Systemic lupus erythematosus and hormone replacement therapy

The indications for hormone replacement therapy (HRT) in postmenopausal women is the treatment of climacteric symptoms and the prevention of osteoporosis. Women with systemic lupus erythematosus (SLE) are more likely to have a premature menopause, osteoporosis and cardiovascular disease. HRT can induce SLE flares and cardiovascular or venous thromboembolic events. Therefore it should not be used in women with active disease or those with antiphospholipid (aPL) antibodies. In general, it should be used only for patients without active disease, a history of thrombosis or aPL antibodies. Non-oral administration of estrogen is recommended because of its lesser effect on coagulation. With regard to the progestogen, progesterone or pregnane derivatives are preferred. Otherwise, non-estrogen-based strategies should be used.     

Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality?

Relocation stress syndrome is a nursing diagnosis characterized by symptoms such as anxiety, confusion, hopelessness, and loneliness. It usually occurs in older adults shortly after moving from a private residence to a nursing home or assisted-living facility. The primary purpose of this study was to validate the symptoms of relocation stress syndrome. Eight nursing home residents and 8 assisted-living facility residents were interviewed 2 to 10 weeks after admission, when symptoms of relocation stress syndrome are most likely to appear. Results of this study indicate that the incidence of relocation stress syndrome may be overestimated. More accurate diagnosis and treatment of depression in older adults is needed.     

Camera-Related Behaviors during Video Recorded Medical Interactions

Video recording provides an objective record of the content of medical interactions. However, there is concern that cameras may be reactive measurement devices that alter what normally transpires during interactions. This study addressed potential reactivity of cameras in medical interactions. Interactions between 45 patients and 14 medical oncologists were video recorded and coded for camera-related behaviors. Eleven of 45 patients performed none of the behaviors. Among the other patients, camera-related behaviors were infrequent and, on average, constituted about 0.1% (one-tenth of one percent) of total interaction time. Behaviors occurred most often in very early stages of interactions, and when physicians were absent from the room. Seven physicians showed camera-related behaviors, comprising less than 0.1% of the time they were in the interaction. Results suggest video recording can provide nonreactive means of studying medical interactions.

Multivariate process dispersion monitoring without subgrouping

The memory-type adaptive and non-adaptive control charts are among the best control charts for detecting small-to-moderate changes in the process parameter(s). In this paper, we propose the Crosier CUSUM (CCUSUM), EWMA, adaptive CCUSUM (ACCUSUM) and adaptive EWMA (AEWMA) charts for efficiently monitoring the changes in the covariance matrix of a multivariate normal process without subgrouping. Using extensive Monte Carlo simulations, the length characteristics of these control charts are computed. It turns out that the ACCUSUM and AEWMA charts perform uniformly and substantially better than the CCUSUM and EWMA charts when detecting a range of shift sizes in the covariance matrix. Moreover, the AEWMA chart outperforms the ACCUSUM chart. A real dataset is used to explain the implementation of the proposed control charts.     

Family structure and income inequality in families with children, 1976 to 2000

Using 24 years of data from the March supplements to the Current Population Survey and detailed categories of family structure, including cohabiting unions, I assess the contribution of changes in family structure to the dramatic rise in family income inequality. Between 1976 and 2000, family structure shifts explain 41% of the increase in inequality, but the influence of family structure change is not uniform within this period or across racial-ethnic groups. In general, the estimated role of family structure change is inversely related to the magnitude of the changes in inequality. Furthermore, by including cohabitation, I find lower levels of total inequality and a weaker role for demographic shifts in family structure for trends in income inequality.