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PubMed2005

Associations between the developmental trajectories of visual scanning and disengagement of attention in infants.

The relation between the developmental trajectories of visual scanning and disengagement of attention and gaze were examined throughout early infancy. A sample of 10 infants carried out a scanning and a disengagement task with the same visual stimuli six times between 6 and 26 weeks of age. Frequency and latency measures were analyzed using multivariate multilevel models and Monte Carlo analyses. The results suggest that the ability to scan a face or an abstract stimulus evolves slightly earlier than the ability to shift gaze to a newly appeared target in the periphery. This is consistent with the account that the parvocellular stream becomes functional slightly before the magnocellular stream. The study revealed no indications of a positive association between the development of scanning and disengagement on the level of the individual infant. Scanning and disengagement change scores contrasted more with one another than could be expected on the basis of chance. This implies that the magnocellular and the parvocellular stream develop rather independently up to the age of 26 weeks.

Attention↗
PubMed1998

Higher prevalence of mental disorders in socioeconomically deprived urban areas in The Netherlands: community or personal disadvantage?

OBJECTIVE: Major mental disorders occur more frequently in deprived urban areas. This study examines whether this occurs for all mental disorders, including less serious ones. It further assesses whether such a concentration can be explained by the socioeconomic status (SES) of the residents concerned or that a cumulation of problems in deprived areas reinforces their occurrence. DESIGN: Mental disorders were assessed by means of the General Health Questionnaire (GHQ) among 4892 residents. Additional data were obtained on area deprivation, and on individual SES. Multilevel logistic regression models were used to take the hierarchical structure of the data into account, residents being nested in boroughs. SETTING: General population of the city of Amsterdam, the Netherlands. MAIN OUTCOME MEASURE: Prevalence of an increased (> or = 2) score on the GHQ, 12 item version. RESULTS: Mental disorders occur more frequently in deprived areas but this can be explained by the lower SES of the residents concerned. CONCLUSIONS: The cumulation of mental disorders in deprived urban areas is mainly a result of a concentration of low SES people in these areas. Contextual factors of deprived urban areas give hardly any additional risk above that resulting from a low individual SES.

Adolescent↗
PubMed2001

Daily interpersonal experiences, context, and alcohol consumption: crying in your beer and toasting good times.

The authors explored a multidimensional view of drinking, whereby social and solitary drinking represent distinct behaviors associated with positive and negative experiences, respectively. Using daily diary methodology and multilevel analytic strategy, the authors examined, over 30 days, the within-person association of negative and positive experiences and alcohol consumption in different contexts and focused on interpersonal experiences. On days with more negative interpersonal experiences, participants engaged in more solitary drinking (i.e., drinking at home and alone), whereas on days with more positive interpersonal experiences they drank more in social contexts. The authors also demonstrated that individuals high on neuroticism drank more in solitary contexts on days with more negative interpersonal experiences, relative to those with lower neuroticism. These findings lend support to models linking daily drinking motivation and context-dependent drinking behavior.

Adaptation, Psychological↗
PubMed2004

Circadian variation in cardiac autonomic activity: reactivity measurements to different types of stressors.

The role of endogenous circadian rhythmicity in autonomic cardiac reactivity to different stressors was investigated. A constant routine protocol was used with repeated exposure to a dual task and a cold pressor test. The 29 subjects were randomly divided into two groups in order to manipulate prior wakefulness. Group 1 started at 09:00 h immediately after a monitored sleep period, whereas group 2 started 12 h later. Measures of interbeat intervals (IBI), respiratory sinus arrythmia (RSA, a measure of parasympathetic activity), pre-ejection period (PEP, a measure of sympathetic activity), as well as core body temperature (CBT) were recorded continuously. Multilevel regression analyses (across-subjects) revealed significant (mainly 24 h) sinusoidal circadian variation in the response to both stressors for IBI and RSA, but not for PEP. Individual 24 + 12 h cosine fits demonstrated a relatively large interindividual variation of the phases of the IBI and RSA rhythms, as compared to that of the CBT rhythm. Sinusoidal by group interactions were found for IBI and PEP, but not for RSA. These findings were interpreted as an indication for endogenous circadian and exogenous parasympathetic (vagal) modulation of cardiac reactivity, while sympathetic reactivity is relatively unaffected by the endogenous circadian drive and mainly influenced by exogenous factors.

