Assessing obesity: classification and epidemiology

Obesity is generally defined as a body mass index (BMI) of 30 kg/m2 and higher. Overweight is defined as a BMI between 25 and 30 kg/m2. The prevalence varies considerably between countries, and between regions within countries. It is estimated that more than half of adults aged 35-65 living in Europe are either overweight or obese. Overweight is more common among men than among women but obesity is more common among women. The prevalence of obesity in Europe is probably in the order of 10-20% in men and 15-25% in adult women. In most European countries who have reliable data on time-trends the prevalence of obesity seems to be increasing. In most European countries, obesity is usually inversely associated with socio-economic status, particularly among women. New classifications of overweight may be based on cut-off points for simple anthropometric measures which reflects both total adiposity as well as abdominal fatness.     

Diagnosis and nosographic classification in the child-psychiatric epidemiology]

Psychiatric epidemiology is founded on clinical experience and scientific research; these two spheres are not contradictory but complementary. Different aspects need to be examined thoroughly; for instance, diagnosis, considered as the result of a rather complicated process has hardly ever been studied. This should not lead us to give up or to act in a pseudo-scientific way as if we could control all the problems. The existing results show us that diagnosis is getting significant only with complementary and specific items. From the methodological point of view, video-tape and discussions about case histories allow us to study the diagnosis process. Field researches, comparative studies about systematic case data of different services, clinical and longitudinal investigations contribute ot epidemiological knowledge and facilitate interdisciplinary and international cooperation. Any linear and causal explanations on epidemiological phenomena appear unreliable.     

The history, epidemiology, and classification of headaches in childhood

The history of headaches in children, their epidemiology, and their classifications are reviewed. Symptoms, prevalence, school absences, risk factors, and treatments are discussed. More data is needed regarding the epidemiology of tension headaches, headaches observed in the emergency room, and headaches observed in the setting of the primary care practitioner.     

Munchausen syndrome by proxy: social work's role

Munchausen syndrome by proxy is the diagnosis used to describe a variation of child abuse whereby the parent or adult caregiver fabricates a medical history or induces symptoms in the child, or both, resulting in unnecessary examinations, treatments, hospitalizations, and even death. This article reviews the assessment procedures, provides case studies, and describes family dynamics of the syndrome. The authors make recommendations for team management of the child-family system and recommendations for social workers. They propose broadening the assessment of the family on the basis of knowledge of the widespread physical and economic oppression of women and children in our society.     

Antisocial personality by proxy: the Norton-Sims syndrome

In order to discern areas of potential improvement in various aspects of glycaemic control for patients with insulin dependent (type 1) diabetes mellitus, blood glucose control is analysed in the light of general engineering feedback control systems theory. This approach is based on models of the system being controlled, using appropriate control strategies. The models presently used for glycaemic control are analysed from this perspective, revealing certain limitations that they impose on the control strategies that use them. Current type 1 diabetes regimens are evaluated for the ease with which they may be analysed mathematically, suggesting areas where improvements in control may be effected by simplifying calculation of appropriate insulin quantities. A new model of undergraded insulin action, derived from established insulin action profiles, along with a control strategy which flexibly extends the basal/bolus regimen using patient-specific parameters, is proposed. This may provide the information needed to enable prediction of expected glycaemia several hours into the future, thereby enabling earlier corrective action to be taken should it fail outside the target range, and in turn potentially reduce the degree and frequency of both hyperglycaemia and hypoglycaemia.     

An object-relational interpretation of Thomas Mann's "Death in Venice"

The protagonist of Thomas Mann's novella "Death in Venice" is examined in terms of object-relational theory. Splitting, his primary defense mechanism, which is employed both intrapsychically and interpersonally, is discussed at length, as is his problematic relationship with his parents, which has resulted in his fixation in the paranoid/schizoid position and his ultimate destruction.     

Munchausen syndrome by proxy: a different kind of child abuse

Munchausen syndrome by proxy (MSBP) continues to mystify health care professionals, law enforcement officials and the judicial system. Even though the first cases were described in 1977, it remains puzzling why a parent would want to induce fictitious symptoms and illnesses in a child. Many professionals do not consider MSBP as a diagnosis because the parent, usually the mother, is so convincing that she is a "good" mother, cares about and wants the best for her child. This article is offered to further educate physicians that MSBP exists, can present in the form of anything and should be considered as a diagnosis in cases that do not make medical sense. Case examples are provided, along with common and not so common presentations. MSBP is a form of severe child abuse that must be reported to Child Protection Service when a child is endangered. Physicians play a critical role in identifying these children and recommending the best course of action to the rest of the system.     

Munchausen syndrome by proxy: report of one case with epilepsy

INTRODUCTION: Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a parent, usually the mother, fabricates or produces illness in a child, so causing them unnecessary medical investigations, treatments and hospitalizations. One of the commonest false presenting symptom is 'seizures'. CLINICAL CASE: An eight years old boy with Munchausen syndrome by proxy is reported. This child had had genuine seizures well controlled by standard anticonvulsant treatment at the start of the false illness. At the age of seven years, the patient showed very frequent seizures. The child was treated with antiepileptic drugs, but treatments were ineffective and seizures continued. Results of multiple tests, including an extensive blood chemistry analyses, CT, MRI, SPECT, were normal. Electroencephalogram showed posterior slow waves. Acute neurological deterioration was observed six weeks after hospitalization and it was finally proved that seizures were caused or triggered by clomipramine poisoning given by her mother. CONCLUSIONS: MSBP frequently presents as epileptic seizures in these abused children. MSBP diagnosis is more difficult to be made if true seizures exists with multiple fictitious seizures. Pediatrician should be alerted to the possibility of MSBP when seizures are poorly controlled, treatments are ineffective and there is no neurophysiologic dysfunction. Early diagnosis and intervention are essential because high mortality and psychologic morbidity are associated with this syndrome.     

Ability evaluation by proxy: Role of maximal performance and related attributes in social comparison.

Four experiments tested the effects of information about a proxy's related attributes and maximal effort in social comparisons of ability. In Study 1, a proxy's prior performance at maximal effort exerted systematic effects on participants' personal performance predictions for a novel task. When information about the proxy's effort was ambiguous (Study 2), information about related attribute similarity was used in the formulation of performance predictions. In Studies 3 and 4, 2-way interaction terms revealed that participants used related attribute information in generating performance predictions when the proxy's maximum effort was unknown. However, related attribute information was disregarded when proxy's maximum effort was unambiguous. Results were consistent with the proxy comparison model of ability self-evaluation (L. Wheeler et al, 1997). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overinterpretation of gastroduodenal motility studies: two cases involving Munchausen syndrome by proxy

Two children were thought to have an atypical gastroduodenal motility disorder because of the history and clinical course; both had received parenteral alimentation because of claims of inability to tolerate enteral feedings, and both continued to have unusual medical problems during parenteral alimentation. Both children had motility studies that were interpreted by a pediatric gastroenterologist to be "abnormal" and "diagnostic" of a motility disorder, but each was eventually shown to have a behavioral abnormality related to Munchausen syndrome by proxy.