Family and marital profiles of couples in which one partner has depression or anxiety

Twenty-nine couples in which one partner was depressed, 21 couples in which one partner had an anxiety disorder, and 26 nondistressed control couples were compared on measures of (1) quality of life, stress, and social support; (2) family functioning; (3) marital functioning; and (4) relationship attributions. The depressed group had significant difficulties in all four domains. In contrast, the control group showed minimal difficulties. The profile of the anxious group occupied an intermediate position between those of the other two groups, with some difficulties in all four domains, although these were less severe and pervasive than those of the depressed group.     

Individual quality of life: can it be accounted for by psychological or subjective well-being?

There is ongoing discussion in the scientific literature about the need for a more theoretical foundation to underpin quality of life (QoL) measurement. This paper applied Keyes et al.’s [J. Pers. Soc. Psychol. 82 (2002) 1007] model of well-being as a framework to assess whether respondents (n = 136 students) focus on elements of subjective well-being (SWB), such as satisfaction and happiness, or on elements of psychological well-being (PWB), such as meaning and personal growth, when making individual QoL (IQoL) judgments using the Schedue of the Evaluation of Individual Quality of Life (SEIQoL). The Keyes et al.’s model was confirmed and explained 41% of the variance in SEIQoL scores. Both SWB and PWB were correlated with the SEIQoL Index Score and SWB was found to be an important mediating variable in the relationship between PWB and SEIQoL. When analyzing different well-being combinations, respondents with high SWB/high PWB had significantly higher SEIQoL scores than did those with low SWB/low PWB. Respondents with high PWB/high SWB had higher SEIQoL scores than did those with high PWB/low SWB. Longitudinal studies in different patient groups are needed to explore the dynamic relationship between IQoL and well-being. Further investigation of the relationship between PWB and SWB with other instruments purporting to measure QoL would contribute to an enhanced understanding of the underlying nature of QoL.     

Bleeding with menopausal hormone therapy: physiological or pathological?

Abnormal bleeding is a common reason for discontinuation of hormone replacement therapy. There is little consensus regarding when to investigate abnormal bleeding, what to do about persistent bleeding or when reinvestigation is indicated. Transvaginal ultrasound, endometrial biopsy and hysteroscopy are discussed. The mechanisms of this bleeding are poorly understood and do not correlate well with endometrial histology or the type or dose of hormone therapy used. Endometrial bleeding requires breakdown of endometrial vessels and their overlying epithelium. Endometrial vascular breakdown appears to be largely locally regulated. Potential mechanisms involved in endometrial bleeding include: changes in the ratio of vascular endothelial growth factor (pro-angiogenic) to thrombospondin-1 (anti-angiogenic); alterations in matrix metalloproteinases and their tissue inhibitors; changes in endometrial haemostasis due to tissue factor; and increased endometrial leucocytes.     

The dynamics of hapū research relationships

Abstract

The Whakaki Lake Trust has a long history of being an active kaitiaki of Whakaki Lake and has developed a hapū-based restoration and enhancement programme at the Lake property. Part of this programme has involved working with a range of external agencies and researchers. Research relationships have become an important part of the restoration process to build the capability and capacity of hapū to execute activities associated with restoration. In addition, relationships have provided an opportunity to strengthen and expand the knowledge base that hapū can draw upon to inform ecological restoration and resource management decisions. Some of these relationships have been adversarial and a source of much frustration. As a consequence the Trust has developed very clear expectations and policy around working with others. My experience of developing a doctoral research project with Whakaki Lake Trust is used here to discuss hapū expectations of research and resultant academic dilemmas.     

Competing statistical methods for the fitting of normal species sensitivity distributions: recommendations for practitioners

A species sensitivity distribution (SSD) models data on toxicity of a specific toxicant to species in a defined assemblage. SSDs are typically assumed to be parametric, despite noteworthy criticism, with a standard proposal being the log-normal distribution. Recently, and confusingly, there have emerged different statistical methods in the ecotoxicological risk assessment literature, independent of the distributional assumption, for fitting SSDs to toxicity data with the overall aim of estimating the concentration of the toxicant that is hazardous to % of the biological assemblage (usually with small). We analyze two such estimators derived from simple linear regression applied to the ordered log-transformed toxicity data values and probit transformed rank-based plotting positions. These are compared to the more intuitive and statistically defensible confidence limit-based estimator. We conclude based on a large-scale simulation study that the latter estimator should be used in typical assessments where a pointwise value of the hazardous concentration is required.     

Penalized Maximum Likelihood Estimator for Normal Mixtures

The estimation of the parameters of a mixture of Gaussian densities is considered, within the framework of maximum likelihood. Due to unboundedness of the likelihood function, the maximum likelihood estimator fails to exist. We adopt a solution to likelihood function degeneracy which consists in penalizing the likelihood function. The resulting penalized likelihood function is then bounded over the parameter space and the existence of the penalized maximum likelihood estimator is granted. As original contribution we provide asymptotic properties, and in particular a consistency proof, for the penalized maximum likelihood estimator. Numerical examples are provided in the finite data case, showing the performances of the penalized estimator compared to the standard one.     

From managing access to managing care: the impact of primary care on health care delivery organizations.

Professional "revenge of the nerds" is currently taking place, as managed care evolves generalist physicians into new professional prominence. Primary care physicians are finding themselves at the center of health care market reform as health plans, insurers, and other financing organizations turn to them as the key to cost control. In short supply, they are prospering financially from the demand. As the source of patients, they are gaining in prestige from specialists and hospitals who once demeaned them. But these newfound roles are only the initial steps in the transformation of the primary care practitioner. The change that the generalists are experiencing is essentially managing access to care, not truly managing care itself. There are large and crucial differences between managing access to care and actually managing care. These differences are, in many ways, a higher calling for primary care practitioners as they refocus attention on patient outcomes, which will in itself result in a lower resource utilization above and beyond the crude controlling of access. What those differences are, what new roles they require, and what impact they will have on organizations that either house or contract with primary care physicians will be the focus of this article.