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The influence of neighbor relatedness on multilevel selection in the Great Lakes sea rocket.

Natural selection can operate at the individual and group level in natural populations. This study investigates the ecological factors that determine the relative importance of individual versus group selection. In particular, it determines how the relatedness of interacting neighbors influences multilevel natural selection in a population of the Great Lakes sea rocket. Focal plants were grown in groups of siblings, groups of plants that were themselves siblings but unrelated to the focal plants, and groups of plants with mixed genotypes. Significant group selection on plant size was observed only when the neighbors were siblings but not when they were unrelated. In sibling groups, individuals with heavier stems had higher fitness, and individuals growing with heavier but shorter neighbors also had higher fitness. Thus, individual and group selection on stem weight operated in the same direction. The detection of group selection in sibling groups can be attributed in part to an increased opportunity for group selection in these groups since sibling groups differed more from one another than the other group types. In addition, the quality of the selective environment in sibling groups may have differed from that for the other group types. Group selection was therefore more prevalent in the most genetically structured sample, in which responses to group selection are also most likely to occur.

Analysis of Variance↗

Individual income, income inequality, health, and mortality: what are the relationships?

OBJECTIVE: To examine the pathways between income inequality, self-rated health, and mortality in the United States. DATA SOURCE: The first National Health and Nutrition Examination Survey and Epidemiologic Follow-up Study. DESIGN: This was a longitudinal, multilevel study. DATA COLLECTION: Baseline data were collected on county income inequality, individual income, age, sex, self-rated health, level of depressive symptoms, and severity of biomedical morbidity from physical examination. Follow-up data included self-rated health assessed in 1982 through 1984 and mortality through 1987. PRINCIPAL FINDINGS: After adjustment for age and sex, income inequality had a modest independent effect on the level of depressive symptoms, and on baseline and follow-up self-rated health, but no independent effect on biomedical morbidity or subsequent mortality. Individual income had a larger effect on severity of biomedical morbidity, level of depressive symptoms, baseline and follow-up self-rated health, and mortality. CONCLUSION: Income inequality appears to have a small effect on self-rated health but not mortality; the effect is mediated in part by psychological, but not biomedical pathways. Individual income has a much larger effect on all of the health pathways.

Adult↗

Rural/urban differences in the association between deprivation and healthcare utilisation.

Whilst associations between inequalities in healthcare utilisation and socio-economic deprivation are well established in the UK it is argued that deprivation indices, such as the Townsend index, remain insensitive to rural/urban differences. This study examines how Townsend and its components differ in their association with healthcare utilisation across the rural/urban spectrum of a large health region. Our research was carried out in the West Midlands National Health Service region (population 5.3 million), comprising of a similar geographical population diversity to that of the United Kingdom (UK) using Hospital Episode Statistics (1994/5-1998/9) and 1991 census socio-demographic data. Retrospective multilevel multivariate models compare three ward-level healthcare utilisation measures (standardised episode-, admission-, and bed-rates) in relation to the Townsend index of material deprivation, its components, and four rural/urban characteristics (population density, population potential, electoral ward area and perimeter size). The associations between outcomes and Townsend were generally not attenuated by the rural/urban characteristics. The constituent component of car-ownership was similarly unperturbed, whereas population potential significantly perturbed the home-ownership model and overcrowding was significantly perturbed by all four rural/urban characteristics considered. A deprivation index may encapsulate different meanings to that of its components when used to assess variations in healthcare utilisation. Constituent components may yield considerable perturbation in relation to healthcare utilisation across the rural/urban spectrum, whilst the composite measure does not. In particular, and contrary to anecdotal opinion, car-ownership and unemployment (as recorded in the 1991 UK census) exhibited a stable relationship across different rural/urban areas with respect to healthcare utilisation.

Automobiles↗

Comorbidity in patients with diabetes mellitus: impact on medical health care utilization.

