Chinese mainland′s first case report of Munchausen syndrome by proxy in children / 中华实用儿科临床杂志

Clinical data of a case of Munchausen syndrome by proxy (MSBP) admitted to the Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology in November 2020 were retrospectively analyzed.The 4 years and 4 months old female patient presented with retrosternal and abdominal pain for 1 month, and aggravated with multi-organ pain for 20 days.She complained about the retrosternal pain with acid reflux, pain in the teeth, esophagus, and abdomen, etc.During the hospitalization, she frequently complained of multi-organ pain.Her mother repeatedly declared her painful hip joint and she often cried for pain at night, and even could not walk.However, the clinical examination showed no obvious abnormalities.Combining characteristics of the patient and her caregiver, the patient was confirmed as MSBP.It is suggested that MSBP in children should be concerned in cases with complicated severe chief complaints, frequent medical visits, and a strong willing to see a doctor or be hospitalized by their caregivers, but normal physical and auxiliary examination findings.

Quality-of-life of Pediatric Cancer Patients Receiving End-of-life Care and Related Factors: Using a Proxy QOL Rating Scale from the Nurse’s Perspective

Objectives: The study purpose was to examine quality-of-life (QOL) of pediatric cancer patients at end-of-life and related factors using a QOL proxy rating scale from the nurse’s perspective. Methods: We conducted a survey in October 2015−February 2016. The subjects to be surveyed were nurses who were primarily in charge of patients with childhood cancer at end-of-life. We investigated 22 items of the Good Death Inventory for Pediatrics (GDI-P) and their related factors. Results: In total, 53 proxy evaluate questionnaires were completed from 18 centers. Among the eight factors of GDI-P, “Relief from physical and psychological suffering” was the lowest. The total score of GDI-P was positively correlated with the structure and process of care (r=0.58). Although there was a bias in the number of cases, in the case of the place of death was the intensive care unit, the total score of GDI-P was lower than home and the general ward. Conclusions: It was suggested that the top priority in improving QOL was relief from suffering and the structure and process of care were related to QOL.

Lesiones orales en víctimas del síndrome de munchausen por poder / Oral lesions in victims of munchausen syndrome by proxy

Resumen La presente es una revisión bibliográfica de casos publicados de niños con manifestaciones orales de maltrato físico, específicamente del Síndrome de Munchausen por poder. Tiene como objetivo resumir y presentar las características de las lesiones de víctimas del Síndrome, utilizando las principales bases de datos de publicaciones científicas. Se encontraron 9 casos, en todos ellos la victimaria fue la madre. Las lesiones se localizaron en la mucosa orofaríngea, las encías, la lengua, el paladar y los labios; fueron causadas por sustancias tóxicas administradas por vía oral o por compresión manual de la boca. En dos casos la víctima falleció. Se registró la muerte previa de 6 hermanos de las víctimas. Finalmente, se propone un esquema de evaluación odontológica forense para establecer o descartar que las lesiones de la cavidad oral sean parte del Síndrome.

Abstract This is a literature review of published cases of children with oral manifestations of physical abuse, specifically of Munchausen Syndrome by proxy. It is intended to summarize and present the characteristics of injuries of victims of the Syndrome, using the main databases of scientific publications. 9 cases were found, all of them the perpetrator was the mother. The lesions were found in the oropharyngeal mucosa, gums, tongue, palate and lips; they were caused by toxic substances administered orally or by manual compression of the mouth. In two cases the victim died. The previous death of 6 brothers of the victims was recorded. Finally, a forensic dental evaluation scheme intends to establish or rule out that lesions of the oral cavity are part of the syndrome.

A Case of Decision-making by Proxy through Community-based Multidisciplinary Collaboration for a Cancer Patient with Intellectual Disabilities

In recent years, cancer treatment methods have diversified, and there are increasing numbers of occasions where patients or their families are required to make increasingly complex decisions. Currently, there are no guidelines for determining the process and the individual who decides the treatment strategy for cancer patients who are unable to decide for themselves. Particularly, no report has been published on decision-making for end-of-life care in patients with intellectual disabilities. This report documents our involvement in decision-making during end-of-life care for a cancer patient with intellectual disabilities. This patient’s decision-making ability or lack thereof was determined using reliable and validated assessment scales. The collective decision to not resuscitate in case of cardiac arrest and to care for the patient in the palliative care unit was made through a multidisciplinary collaboration between the social welfare team and the hospital based on reports and guidelines from abroad. Going forward, guidelines for decision-making support for terminal ill cancer patients with intellectual disabilities and decision-making by proxies for such patients need to be established in Japan.