Adolescent↗
PubMed2006

Country material distribution and adolescents' perceived health: multilevel study of adolescents in 27 countries.

OBJECTIVE: To assess the impact of country material distribution on adolescents' perceptions of health. DESIGN: Cross sectional multilevel study. SETTING: Data were collected from the school based health behaviour in school aged children: WHO cross national study 1997/98, which includes students from 27 European and North American countries. PARTICIPANTS: 12 0381 students in year 6, 8, and 10 who were attending school classes on the day of data collection. MAIN RESULT: Adolescents in countries with a high dispersion of family affluence were more likely to have self rated poor health even after controlling for individual family level of affluence and family social resources. CONCLUSION: There are substantial inequalities in subjective health across European and North American countries related to the distribution of family material resources in these countries.

Adolescent↗
PubMed2005

A dynamic multilevel model of demographic diversity and misfit effects.

In this study, the authors proposed and evaluated the linkages of a dynamic multilevel model of demographic diversity and misfit effects in a large sample of quick-service restaurants. Using a cross-level approach, the authors studied an employee's demographic misfit in relation to coworkers' demographics as a predictor of turnover risk over time. At the business-unit level, they studied changes in restaurant demographic diversity in relation to changes in profitability over time and unit turnover rates in relation to profitability. The authors also studied the impact of the match between the racial compositions of the restaurants and their communities on profitability. The results supported linkages between demographic misfit and turnover and partially supported a negative association between racial diversity and changes in profitability.

Adolescent↗
PubMed2000

Use of the surgical blood order equation in spinal instrumentation and fusion surgery.

STUDY DESIGN: A retrospective review of 182 cases of adult spine instrumentation and fusion surgery (1994-1995) from one institution. OBJECTIVES: To develop and retrospectively evaluate the use of the surgical blood ordering equation for patients undergoing spinal instrumentation and fusion surgery. SUMMARY OF BACKGROUND DATA: The provision of effective and safe blood and blood products is the primary function of the hospital transfusion service. A quantification of blood bank efficiency is the crossmatch-to-transfusion ratio. The maximal surgical blood order schedule system has been used to improve the efficiency of surgical ordering practices. The current authors have developed a theoretically more efficient system, the surgical blood ordering equation, which incorporates patient factors for ordering red blood cell units for surgical patients. METHODS: The charts of 63 patients with autologous red blood cells available and 119 adult patients with none available, who underwent multilevel spine surgery from January 1994 to July 1995, were reviewed. RESULTS: The surgical blood ordering equation was exactly correct in the ordering for 37 (20.3%) of 182 patients. The maximal surgical blood order schedule was exactly correct in ordering blood for 14 patients (7.6%). Use of the new surgical blood ordering equation to order red blood cells for surgery would result in a lower crossmatch-to-transfusion ratio than with the current system, the maximal surgical blood order schedule, for patients with autologous red blood cells available (1. 0 vs. 1.3) and patients with none available (0.9 vs. 1.2). CONCLUSION: Incorporating patient factors resulted in increased efficiency of blood ordering practices.

Adult↗
PubMed2000

Positive and negative daily events, perceived stress, and alcohol use: a diary study.

Using daily diary methodology, the authors examined over 60 days the within-person associations among positive and negative daily experiences, perceptions of stress, desire to drink, and alcohol consumption in a sample of 83 regular drinkers. Multilevel regression analyses indicated that days on which individuals reported more positive and negative nonwork events were also days they reported higher levels of desire to drink and actual consumption. Days on which individuals reported more negative work events were also days they reported a greater desire to drink, and days on which individuals reported more positive and negative health events were also days they reported lower levels of desire to drink and actual consumption. Weak evidence was found for the mediating effects of perceived stress in these associations. Several of the within-person associations varied as a function of gender, neuroticism, and drinking to cope; no moderating effects were found for extraversion.