BACKGROUND: Comorbidity has been shown to intensify health care utilization and to increase medical care costs for patients with diabetes. However, most studies have been focused on one health care service, mainly hospital care, or limited their analyses to one additional comorbid disease, or the data were based on self-reported questionnaires instead of health care registration data. The purpose of this study is to estimate the effects a broad spectrum of of comorbidities on the type and volume of medical health care utilization of patients with diabetes. METHODS: By linking general practice and hospital based registrations in the Netherlands, data on comorbidity and health care utilization of patients with diabetes (n = 7,499) were obtained. Comorbidity was defined as diabetes-related comorbiiabetes-related comorbidity. Multilevel regression analyses were applied to estimate the effects of comorbidity on health care utilization. RESULTS: Our results show that both diabetes-related and non diabetes-related comorbidity increase the use of medical care substantially in patients with diabetes. Having both diabeterelated and non diabetes-related comorbidity incrases the demand for health care even more. Differences in health care utilization patterns were observed between the comorbidities. CONCLUSION: Non diabetes-related comorbidity increases the health care demand as much as diabetes-related comorbidity. Current single-disease approach of integrated diabetes care should be extended with additional care modules, which must be generic and include multiple diseases in order to meet the complex health care demands of patients with diabetes in the future.

Adult↗

Predictors of blood transfusions in spinal instrumentation and fusion surgery.

STUDY DESIGN: A retrospective review of 244 adult spine instrumentation and fusion surgery cases (1994-1995) from one institution. OBJECTIVES: To ascertain the predictors of blood transfusions for adult patients undergoing different types of multilevel spine surgery. SUMMARY OF BACKGROUND DATA: Blood loss and transfusion requirements during and after multilevel spine surgeries have always been perceived as great. Identifying the predictors of blood transfusion with this type of surgery may aid in reducing the amount of blood loss and the transfusion requirements. METHODS: The charts of 244 adult patients who underwent multilevel spine surgery from January 1994 to July 1995 were retrospectively reviewed. RESULTS: A large percentage of patients required blood transfusion. The significant determinants for increased amounts of allogeneic red blood cell units transfused on the day of surgery using linear multiple regression modeling were low preoperative hemoglobin concentration, tumor surgery, increased number of posterior levels surgically fused, history of pulmonary disease, decreased amount of autologous blood available, and no use of the Jackson table (R2 = 0. 63). The significant determinants for an increased amount of autologous red blood cell units transfused on the day of surgery using linear multiple regression modeling were increased autologous red blood cells available, low preoperative hemoglobin concentration, and increased number of posterior levels surgically fused (R2 = 0. 60). CONCLUSION: The need for transfusion is associated with multiple factors, suggesting that a multifaceted, integrated approach may be necessary to reduce this risk.

Adult↗

Transportability of multisystemic therapy: evidence for multilevel influences.

This study examines factors associated with the implementation and short-term outcomes in dissemination sites of Multisystemic Therapy (MST), an intensive, short-term, family- and community-based treatment for serious antisocial behavior in youth. Participants were 666 children and families served by 217 therapists in 39 sites. Pre- (T1) to immediate posttreatment (T2) differences in child problems and functioning were similar in magnitude to those found in randomized trials of MST. Results of random effects regression supported direct effects of therapist adherence, organizational climate, and structure at baseline on immediate posttreatment child outcomes. However, organizational factors were unrelated to adherence; thus, a hypothesized mediation model in which organizational climate and structure affect outcomes through therapist adherence to MST was not supported. Furthermore, the direction of associations between some organizational climate variables and outcomes countered expectations. Post hoc moderation analyses clarify these findings, with organizational effects differing by level of therapist adherence during treatment. Implications for the transfer of evidence-based psychosocial treatments for youth to usual care practice settings are discussed.

Adolescent↗

Co-operative learning processes of students: a longitudinal multilevel perspective.

BACKGROUND: This article describes the outcomes of a longitudinal, multilevel observational study in which the relationship between the processes of co-operation and giving explanations was compared between classes trained in communication skills and classes that were untrained. AIMS: This study examined the effects of training in basic communication skills on the processes of co-operation and giving explanation in co-operative groups. In particular, the study investigated: (a) How the processes of co-operation and giving explanations develop over time; (b) How the underlying processes of co-operation and giving explanations are related; (c) Which factors at the student and class level facilitate or hinder these processes. SAMPLE: The study involved 192, Year 6 primary school children (mean age = 134.3 months) who worked in four-person, mixed ability, gender-balanced groups on a social studies unit of work for 12 weeks. RESULTS: The students in the trained classes were more co-operative and gave more explanations to each other than their peers in the untrained classes. Giving solicited explanations could be traced back to co-operation and this process was enhanced by ability. In other words, the higher the individual ability levels of the students, the more co-operation was transformed into giving solicited explanations. Furthermore, over and above the effects of student ability, the higher the class' ability level, the more explanations the students gave. CONCLUSION: The results of this study are useful in explaining why high-ability students benefit more from co-operative learning than low-ability students and why solicited explanations are more effective than unsolicited explanations. By opening the black box of co-operative learning, our analysis enables us to attribute the effects of co-operative learning to peer interactions with more able peers and this is promoted by class ability level. These factors have been mentioned in the literature as a possible explanation of 'contextual effects' but not investigated empirically.