Discrepancia en la evaluación de la calidad de vida relacionada con la salud entre niños y padres a través del cuestionario EQ-5D-Y / Parent-child discrepancy in the assessment of health-related quality of life using the EQ-5D-Y questionnaire

Introducción. La evaluación de la calidad de vida relacionada con la salud (CVRS) permite detectar cambios en el tiempo en la salud de pacientes y posibilita realizar un análisis de coste-efectividad de tratamientos. En niños con características especiales de salud que no pueden autoevaluarse, existe la posibilidad de evaluar su CVRS a través de padres o cuidadores. Hasta la fecha, no se ha analizado la discrepancia en la evaluación de la CVRS a través del cuestionario EQ-5D-Y entre niños con parálisis cerebral (PC) y sus padres. El objetivo del presente estudio fue analizar el grado de concordancia en la evaluación de la CVRS a través del cuestionario EQ-5D-Y y su versión Proxy entre niños con PC y sus padres o cuidadores. Población y métodos. Participaron, en el estudio, niños y adolescentes con PC, así como sus padres y madres, procedentes de un centro de educación especial de la región de Extremadura (España). Se utilizó el cuestionario EQ-5D-Y para los niños y el EQ-5D-Y Proxy para los padres. Las entrevistas fueron llevabas a cabo durante el primer trimestre de 2015. Se analizó la concordancia en las respuestas mediante el nivel de acuerdo con kappa de Cohen para las 5 dimensiones que componen el EQ-5D-Y y el coeficiente de correlación intraclase para la escala visual analógica. Resultados. Participaron 62 niños con PC con afectación leve y/o moderada de su capacidad funcional, sus padres y madres. Hubo una pobre concordancia en la evaluación de la CVRS entre niños y padres en todas las dimensiones del cuestionario (< 0, 20) y justo o pobre (< 0, 60) en la escala visual analógica. Conclusiones. Existe un alto desacuerdo en la evaluación de la CVRS entre padres e hijos en población con PC a través del cuestionario EQ-5D-Y.

Introduction. The assessment of health-related quality of life (HRQoL) serves to detect changes over time in patients' health status and allows to do a cost-effectiveness analysis of treatments. When children with special health features cannot perform a self-assessment, it is possible to assess their HRQoL through their parents or caregivers. To date, the discrepancy in the assessment of HRQoL using the EQ-5D-Y questionnaire among children with cerebral palsy (CP) and their parents has not been analyzed. The objective of this study was to analyze the level of agreement in the HRQoL assessment using the EQ-5D-Y questionnaire and its proxy version among children with CP and their parents or caregivers. Population and methods. Children and adolescents with CP, and their parents, from a special education school in the region of Extremadura (Spain) participated in the study. The EQ-5D-Y questionnaire was used for children and the EQ-5D-Y proxy version, for parents. Interviews were conducted in the first quarter of 2015. The level of agreement in the responses was analyzed using the Cohen's kappa coefficient for the five domains of the EQ-5D-Y and the intraclass correlation coefficient for the visual analogue scale. Results. Sixty-two children with CP and mild and/or moderate functional capacity impairment, and their parents, participated in the study. The level of agreement was poor in the HRQoL assessment between children and parents in all the questionnaire domains (<0.20) and fair or poor (<0.60) in the visual analogue scale. Conclusions. A high level of parent-child disagreement was observed in the HRQoL assessment in the population with CP using the EQ-5D-Y questionnaire.