Adult↗
PubMed2005

Subtle fluctuations in psychotic phenomena as functional states of abnormal dopamine reactivity in individuals at risk.

BACKGROUND: Subjects at increased risk for psychosis experience continuous variation in the intensity of subtle psychotic experiences in response to minor stressors. It was investigated whether this psychotic reactivity in individuals at risk for psychosis is the exophenotypic expression of an underlying endophenotype characterized by a hyperreactive dopamine (DA) system. METHODS: First-degree relatives (n = 47) and control subjects (n = 49) were studied with the Experience Sampling Method (ESM), a structured diary technique assessing current context and psychopathology in daily life, to assess psychotic experiences in response to stress. A metabolic perturbation paradigm (administration of 2-deoxy-D-glucose inducing a mild state of glucoprivation) causing plasma elevation of homovanillic acid (HVA) was used as a proxy of DA reactivity. RESULTS: Multilevel regression analyses revealed that the interaction between HVA reactivity and daily stress in their effect on psychotic experiences differed according to underlying vulnerability. In the first-degree relatives, underlying HVA reactivity modified the psychotic experiences to daily stress, whereas no such effect was found in control subjects. CONCLUSIONS: These results suggest that psychotic experiences in response to minor stresses in the flow of daily life may be functional states of an underlying abnormal DA reactivity in subjects at risk to develop psychosis. The results add credence to the suggestion that abnormal DA reactivity may be part of the substrate that increases risk for psychotic symptoms in individuals at risk.

Adult↗
PubMed2000

Longitudinal changes in 11-13-year-olds' physical activity.

UNLABELLED: The influence of age, sex, maturity, body mass and body fatness on the physical activity (PA) of 11-13-y-olds was examined longitudinally. Body mass, triceps and subscapular skinfold thickness and pubic hair were recorded and 3-d continuous heart rate (HR) monitoring was used to estimate PA on each annual measurement occasion. At the onset, subjects were 11.0 (0.4)-y-old and data were available on 202, 143 and 160 subjects in years 1 to 3, respectively with an almost equal sex distribution. Multilevel regression modelling examined age-, sex- and maturity-related changes in time spent with HR above 139 (moderate activity) and 159 (vigorous activity) bpm. Sustained (10 or 20 min) periods of moderate or vigorous activity were not characteristic of PA patterns. Both PA measures declined with age, with a consistent sex difference reflecting the lower PA levels of girls. Body mass and fatness were not significant explanatory variables, but an additional decrement in activity was evident in late maturity. CONCLUSION: Few children experience extended bouts of PA, and from 11-13 y, PA decreases, with more girls than boys becoming inactive. The data emphasize the importance of promoting active lifestyles during youth.

Adolescent↗
PubMed2004

Community-based prevention of marital dysfunction: multilevel modeling of a randomized effectiveness study.

This study is a cluster randomized controlled trial of the Prevention and Relationship Enhancement Program (PREP; H. J. Markman, S. M. Stanley, & S. L. Blumberg, 2001). Fifty-seven religious organizations (ROs), consisting of 217 newlywed couples, were randomly assigned to 1 of 3 intervention conditions: PREP delivered by university clinicians (U-PREP), PREP delivered by RO clergy (ROPREP), and naturally occurring (NO) marriage preparation. Self-reported relationship satisfaction, negative behavior, and positive behavior were assessed at preintervention, postintervention, and 1-year follow-up. Trajectories of relationship satisfaction showed no change over time and did not differ across conditions. Trajectories of negative behavior for RO-PREP wives showed significantly greater linear declines in comparison with NO trajectories. Trajectories of positive behavior for NO and U-PREP partners showed significant declines compared with RO-PREP trajectories. Effectiveness, transportability, and dissemination of marital distress prevention programs in community settings are discussed.

Adult↗
PubMed2005

Discriminating patients with frontal-lobe epilepsy and temporal-lobe epilepsy: utility of a multilevel design fluency test.