Australia↗

Posterior instrumentation of the cervical spine using the neon occipito-cervical system. Part 2: cervical and cervicothoracic instrumentation.

OBJECTIVE: Posterior cervical and cervicothoracic stabilization, if necessary, in combination with posterior spondylodesis, after closed or open reduction as well as with or without neural decompression as clinically indicated. INDICATIONS: Instabilities and deformities of rheumatoid, traumatic, neoplastic, infectious, iatrogenic or congenital origin. Multilevel cervical spinal stenosis with degenerative instability or kyphosis of the affected spinal segment. Corrective spondylodesis for posttraumatic or postinfectious kyphosis. CONTRAINDICATIONS: Infection in the operative field. Inability to undergo anesthesia. SURGICAL TECHNIQUE: Prone position, rigid head fixation, e. g., with Mayfield tongs. If appropriate, closed reduction under lateral image intensification. Midline posterior surgical approach at the level of the segment to be instrumented. If necessary, open reduction. Insertion of the cervical/upper thoracic screws. If necessary, posterior decompression. Instrumentation with prebent longitudinal rods. If a fusion is to be obtained, decortication of the posterior bone elements with a burr and onlay of cancellous bone. RESULTS: 44 patients, 13 women and 31 men, with an average age of 57 years were operated on between August 2000 and August 2003. All patients underwent a follow-up examination 4-39 months (average 15.7 months) after the initial surgery. Fusion was achieved in all patients who had undergone a posterior spondylodesis: no implant failure, no implant removal or reoperation. The preoperatively planned instrumentation could be implemented intraoperatively in all patients.

Bone Screws↗

Computed tomography using algebraic reconstruction techniques (ARTs) with different projection access schemes: a comparison study under practical situations.

In a previous report we presented a novel ART technique with the projections arranged and accessed in a multilevel scheme (MLS) for efficient algebraic image reconstruction, but whether the scheme is still superior in real situations where the data are noisy is unknown. In this paper, we make a detailed comparison between MLS and the other two conventional projection access orderings in ART: the random permutation scheme (RPS) and the sequential access scheme (SAS). By simulating reconstructions of a human head using different sizes of detector, taking different numbers of projections, each measurement under a different number of photons, a full mapping of the reconstruction accuracy measured by correlation coefficient for the three schemes has been made. Test results demonstrate that one-iteration MLS produces the best reconstruction in many situations. It outperforms one-iteration RPS when the noise level is low. SAS in many cases can never attain the image quality of one-iteration MLS, even with many more iterations. A convergence test using different initial guesses also demonstrates that MLS has less initial dependence. In the Fourier domain, it also represents an efficient and fast implementation of the Fourier slice theorem.

Adult↗

Provincial income inequality and self-reported health status in China during 1991-7.

BACKGROUND: The relationship between income inequality and health has been widely explored. Today there is some evidence suggesting that good health is inversely related to income inequality. After the economic reforms initiated in the early 1980s, China experienced one of the fastest-growing income inequalities in the world. The state of China in the 1990s is focussed on and possible effects of provincial income inequality on individual health status are explored. METHODS: A multilevel regression model is used to analyse the data collected in 1991, 1993 and 1997 from nine provinces included in the China Health and Nutrition Survey. The effects of provincial Gini coefficients on self-rated health in each year are evaluated by two logistic regressions estimating the odds ratios of reporting poor or fair health. The patterns of this effect are compared among the survey years and also among different demographic groups. RESULTS: The analyses show an independent effect of income inequality on self-reported health after adjusting for individual and household variables. Furthermore, the effect of income distribution is not attenuated when household income and provincial gross domestic product per capita are included in the model. The results show that there is an increased risk of about 10-15% on average for fair or poor health for people living in provinces with greater income inequalities compared with provinces with modest income inequalities. CONCLUSIONS: In China, societal income inequality appears to be an important determinant of population health during 1991-7.