Munchausen syndrome and Munchausen syndrome by proxy: a narrative review / Síndrome de Munchausen e síndrome de Munchausen por procuração: uma revisão narrativa

ABSTRACT The Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. They are frequently observed by health teams in clinics, hospital wards and emergency rooms. We performed a narrative, nonsystematic review of the literature, including case reports, case series, and review articles indexed in MEDLINE/PubMed from 1951 to 2015. Each study was reviewed by two psychiatry specialists, who selected, by consensus, the studies to be included in the review. Although Munchausen syndrome was first described more than 60 years ago, most of studies in the literature about it are case reports and literature reviews. Literature lacks more consistent studies about this syndrome epidemiology, therapeutic management and prognosis. Undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities, and their underdiagnose might be for lack of health professional's knowledge about them, and to the high incidence of countertransference to these patients and to others, who are exposed to high morbidity and mortality, is due to symptoms imposed on self or on others.

RESUMO A síndrome de Munchausen e a síndrome de Munchausen por procuração são condições caracterizadas pela invenção ou pela produção intencional de sinais ou sintomas de doenças, bem como alterações de exames laboratoriais. Indivíduos com esta síndrome fingem que estão doentes e tendem a procurar tratamento, sem ganho secundário, em diferentes serviços de saúde. Ambas as síndromes são condições bem descritas na literatura desde 1951. Elas são frequentemente observadas pelas equipes de saúde em clínicas, enfermarias hospitalares e prontos-socorros. Conduziu-se revisão narrativa, não sistemática da literatura, incluindo relatos de caso, séries de relatos de caso, artigos de revisão indexados no MEDLINE/PubMed de 1951 a 2015. Cada estudo foi revisado por dois especialistas em psiquiatria que, por meio de consenso, escolheram quais estudos seriam incluídos nesta revisão. Apesar da síndrome de Munchausen ter sido descrita pela primeira vez há mais de 60 anos, a maioria dos estudos conduzidos sobre esta condição são relatos de caso e revisões da literatura. A literatura é carente de estudos mais consistentes sobre epidemiologia, manejo terapêutico e prognóstico da síndrome. Sem dúvida, tais condições geram altos custos e procedimentos desnecessários nos serviços de saúde. Seu subdiagnóstico pode se dar pela falta de conhecimento das síndromes por parte dos profissionais de saúde, e à alta incidência de contratransferência aos pacientes e a outros que são expostos à alta morbidade e à mortalidade é justificada pelos sintomas impostos em si mesmo ou em terceiros.

Research advance of cognitive reserve in brain aging / 医疗卫生装备

The current proxy indicators and quantitative strategy were summarized for cognitive reserve,the findings of cognitive reserve was discussed then in brain aging and Alzheimer's disease,and some future research directions were presented about cognitive reserve.The reserve of brain explains the disjunction between clinical symptoms and the degree of brain damage,whereby some people can tolerate more of age-related or Alzheimer's disease pathology than others and maintain brain function.The cognitive reserve hypothesis has been widely used in epidemiological and neuroimaging studies,but it lacks a unified quantitative indicator.The future research of cognitive reserve should be focused on the development of quantitative indicators that cover a variety of potential factors dynamically.

Research advance of cognitive reserve in brain aging / 医疗卫生装备

The current proxy indicators and quantitative strategy were summarized for cognitive reserve,the findings of cognitive reserve was discussed then in brain aging and Alzheimer's disease,and some future research directions were presented about cognitive reserve.The reserve of brain explains the disjunction between clinical symptoms and the degree of brain damage,whereby some people can tolerate more of age-related or Alzheimer's disease pathology than others and maintain brain function.The cognitive reserve hypothesis has been widely used in epidemiological and neuroimaging studies,but it lacks a unified quantitative indicator.The future research of cognitive reserve should be focused on the development of quantitative indicators that cover a variety of potential factors dynamically.

Síndrome de Münchausen por poder en otorrinolaringología / Münchausen syndrome by proxy in otorhinolaryngology

El síndrome de Münchausen por poder es una forma de maltrato infantil, con graves consecuencias para el niño afectado. El diagnóstico de esta afección constituye un desafío para los médicos por su heterogeneidad en los síntomas y signos de presentación. Variadas manifestaciones otorrinolaringológicas están descritas en esta patología. En este artículo se presenta un caso clínico de otitis media crónica con otorragia en un paciente de 2 años, donde se logró establecer el diagnóstico de síndrome de Münchausen por poder a través de la identificación de elementos incongruentes en la historia clínica y finalmente por la detección in fraganti de la agresión por parte de la madre. En esta revisión se concluye que es necesario un alto índice de sospecha para identificar esta patología, la que debe ser una preocupación habitual del equipo de salud para evitar asi consecuencias graves en estos pacientes, tales como secuelas psiquiátricas o incluso la muerte.

