction with a multidisciplinary approach to patient management, the model may be used in everyday practice for perioperative counselling of patients and their carers.

Adult↗
PubMed1994

The process of faculty-mentored student research in family medicine: motives and lessons.

BACKGROUND AND OBJECTIVES: Research suggests that the strongest predictor of postgraduate research activity is medical student research involvement. Yet many medical students still regard family medicine as a "nonresearch" specialty. The purposes of this study were to discover what motivated a group of first-year medical students (and their faculty mentors) to participate in a summer research assistantship and how both groups evaluated the challenges and satisfactions of the experience. METHODS: The study used a grounded theory qualitative methodology that emphasizes an in-depth, inductive approach to evaluation research. Over a 2-year period, 11 first-year medical students who participated in a summer research assistantship and their 10 faculty mentors completed written questionnaires and were interviewed by our research team. Various categories of analysis were constructed and refined over the course of the study to explain the raw data collected through interviews, written questionnaires, and field notes. RESULTS: Findings included identification of a core theme or meaning that motivated participation in the project for students and faculty. This theme was expressed in terms of professional, personal, relational, and societal goals. The study also identified three interrelated mechanisms (socialization, relationship, and technical skill transmission) used in varying degrees by students and faculty to achieve these goals. CONCLUSION: In addition to technical mastery and knowledge, students were actively seeking professional relationships with faculty mentors, greater understanding of other peoples and cultures, and increased self-understanding and self-esteem. Junior and senior faculty reflected differing and multilevel motivations for participating in a research assistantship program.

Adult↗
PubMed1996

Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis.

STUDY DESIGN: Back muscle injury after posterior lumbar surgery was studied by muscle histology and serum creatine phosphokinase MM isoenzyme activity. OBJECTIVES: To investigate intraoperative factors influencing the magnitude of back muscle injury after posterior lumbar surgery. SUMMARY OF BACKGROUND DATA: The authors previously have reported iatrogenic back muscle injury in an animal model and in humans. Serious injury of the back muscle has been shown by short-term and long-term follow-up evaluation. METHODS: The retraction pressure was monitored, and the retraction pressure-time products were calculated in 24 patients. Early histologic changes of multifidus muscle, which were taken at completion of surgery, and serum creatine phosphokinase MM isoenzyme activity changes were examined. RESULTS: The magnitude of back muscle injury was significant as the pressure-time product increased. Creatine phosphokinase MM isoenzyme activity increased after surgery and reached a plateau 1 day after surgery, followed by recovery to the normal value 1 week after surgery. Creatine phosphokinase MM isoenzyme activity tended to be high in cases with multilevel exposure and with high pressure-time product. CONCLUSIONS: Back muscle injury occurs in all patients who underwent posterior lumbar surgery, and these injuries are related to the retraction pressure, time, and extent of exposure.

Adult↗
PubMed2005

Cardiovascular reactivity during dyadic social interaction: the roles of gender and dominance.

The present study examined relationships among gender, trait dominance, and cardiovascular reactivity assessed during dyadic social interactions between same-gender and same-ethnicity participants. One-hundred sixty dyads, 76 comprised of African American participants and 84 comprised of European American participants, engaged in three 4-min discussions while their heart rate and blood pressure responses were assessed. All dyads were composed of unacquainted partners. Multilevel modeling for dyadic data revealed that trait dominance was significantly and positively associated with blood pressure reactivity during the discussions, but only among men who interacted with a highly dominant partner. The results of the present study add to the weight of the evidence identifying dominance as a social domain of significance for cardiovascular functioning, particularly among men. Potential reasons for gender-specific patterning are considered.

Adolescent↗