China↗

Surgery for obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea/hypopnoea syndrome(OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated with loud snoring, disrupted sleep and observed apnoeas. Surgery for obstructive sleep apnoea/hypopnoea syndrome aims to alleviate symptoms of daytime sleepiness, improve quality of life, and reduce the signs of sleep apnoea recorded by polysomnography. OBJECTIVES: The objective of this review was to assess the effects of any type of surgery for the treatment of the symptoms of obstructive sleep apnoea/hypopnoea syndrome in adults. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register and reference lists of articles. We contacted experts in the field, research dissemination bodies and other Cochrane Review Groups. Searches were current as of July 2005. SELECTION CRITERIA: Randomised trials comparing any surgical intervention for obstructive sleep apnoea/hypopnoea syndrome with other surgical or non-surgical interventions or no intervention. DATA COLLECTION AND ANALYSIS: Two reviewers assessed electronic literature search results for possibly relevant studies. Characteristics and data from studies meeting the inclusion criteria were extracted and entered into RevMan 4.2. MAIN RESULTS: In the 2005 update for this review eight studies (412 participants) of mixed quality met the inclusion criteria. Data from seven studies were eligible for assessment in the review. No data could be pooled. Uvulopalatopharyngoplasty (UPPP) versus conservative management (one trial): An un validated symptom score showed intermittent significant differences over a 12-month follow-up period. No differences in Polysomnography (PSG) outcomes were reported. Laser-assisted uvulopalatoplasty (LAUP) versus conservative management/placebo (two trials): One study recruited mixed a population, and separate data could not be obtained for this trial. In the other study no significant differences in Epworth scores or quality of life reported. A significant difference in favour of LAUP was reported in terms of apnoea hypopnoea index (AHI) and frequency and intensity of snoring. UPPP versus oral appliance (OA) (one trial): AHI was significantly lower with OA therapy than with UPPP. No significant differences were observed in quality of life. UPPP versus lateral pharyngoplasty (lateral PP) (one trial): No significant difference in Epworth scores, but a greater reduction in AHI with lateral PP was reported. Tongue advancement (mandibular osteotomy) + PPP versus tongue suspension + PPP (one trial): There was a significant reduction in symptoms in both groups, but no significant difference between the two surgery types. Complications reported with all surgical techniques included nasal regurgitation, pain and bleeding. These did not persist in the long term. An additional study assessed the effects of four different techniques. No data were available on between group comparisons. Multilevel temperature-controlled radiofrequency tissue ablation (TCRFTA) versus sham placebo and CPAP (one trial): There was an improvement in primary and secondary outcomes of TCRFTA over sham placebo and but no difference in symptomatic improvement when compared with CPAP. AUTHORS' CONCLUSIONS: There are now a small number of trials assessing different surgical techniques with inactive and active control treatments. The studies assembled in the review do not provide evidence to support the use of surgery in sleep apnoea/hypopnoea syndrome, as overall significant benefit has not been demonstrated. The participants recruited to the studies had mixed levels of AHI, but tended to suffer from moderate daytime sleepiness where this was measured. Short-term outcomes are unlikely to consistently identify suitable candidates for surgery. Long-term follow-up of patients who undergo surgical correction of upper airway obstruction is required. This would help to determine whether surgery is a curative intervention, or whether there is a tendency for the signs and symptoms of sleep apnoea to re-assert themselves, prompting patients to seek further treatment for sleep apnoea.

Adult↗

An experimental study of catechol-o-methyltransferase Val158Met moderation of delta-9-tetrahydrocannabinol-induced effects on psychosis and cognition.