Münchausen's syndrome by proxy is a form of child abuse with severe consequences for the affected child. The diagnosis of this condition is a challenge for physicians due to the heterogeneity of the presentation symptoms. A lot of otorhinolaryngological manifestations have been described in this syndrome. We present a case of a 2 year old patient with chronic otitis media and otorrhagia, where we could establish the diagnosis of Münchausen's syndrome by proxy through the identifications of incongruent elements on the clinical history and finally the direct visualization of mother's aggression. In this should be a common concern for health workers to avoid severe consequences in these patients like psychiatric diseases or even death.

Validity of the Katz Index to assess activities of daily living by informants in neuropathological studies / Validade do índice de katz para avaliar atividades básicas de vida diária por informantes em estudos neuropatológicos / Validez del índice de katz para evaluar las actividades básicas de vida diaria por informantes en estudios neuropatológicos

Abstract OBJECTIVE To analyze the evidences of construct validity of the Katz Index for the retrospective assessment of activities of daily living (ADL) by informants, to assist neuropathological studies in the elderly. METHOD A cross-sectional study analyzed the functional ability of ADL measure by the Katz Index, of 650 cases randomly selected from the Brazilian Brain Bank of the Ageing Brain Study Group (BBBABSG) database. Sample was divided in two subsamples for the analysis (N=325, each) and then stratified according to cognitive decline assessed by the Clinical Dementia Rating Scale (CDR). Factor analyses with calculations of internal consistency and invariance were performed. RESULTS Factor analysis evidenced a unidimensional instrument with optimal internal consistency, in all subgroups. Goodness of fit indices were obtained after two treatments of covariance, indicating adequacy of the scale for assessing ADL by informants. The scale is invariant to cognitive decline meaning that it can be used for subjects with or without cognitive impairment. CONCLUSION Katz Index is valid for the retrospective assessment of basic ADL by informants, with optimal reliability.

Resumo OBJETIVO Analisar as evidências de validade de constructo do Índice de Katz para a avaliação retrospectiva das Atividades Básicas de Vida Diária (AbVD) por informantes, para apoiar estudos neuropatológicos no envelhecimento. MÉTODO Por meio de estudo transversal foi analisada a capacidade funcional para as AbVD mensurada pelo Índice de Katz em 650 casos randomizados das bases de dados do Banco de Encéfalos Humanos do Grupo de Estudos em Envelhecimento Cerebral (BEHGEEC). A amostra foi particionada em duas subamostras para as análises (N=325, cada) e então estratificada de acordo com o comprometimento cognitivo determinado pelo Escore Clínico de Demência (CDR). Foram realizadas análise fatorial, de consistência interna e de invariância. RESULTADOS A análise fatorial evidenciou um instrumento unidimensional com ótima consistência interna, em todos os grupos. Ótimos índices de ajuste foram obtidos após o tratamento de duas covariâncias, indicando adequação da escala para avaliar AbVD por informantes. A escala é invariante para o comprometimento cognitivo, o que significa que pode ser usada em indivíduos com ou sem comprometimento cognitivo. CONCLUSÃO O Índice de Katz apresenta validade de constructo para a avaliação retrospectiva das AbVD por informantes, com confiabilidade.

Resumen OBJETIVO Analizar las evidencias de validez de constructo del Índice de Katz para la evaluación retrospectiva de las Actividades Básicas de Vida Diaria (AbVD) por informantes para apoyar estudios neuropatológicos en el envejecimiento. MÉTODO Por medio de estudio transversal se analizó la capacidad funcional para las AbVD mensurada por el Índice de Katz en 650 casos randomizados de las bases de datos del Banco de Encéfalos Humanos del Grupo de Estudios en Envejecimiento Cerebral (BEHGEEC). La muestra fue dividida en dos submuestras para los análisis (N=325, cada) y luego estratificada de acuerdo con el compromiso cognitivo determinado por la Escala de Clasificación de la Demencia Clínica (CDR). Se hicieron análisis factorial, de consistencia interna y de invariancia. RESULTADOS El análisis factorial evidenció un instrumento unidimensional con excelente consistencia interna, en todos los grupos. Excelentes índices de ajuste fueron obtenidos después del tratamiento de dos covariancias, indicando la adecuación de la escala para evaluar AbVD por informantes. La escala es invariante para el compromiso cognitivo, lo que significa que se puede utilizarla en individuos con o sin compromiso cognitivo. CONCLUSIÓN El Índice de Katz presenta validez de constructo para la evaluación retrospectiva de las AbVD por informantes, con confiabilidad.