Patients with frontal-lobe epilepsy (FLE) or temporal-lobe epilepsy (TLE) and matched control participants were given a design fluency test that assessed nonverbal fluency and switching ability. Patients with FLE generated fewer designs in the switching condition relative to the TLE patients and controls, whereas group differences did not emerge in the basic fluency conditions. When the side of the seizure focus and the presence or absence of a structural lesion were considered in patients with FLE, only those with left-lesional FLE generated fewer designs than controls did in the switching condition. Furthermore, patients with left-lesional and nonlesional FLE produced a greater proportion of set-loss errors than did controls. These results indicate that patients with FLE are impaired when they must simultaneously generate new designs and engage in cognitive switching; however, the pattern of impairment may depend on the side of the seizure focus and the presence of a structural lesion.

Adult↗
PubMed2004

[Multiple-level instrumented anterior cervical fusion: a risk factor for pseudoarthrosis? A prospective study with a minimum of 3-year follow-up].

PURPOSE OF THE STUDY: This prospective study with minimal 3-year follow-up was performed to compare fusion rates, course of fusion, collapse incidence and occurrence of subsidence in one- and two-level instrumented anterior cervical fusions (ACDF) and thus to proof the hypothesis that use of internal fixation decreases the risk of non-union in bi-segmental ACDFs to the same level that can be expected in mono-segmental procedure. MATERIAL: In 79 consecutive patients operated upon by the Smith-Robinson technique for degenerative process of cervical spine in one or two levels was applied single instrumentation system in order to ensure ideal condition for solid bone fusion of 113 grafts (45 in one and 68 in two levels). All the patients were invariably followed for a minimum of 3 years. METHODS: Radiological criteria were used for evaluation of intervertebral fusion, graft collapse and its subsidence and results were statistically analyzed using M-L Chi-square test for the comparison of fusion and collapse incidence and further Chi-square test for the analysis of fusion course. All these figures were calculated at the level of significance 0.05 (alpha=0.05). RESULTS: Overall, no significant difference was observed in achieving solid bone fusion 3 years after the surgery in one- and two-level procedures (95.6% vers. 92.6%, p=0.522), neither the bone graft collapse rate was of significant difference (2.2% vers. 7.6%, p=0.208). In single-level group the time to bone fusion was significantly shorter (p<0.001). When pooling the data into autologous and allogenic graft subgroup, there was observed no statistically significant difference in achieving union in autologous subgroup (100% vers. 90.9%, p=0.142); in allogenic subgroup this situation was similar: no significant difference in fusion rate (93.3% vers. 93.5%, p=0.980) was observed. In both auto- and allogenic subgroups monosegmentally implanted grafts fused more readily (p<0.001). There was no case of graft subsidence in any investigated group. DISCUSSION: Our prospective study did not find any statistically significant difference in graft collapse and fusion rate when comparing one- and two-level instrumented ACDFs 3 years after the surgery. Plating system used in our patients brings more stability to operated segments and thus presumably prevents micromotions in postoperative period. Micromovements seems to be the major risk factor for non-union in non-instrumented multilevel cervical fusion. Other risk factor that should be considered in non-instrumented procedure is increase in compressive forces that are also partially eliminated by the semirigid internal fixation. Significantly delayed time to union observed in two level fusions shows most probably on increased number of surfaces that must be consolidated during the bone-healing process. CONCLUSION: This study demonstrates that internal fixation used in multilevel ACDF decreases risk of pseudoarthrosis to the same level that can be expected in monosegmental procedures.

Adult↗
PubMed2006

Longitudinal analysis of haplotypes and polymorphisms of the APOA5 and APOC3 genes associated with variation in serum triglyceride levels: the Bogalusa Heart Study.