Observational studies have suggested that psychometric psychosis liability and a functional polymorphism in the catechol-O-methyltransferase (COMT Val(158)Met) gene moderate the psychosis-inducing effect of cannabis. To replicate and extend this finding, a double-blind, placebo-controlled cross-over design was used in which patients with a psychotic disorder (n=30), relatives of patients with a psychotic disorder (n=12), and healthy controls (n=32) were exposed to Delta-9-tetrahydrocannabinol (Delta-9-THC, the principal component of cannabis) or placebo, followed by cognitive assessment and assessment of current psychotic experiences. Previous expression of psychometric psychosis liability was also assessed. Models of current psychotic experiences and cognition were examined with multilevel random regression analyses to assess (i) main effects of genotype and condition, (ii) interactions between condition and genotype, and (iii) three-way interactions between condition, genotype, and psychometric psychosis liability. Carriers of the Val allele were most sensitive to Delta-9-THC-induced psychotic experiences, but this was conditional on prior evidence of psychometric psychosis liability. Delta-9-THC impacted negatively on cognitive measures. Carriers of the Val allele were also more sensitive to Delta-9-THC-induced memory and attention impairments compared to carriers of the Met allele. Experimental effects of Delta-9-THC on cognition and psychosis are moderated by COMT Val(158)Met genotype, but the effects may in part be conditional on the additional presence of pre-existing psychosis liability. The association between cannabis and psychosis may represent higher order gene-environment and gene-gene interactions.

Adolescent↗

Neighborhood socioeconomic deprivation and residential instability: effects on incidence of ischemic heart disease and survival after myocardial infarction.

BACKGROUND: Previous literature has shown that neighborhood socioeconomic position influences the risk of ischemic heart disease, but little is known about the mechanisms linking the residential context to ischemic heart disease incidence and mortality. We examined whether neighborhood socioeconomic position and neighborhood residential stability (as a determinant of social interaction patterns) have an influence on ischemic heart disease risk. Moreover, we investigated whether dissimilar contextual influences operate at different stages of the disease process, ie, on incidence, 1-day case-fatality, and long-term survival after acute myocardial infarction (MI). METHODS: Using a large 27-year longitudinal cohort (baseline: 1 January 1996) defined in the Scania region, Sweden, we estimated multilevel survival models adjusted for individual sociodemographic factors and previous diseases of the persons. RESULTS: After adjustment, multilevel survival models indicated that the incidence of ischemic heart disease increased with neighborhood socioeconomic deprivation but was only weakly associated with neighborhood residential instability (for high vs low residential instability, hazard ratio = 1.2; 95% credible interval = 1.0-1.4). Conversely, beyond effects of individual and contextual socioeconomic circumstances and distance to the hospital, we saw a markedly higher 1-day case-fatality (4.9; 1.8-15) and shorter survival time after MI among individuals still alive 28 days after MI (4.3; 1.2-17) in neighborhoods with a high versus low residential instability. CONCLUSIONS: Effects of residential instability on post-MI survival may be mediated by the lower availability of social support in residentially unstable neighborhoods, suggesting a new class of intermediate processes that should be taken into account when investigating contextual influences on ischemic heart disease. Moreover, dissimilar contextual effects may operate at various stages of the disease process (ie, on incidence, case-fatality, and survival after MI).

Cohort Studies↗

Brief cognitive-behavioral therapy for temporomandibular disorder pain: effects on daily electronic outcome and process measures.

We used patient daily electronic ratings of outcome (activity interference, pain intensity, jaw use limitations, negative mood) and process (pain-related beliefs, catastrophizing, and coping) variables to evaluate a brief cognitive-behavioral (CB) treatment for chronic temporomandibular disorder (TMD) pain. TMD clinic patients (N=158) were assigned randomly to four biweekly sessions of either CB pain management training (PMT) or an education/attention control condition [self-care management (SCM)] and were asked to complete electronic interviews three times daily for the 8-week treatment. We analyzed diary data from 126 participants who completed >50% of requested interviews for >6 weeks. Multilevel regression analyses indicated no statistically significant difference between the study groups in rate of within-subject change over time on the daily outcome measures, but consistently greater within-subject improvement in the PMT group on the daily process measures. Significantly (P<0.05) greater proportions of PMT than of SCM patients showed clinically important (>50%) improvement from weeks 1 to 8 in daily activity interference and jaw use limitations. This study is novel in its application of electronic diary methods for assessing outcome and process variables in a chronic pain treatment trial, and supports the feasibility and utility of such methods. The brief CB treatment was efficacious in decreasing catastrophizing and increasing perceived control over pain, and in improving activity interference and jaw use limitations for a subgroup of patients. Longer-term follow-ups are ongoing to determine if there is an impact on outcomes over time.