A Novel Method for Coloring and Labeling Specimens in the Anatomy Museum.

Introduction: In today’s medical educational programs in various institutes anatomy is an essential part of the curriculum in the first year of the medical course. An attractive and innovative anatomical museum forms a vital role in furthering the interest and educating a medical student. Once a specimen has undergone fixation it is essential to color and label the specimens in order to ensure better visualization of required structures and for its proper placement in the museum. Materials and methods: We have utilized a novel method of using commercially available nail polish as a coloring agent and as a part of the labeling of museum specimens. Results: Nail polish being non- toxic and readily available can be used without causing any complications. Discussion: Commercially available nail polish is cost effective and non-toxic. Its various usages are described along with the techniques of labeling done in our anatomy museum.

Agreement between adolescents' and their mothers' reports of oral health-related quality of life

The aim of this study was to determine the level of agreement between reports by adolescents and their mothers regarding the impact of oral health on the adolescents' quality of life. The sample consisted of 960 pairs of adolescents aged 11 to 14 years and their mothers. The Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) and the short form of the Child Perceptions Questionnaire (CPQ11-14) were administered. Agreement on the total scale and the subscales was determined through a comparison of mean values. The means of the directional and absolute differences were also determined. Agreement on each item on the group level and in the individual pairs was analyzed using the Intraclass Correlation Coefficient (ICC). The difference between the means and the directional differences were significant for the total score as well as for the functional limitation and social well-being subscales (p < 0.001). The ICC for the total P-CPQ and CPQ11-14 scores was 0.43. The ICC indicated weak agreement on the subscales, ranging from 0.36 to 0.40. Agreement between reports by adolescents and their mothers regarding oral health-related quality of life (OHRQoL) was moderate, indicating that both perspectives should be considered.

Síndrome de Munchausen por poder. Evaluación, diagnóstico. ¿Después que? / Munchausen by proxy syndrome. Evaluation - diagnosis and then what?

La presente investigación se desarrollo en el Hospital de Pediatría Juan P. Garrahan. La investigación se centro en analizar un fenómeno complejo tanto en su diagnóstico como en su tratamiento el Síndrome de Munchausen por poder. El Hospital de Pediatría Juan P. Garrahan, presenta un número elevado de casos con síndrome de munchausen, la cual constituye una forma de maltrato infantil. Aquí se simula o se produce enfermedad en un niño sano, por par te de quien lo cría, que es quien debería protegerlo y ampararlo. El objetivo final de un equipo interdisciplinario frente a este tipo de casos es, hacer un trabajo minucioso con el paciente, familia nuclear, red ampliada y personas significativas, con los recursos profesionales que correspondan, al contexto del paciente, a la red institucional (contra referencia), a fin de que ese niño no vuelva a sufrir ninguna forma de daño intencional. Como obstáculo para el tratamiento y seguimiento de estos niños y sus familias, en la práctica profesional de este Servicio Social, se observa escasa cantidad de equipos profesionales y centros especializados para tal fin, como así también interrogantes acerca de los resultados de las estrategias de intervención de las instituciones a las cuales se derivan estos niños y sus grupos familiares.

The present study was conducted at the Pediatric HospitalJuan P. Garrahan. The study focuses on the phenomenonof Munchausen by proxy syndrome, a complex syndromeboth in its diagnosis and treatment. At the Pediatric HospitalJuan P. Garrahan a high rate of cases of Munchausen by proxy syndrome, a form of child abuse, is found. In this syndrome the parent or caretaker, who is supposed to protectthe child, deliberately makes the child sick or simulates anillness. The main aim of an interdisciplinary team managingthese cases is to closely work with the patient, the close and extended family, and persons important to the child withthe necessary professional resources in an institutional net-work (counter referral) to protect the child from further intentional harm. In the practice of the Social Service of this institution, the main obstacle in the treatment and follow-up of these children and their families is the scarcity of professional teams and centers specialized in the syndrome as well as uncertainty about results of interventional therapies at the centers these children and their families are referred to.