Polymorphisms in the APOC3 and APOA5 genes, from the APOA1/APOC3/APOA4/APOA5 gene cluster on chromosome 11q23, have been associated with interindividual variation in plasma triglycerides. APOA5 polymorphisms implicated include 2 in the promoter region (-1131 T/C and -3 A/G) and 1 in exon 2 (+56 C/G). APOC3 polymorphisms implicated include 1 (SstI) in the 3' untranslated region and 1 (-2854 G/T) in the APOC3-APOA4 intergenic region. We analyzed the associations of haplotypes and multilocus genotypes of these polymorphisms on longitudinal serum triglyceride profiles in 360 African American and 823 white subjects from the Bogalusa Heart Study. Subjects were examined from 2 to 8 times (mean +/- SD, 5.4 +/- 1.3) between 1973 and 1996, at ages ranging from 4 to 38 years, with 1978 observations in African Americans and 4465 in whites. Serum triglycerides were significantly higher among whites across all ages. Allele frequencies differed significantly between African Americans and whites at all but the APOA5 +56 C/G locus. Linkage disequilibrium among the loci was higher in whites and haplotype diversity lower: 6 haplotypes had estimated frequencies of more than 1% in African Americans, 5 in whites. Individually, all polymorphisms except APOC3 -2854 G/T showed significant associations with triglyceride levels in the full sample. However, genotype models including all 5 loci showed significant triglyceride associations for only 3 (APOC3 SstI, APOA5 -1131 T/C, and APOA5 +56 C/G); significant interactions among them indicated their effects were not independent. Neither APOC3 -2854 G/T nor APOA5 -3 A/G had significant effects when the other 3 loci were in the models. The EM algorithm was used to estimate haplotype frequencies and assign haplotype probabilities to individuals, which is conditional on their genotypes; individuals' haplotype probability vectors were then used as predictors in multilevel mixed models of longitudinal triglyceride profiles. Of haplotypes comprising, in order, APOC3 SstI and -2854 G/T and APOA5 -1131 T/C, -3 A/G, and +56 C/G, 3 were significantly associated with higher triglycerides, even after adjusting for multiple tests: GGTAG (P = .002), GTTAG (P < .0001), and CGCGC (P = .0002). Each GGTAG haplotype carried would be expected to raise triglyceride levels (relative to those of GTTAC homozygotes) by approximately 19 mg/dL, each GTTAG haplotype by approximately 15 mg/dL, and each CGCGC haplotype by approximately 7 mg/dL. Haplotypes comprising the 3 loci implicated by genotype analyses (SstI, -1131 T/C, and +56 C/G) were also tested: haplotypes C_C_C and G_T_G significantly raised triglycerides, even after adjustment for multiple comparisons (P < .002 for both), with each copy of C_C_C expected to raise triglycerides by approximately 7 mg/dL and each copy of G_T_G by approximately 15 mg/dL. Overall, our findings support those of others in associating specific polymorphisms and haplotypes in the APOA1/C3/A4/A5 gene cluster with higher serum triglyceride levels. However, the degree to which polymorphisms in the APOC3 and APOA5 genes may be independently associated with triglyceride levels remains to be determined.

Adolescent↗
PubMed2003

Effect of lymphatic mapping on the new tumor-node-metastasis classification for colorectal cancer.

PURPOSE: Sensitive detection methods and accurate reporting are necessary to determine the prognostic significance of micrometastases (MM) and isolated tumor cells (ITCs) in lymph nodes that drain colorectal cancers (CRCs). This study examined the role of lymphatic mapping (LM) in the application of the new tumor-node-metastasis (TNM) classification for MM and ITC. PATIENTS AND METHODS: All patients at the John Wayne Cancer Institute underwent LM immediately before standard resection of primary CRC between 1996 and 2001. Sentinel nodes (SNs) were identified using blue dye and/or radiotracer and were examined by hematoxylin-eosin (H&E) staining, cytokeratin immunohistochemistry, and multilevel sectioning. The comparison group comprised 370 patients whose primary CRCs were resected without LM during the same period at the same institution. RESULTS: LM was successfully performed in 115 of 120 (96%) patients and correctly predicted the tumor status of the nodal basin in 110 of 115 (96%) patients. Thirty-seven patients (32%) were lymph node-positive by H&E, ITC and MM were found in 23 patients (29.4%) whose lymph nodes were negative by H&E. Tumor deposits were found in the SN only in 29 patients (50%). Nodal involvement was identified for 14.3%, 30%, 74.6%, and 83.3% of T1, T2, T3, and T4 tumors, respectively, in the study group, and for 6.8%, 8.5%, 49.3%, and 41.8% of T1, T2, T3, and T4 tumors, respectively, in the comparison group. The study group had a higher percentage of nodal metastases (53% v 36%; P <.01) and a higher incidence of MM and ITC (29.4% v 1.9%; P <.0001). The mean number of lymph nodes found in the study group (14) was also significantly more than the number found in the comparison group (10; P <.00001). CONCLUSION: Conventional examination of lymph nodes for CRC is inadequate for the detection of MM and ITC as described in the new TNM classification. Thus, LM and focused SN analysis should be considered to fully stage CRC.