Activities of Daily Living↗

The use of dental care facilities and oral health: a multilevel approach of schoolchildren in the Brazilian context.

PURPOSE: To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children). MATERIALS AND METHODS: A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus. RESULTS: Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus. CONCLUSION: This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies.

Black People↗

Early environment and child-to-adult growth trajectories in the 1958 British birth cohort.

BACKGROUND: Genetics and environmental conditions early in life are known to influence height. However, evidence is restricted to studies conducted at a specific age, and thus the effect on the entire growth trajectory has been neglected. OBJECTIVE: The objective was to determine when parental height and factors early in offspring life start to affect offspring height, when these variables have the strongest effect, and whether these variables persist to adulthood. DESIGN: Longitudinal data from the 1958 British birth cohort (all of whom were born during 1 wk in March 1958), including height measurements at 7, 11, 16, and 33 y of age, were analyzed by using multivariate multilevel response models. RESULTS: Parental height, birth weight, maternal smoking during pregnancy, breastfeeding, parental divorce, and socioeconomic factors were all significantly associated with childhood height, but their effects differed thereafter. Parental height and birth weight were most strongly associated with offspring height, and their effects persisted (adjusted increase in adult height: 2 cm for 1 SD of maternal or paternal height, or 1 kg of birth weight). Socioeconomic disadvantage (manual social class, large family size, and overcrowded households) was associated with substantial deficits of 2-3 cm (adjusted estimates) in height at 7 y. Catch-up growth was apparent but was insufficient to overcome the initial insult on growth; the adjusted deficit was as high as 1 cm in adulthood. CONCLUSIONS: Children from disadvantaged backgrounds have a delayed pattern of growth before the pubertal spurt, which is followed by catch-up growth. The health consequences of this pattern of growth need to be examined in future studies.

Adolescent↗

Factors associated with pattern of care before surgery for breast cancer in Quebec between 1992 and 1997.

BACKGROUND: Practice guidelines for breast cancer emphasize the importance of establishing an accurate diagnosis using a minimum number of procedures and selecting optimal treatment regimens. Understanding the determinants of waiting time is essential to develop optimum interventions to reduce delay. OBJECTIVES: The purpose of this study is to estimate the extent to which variability in 1) the number of procedures before surgery and 2) waiting time from initial procedure to surgery are explainable by factors related to the woman, to the provider, and to the care setting. RESEARCH DESIGN: Records of physicians' fee-for-service claims were obtained for 23,370 women undergoing breast cancer surgery in Quebec between 1992 and 1997. Multilevel logistic regression was used to determine predictors of having multiple procedures before surgery. Hierarchical linear regression models were used to identify predictors of waiting time, separately for women with lymph node involvement and without this involvement. RESULTS: Overall, 23% of the women had 3 or more procedures before surgery with significant variation found across hospitals and surgeons. Number of procedures was a strong predictor of waiting time. Waiting time also varied by stage, age, comorbidity, a history of benign disease, surgical setting, calendar time, month of initial procedure, and hospital teaching status. CONCLUSION: Although variability in waiting time was more strongly influenced by the characteristics of the women rather than by physician- or hospital-related factors, most variation remained unexplained by the factors included in this study. To reduce overall waiting time, strategies would need to be systemically applied.

Adult↗

The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research.

BACKGROUND: There is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and discuss emerging areas of research with the University of Texas Safety Attitudes Questionnaire. METHODS: Six cross-sectional surveys of health care providers (n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries (USA, UK, New Zealand). Multilevel factor analyses yielded results at the clinical area level and the respondent nested within clinical area level. We report scale reliability, floor/ceiling effects, item factor loadings, inter-factor correlations, and percentage of respondents who agree with each item and scale. RESULTS: A six factor model of provider attitudes fit to the data at both the clinical area and respondent nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition. Scale reliability was 0.9. Provider attitudes varied greatly both within and among organizations. Results are presented to allow benchmarking among organizations and emerging research is discussed. CONCLUSION: The Safety Attitudes Questionnaire demonstrated good psychometric properties. Healthcare organizations can use the survey to measure caregiver attitudes about six patient safety-related domains, to compare themselves with other organizations, to prompt interventions to improve safety attitudes and to measure the effectiveness of these interventions.

Ambulatory Care Facilities↗