Phenotypic plasticity and fitness in egg parasitoids

Several proxies can be used to estimate the fitness of egg parasitoids: size, longevity, fecundity, mating ability and vagility. All these proxies are positively correlated with the lifetime fitness gain of an individual. However, the phenotypic plasticity, which is the ability of a genotype to produce distinct phenotypes depending on environmental conditions, may alter the value of these proxies. Host related factors (host species and quality), competition and duration of development will influence the proxies expressed by a given phenotype. When the phenotype is modified by the temperature at which an individual develops, the resulting phenotype will vary based on the life history strategy of the parasitoid. While in koinobiont species an increase in size is positively correlated with longevity and fecundity, the reverse occurs with idiobiont parasitoids. Using size as a proxy could thus be misleading depending on the factors that influence the size of the adult.

Study of consistency between asthma children's self-assessment health-related quality of life and their proxies' assessment / 中国实用护理杂志

Objective To examine the consistency between asthma children's self-assessment health-related quality of life and their proxies' assessment, to give theoretic basis of clinical treatment for asthma children. Methods Parents and asthma children completed the PedsQLTM 4.0 Generic Core Scales and PedsQLTM 3.0 Asthma Module during an outpatient visit or in the hospital. Wilcoxon signed rank test and ICC were used to compare the difference between asthma children's self-report and their proxies' report. Results The findings indicated that neither the total scores nor domain scores (except physiological domain) between asthma children's self-reports and proxies' reports (parents most of all)showed inconsistency. The value of ICC was not less than 0.7 except physiological dimension and showed consistency. Some different information in several domains was founded by the scores after layered by age. Conclusions There are consistency between children's self assessment of health-related quality of life and their proxies' assessment based upon results of PedsQLTM scale.

Some considerations about the use and applicability of preference-based health-related quality of life measures to survivors of cancer in childhood and adolescence in developing countries / Algumas considerações acerca do uso e aplicação de medidas de qualidade de vida associada à saúde, com ênfase em estudos sobre sobreviventes de câncer na infância e adolescência em países em desenvolvimento / Algunas consideraciones sobre el uso y la aplicación de medidas de calidad de vida asociada a la salud, con énfasis en estudios sobre sobrevivientes de cáncer en la infancia y adolescencia en países en desarrollo

Measures of health-related quality of life (HRQoL) have become widely available in developed countries such as the United States, Canada and the United Kingdom. Such measures, instruments or questionnaires need to undergo translation processes, validation and cultural adaptation in order to be used in other countries and in other languages. The utilization of measures developed in settings other than the originating ones poses several challenges, including the appropriateness of the translation and of the cross-cultural adaptation and adequate validation process. Preference-based or preference-weighted utilities for health states have an important role in measurement and in economic evaluation regarding a wide range of conditions, such as childhood cancer and survivorship. Some attempts have been made to create and apply preference-based HRQoL indexes to young populations, such as children, adolescents and young adults. Use of proxy respondents is an issue for studying HRQoL in these groups, especially children. This review aims at providing a critical evaluation of the use of preference-based HRQoL measures in developing countries, focusing on the Health Utilities Index, Mark 2 and Mark 3, commonly called HUI2 and HUI3, and their application to survivors of childhood cancer in Latin America. The process researchers undertake, especially in regards to the use of already translated instruments is discussed. The appropriateness of the instruments is also assessed and focus is on the attributes of the instrument and the population, the cultural aspects and the use of proxy respondents. Finally, the adequateness of other commonly used preference-based instruments for childhood cancer is discussed. This critical assessment could benefit future work in the area of health-related quality of life, especially guiding those interested in the trans-cultural use of existing generic preference-based HRQoL instruments.