Aged↗
PubMed2002

Early results using the Atlantis anterior cervical plate system.

OBJECT: The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease. METHODS: There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material. The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine. Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which required reoperation and intravenous antibiotic medication. Two cases (2.6%) of anterior screw backout and/or breakage were identified. One patient died of unrelated causes within 3 months of operation. CONCLUSIONS: These initial results indicate that use of the Atlantis plate system for anterior cervical arthrodesis produces fusion rates and clinical outcomes that are comparable with those obtained using other locking plating systems. It has the unique advantage, however, of providing the surgeon with the choice of fixed, variable, or hybrid screw constructs as a way of tailoring screw angles to individual anatomical/biomechanical needs.

Adult↗
PubMed2002

Spinal injury patterns resulting from car and motorcycle accidents.

STUDY DESIGN: Retrospective data analysis. OBJECTIVES: To determine spinal injury patterns and clinical outcomes in patients involved in automotive accidents. SUMMARY OF BACKGROUND DATA: The records of 22,858 patients collected prospectively as part of the Trauma Audit Research Network (UK) Database (1993-2000). METHODS: Analysis of the records of 1121 motorcyclists and 2718 car occupants involved in automotive trauma. RESULTS: Spinal injury occurred in 126 (11.2%) motorcyclists and 383 (14.1%) car occupants. Victims were predominantly young (mean ages: motorcycle 30.2 years, car 37.8 years) and male (motorcycle 88.9%, car 60.6%). The mean Injury Severity Scores were 18.8 and 15.1, respectively. Isolated spinal injuries occurred in 30 (23.8%) motorcyclists and 130 (33.9%) car occupants. The thoracic spine was most commonly injured in motorcyclists (54.8%), and the cervical spine was most commonly injured in car occupants (50.7%). Multiple regions were injured in 14 (10.3%) motorcyclists and 33 (8.5%) car occupants. Nine motorcyclists and 43 car occupants required spinal surgery. Median hospital stays were 11.5 days (range 0-235 days) and 10 days (range 0-252 days) in the motorcyclists and car occupants, respectively. There were 13 (10.3%) motorcycle- and 26 (6.8%) car-related deaths. CONCLUSION: Spinal injury patterns may reflect differing mechanisms of injury between the restrained car occupant and unrestrained motorcyclist. The motorcyclists were more severely injured, had more extremity trauma, a higher mortality rate, and a spinal injury pattern consistent with forced hyperflexion of the thoracic spine. The predominance of cervical injuries and higher incidence of neck and facial injuries in car occupants may reflect abdominothoracic seat belt restraint. The high frequency of multilevel injuries reaffirms the need for vigilance in patient assessment.

Accidents, Traffic↗
PubMed2004

Developing the formula for state subsidies for health care in Finland.

AIM: The aim was to generate a research-based proposal for a new subsidy formula for municipal healthcare services in Finland. METHODS: Small-area data on potential need variables, supply of and access to services, and age-, sex- and case-mix-standardised service utilisation per capita were used. Utilisation was regressed in order to identify need variables and the cost weights for the selected need variables were subsequently derived using various multilevel models and structural equation methods. RESULTS: The variables selected for the subsidy formula were as follows: age- and sex-standardised mortality (age under 65 years) and income for outpatient primary health services; age- and sex-standardised mortality (all ages) and index of overcrowded housing for elderly care and long-term inpatient care; index of disability pensions for those aged 15-55 years and migration for specialised non-psychiatric care; and index of living alone and income for psychiatric care. CONCLUSION: Decisions on the amount of state subsidies can be divided into three stages, of which the first two are mainly political and the third is based on the results of this study.

Adolescent↗