Instrumentos para medir a qualidade de vida associada à saúde vêm se tornando cada vez mais usados em países desenvolvidos, como Estados Unidos, Canadá e Reino Unido. Essas medidas devem passar por processos de tradução, validação e adaptação cultural antes de serem usadas em países e/ou línguas, que não os de origem. A utilização de instrumentos desenvolvidos em outros contextos culturais apresenta vários desafios, tais como a propriedade da tradução, adequação da adaptação cultural, bem como satisfatório processo de validação. Preferências por estados de saúde baseadas na teoria da utilidade têm papel importante na avaliação econômica, principalmente em análises de custo-efetividade e custo-utilidade de intervenções relacionadas a diversas doenças e condições de saúde, como câncer infantil e sobrevivência. Alguns trabalhos desenvolvidos recentemente visam criar e aplicar medidas de qualidade de vida obtidas por meio da mensuração de preferências por estados de saúde, em grupos jovens, tais como crianças e adolescentes. A necessidade de utilização de respondentes substitutos é uma questão que permeia o uso dessas medidas nestes grupos, especialmente em crianças. Esta revisão apresenta uma avaliação crítica do uso de medidas de qualidade de vida associadas à saúde, obtidas por meio de preferências por estados de saúde, em países em desenvolvimento, com enfoque nas medidas denominadas Health Utilities Index, Mark 2 e Mark 3, comumente conhecidas como HUI2 e HUI3, e sua aplicação para sobreviventes de câncer na infância, na América Latina. Realiza-se uma discussão crítica do processo utilizado pelos pesquisadores quando empregam instrumentos já anteriormente traduzidos. A propriedade de outros instrumentos também é abordada, com ênfase nos atributos ou domínios abrangidos por cada medida analisada, para o câncer infantil. Espera-se que esta revisão beneficie futuros trabalhos na área de qualidade de vida associada à saúde, especialmente ...

En los países en desarrollo, como Estados Unidos, Canadá y Reino Unido, es cada vez mayor el empleo de instrumentos para medir la calidad de vida asociada a la salud. Estas medidas deben pasar por procesos de traducción, validación y adaptación cultural antes de ser utilizadas en países y/o idiomas diferentes a los de su origen. La utilización de instrumentos desarrollados en otros contextos culturales presenta varios desafíos, tales como la propiedad de la traducción, la adecuación de la adaptación cultural, así como un proceso de validación satisfactorio. Las preferencias por estados de salud basadas en la teoría de la utilidad tienen un rol importante en la evaluación económica, principalmente en el análisis de costo-eficacia y costo-utilidad de intervenciones relacionadas con diversas enfermedades y condiciones de salud, como el cáncer en la infancia y la supervivencia. Algunos trabajos desarrollados recientemente tienen como objetivo crear y aplicar medidas de calidad de vida obtenidas a través de la medición de preferencias por estados de salud, en grupos jóvenes, tales como niños y adolescentes. La necesidad de utilización de informantes sustitutos es un tema que traspasa el uso de estas medidas en estos grupos, especialmente en niños. Esta revisión presenta una evaluación crítica del uso de medidas de calidad de vida asociadas a la salud, obtenidas a través de las preferencias por estados de salud en países en desarrollo, con foco en las medidas denominadas Health Utilities Index, Mark 2 y Mark 3, comúnmente conocidas como HU12 y HU13, y su aplicación para sobrevivientes de cáncer en la infancia en América Latina. Se realiza una discusión crítica del proceso utilizado por los investigadores cuando emplean instrumentos anteriormente traducidos. También se plantea la propiedad de otros instrumentos, con énfasis en los atributos o dominios comprendidos por cada medida analizada para el cáncer en la infancia. Se espera que esta revisión ...

Falhas na operação transitivista materna na síndrome de Münchhausen por procuração / Fallas en la operación transitivista materna en el síndrome de Münchhausen por poder / La faillite de la fonction transitiviste dans le syndrome de Münchhausen par procuration / Failings in maternal transitivist operation in the Münchhausen syndrome by proxy

A síndrome de Münchausen por procuração (Münchhausen syndrom by Proxy - MSBP), incluída desde 1980 no DSM-III, se configura quando uma pessoa próxima da criança (na grande maioria dos casos, a mãe) sugere ou produz signos falsos para que ela seja examinada por médicos. O presente artigo propõe uma leitura dessa configuração desde a perspectiva psicanalítica. Trabalha-se com a hipótese de tratar-se de um quadro ocasionado por uma falha na operação transitivista materna.

El síndrome de Münchhausen por poder (Münchhausen syndrom by Proxy-MSBP), incluido desde 1980 en el DSM-III, se configura cuando una persona próxima al niño (en la mayoría de los casos, la madre) sugiere o produce signos falsos para que él sea examinado por médicos. El presente artículo propone una lectura de esta configuración desde la perspectiva psicoanalítica. Se trabaja con la hipótesis de que se trata de un cuadro ocasionado por una falla en la operación transitivista materna.

Le syndrome de Münchhausen par procuration (Münchhausen syndrom by Proxy-MSBP), inclus dans le DSM-III depuis 1980, se configure quand une personne proche de l'enfant (en général la mère) suggère ou produit de faux signes pour que celui-ci soit examiné par le corps médical. Cet article propose une lecture de cette configuration du point de vue de la psychanalyse. Il développe l'hypothèse d'un tableau clinique provoqué par une faille de la position transitiviste chez la mère.

The Münchhausen syndrome by proxy (MSbP), included in the DSM-III since 1980, consists of behaviors whereby a person who is close to a child (almost always the mother) suggests or feigns false signs in order to have the child submitted to medical examination. The present article proposes a reading of this configuration from a psychoanalytic perspective. The basic hypothesis is that this disorder is produced by failings in the mother's operation of transitivism.

A Case of Munchausen Syndrome by Proxy / 대한소아신경학회지

Munchausen syndrome by proxy(MBP) is the act of one person fabricating or inducing an illness in another to meet his or her own emotional needs through the treatment process. MBP is thought to be rare. We report the case of 11-year-old girl who presented with general weakness, dizziness, headache, and nausea and she was suspected of Munchausen syndrome by proxy.

El barón enfermo: síndrome de Münchausen / The sick baron: Münchausen’s syndrome

El Síndrome de Münchausen es una entidad psiquiátrica relativamente rara en la cual el paciente se provoca a sí mismo, o a las personas, a su cargo múltiples sintomatologías de manera deliberada, pudiendo resultar incluso en amputaciones o muerte. Lo hace de una forma consciente pero sin ningún tipo de ganancia primaria presente, sólo por el “placer” de sentirse atendido por el personal asistencial. Es una patología que plantea todo un reto para el clínico, puesto que no posee un cuadro sindrómico típico.

Münchausen’s Syndrome is a psychiatric disease that’s considered as relatively rare; in which the patients causes multiple symptoms and diseases Either to themselves or the people around them, with the possibility of resulting in amputations or even death. The patient engages in this behavior being conscious of what he’s doing, butwith no secondary gain at all, just the “pleasure” of feeling taken care of by the medical personnel. It is a disease that lacks a characteristic clinical course, therefore is of great difficulty to the doctor to diagnose properly an in time.

Research on translation and psychometric evaluation and test of chinese version of Stroke Impact Scale 3.0 for Proxy / 中国神经精神疾病杂志

Background Quality of life(QOL) refers to the person's subjective appraisal of well-being,life satisfaction,health and functional performance. For those stroke patients who cannot finish the scale themselves,we can try the proxy measurement. However,until recently no QOL scale for proxies were induced to Chinese stroke patients. The goal of this research is to translate and test the SIS 3.0 for proxy,and differences between patient and proxy scores. To translate and test the SIS 3.0 for proxy, and analyzed differences between patient and proxy scores.Methods Ten pairs of patients and their proxies were involved in the primary test. Two hundreds and thirty-three pairs were involved in the formal test. We analyzed the validity, responsiveness, reliability and feasibility of the SIS 3.0 for proxy, as well as the validity in proxy assessment. Results The feasibility was sufficient. Both Split reliability and α coefficient were more than 0.8, demonstrating SIS a reliable instrument. SIS had a good content validity with correlation coefficient more than 0.6. Good criterion validity was established by comparing the scores on various domains to standardized measures with P=0.000. Construct validity was also good as indicated by factor analysis. Proxy scores were significantly different across OHS scales which showed domain responsiveness was good. Comparison of patient and proxy responses resulted in no significant difference. Conclusions SIS for proxy is satisfactory for chinese patients. It is feasible to use a proxy respondent to answer questions on the patient's behalf.