Munchausen Syndrome by Proxy: A phenomenon in which symptoms of a disease are fabricated by an individual other than the patient causing unnecessary, and often painful, physical examinations and treatments. This syndrome is considered a form of CHILD ABUSE, since another individual, usually a parent, is the source of the fabrication of symptoms and presents the child for medical care.Third-Party Consent: Informed consent given by someone other than the patient or research subject.Mental Competency: The ability to understand the nature and effect of the act in which the individual is engaged. (From Black's Law Dictionary, 6th ed).Self-Assessment: Appraisal of one's own personal qualities or traits.Munchausen Syndrome: A factitious disorder characterized by habitual presentation for hospital treatment of an apparent acute illness, the patient giving a plausible and dramatic history, all of which is false.Spheniscidae: The sole family in the order Sphenisciformes, comprised of 17 species of penguins in six genera. They are flightless seabirds of the Southern Hemisphere, highly adapted for marine life.Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.Reproducibility of Results: The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.Advance Directives: Declarations by patients, made in advance of a situation in which they may be incompetent to decide about their own care, stating their treatment preferences or authorizing a third party to make decisions for them. (Bioethics Thesaurus)KansasCaregivers: Persons who provide care to those who need supervision or assistance in illness or disability. They may provide the care in the home, in a hospital, or in an institution. Although caregivers include trained medical, nursing, and other health personnel, the concept also refers to parents, spouses, or other family members, friends, members of the clergy, teachers, social workers, fellow patients.Child Custody: The formally authorized guardianship or care of a CHILD.Questionnaires: Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.Health Status Indicators: The measurement of the health status for a given population using a variety of indices, including morbidity, mortality, and available health resources.Sickness Impact Profile: A quality-of-life scale developed in the United States in 1972 as a measure of health status or dysfunction generated by a disease. It is a behaviorally based questionnaire for patients and addresses activities such as sleep and rest, mobility, recreation, home management, emotional behavior, social interaction, and the like. It measures the patient's perceived health status and is sensitive enough to detect changes or differences in health status occurring over time or between groups. (From Medical Care, vol.xix, no.8, August 1981, p.787-805)Natural History: A former branch of knowledge embracing the study, description, and classification of natural objects (as animals, plants, and minerals) and thus including the modern sciences of zoology, botany, and mineralogy insofar as they existed at that time. In the 17th, 18th, and 19th centuries it was much used for the generalized pursuit of certain areas of science. (Webster, 3d ed; from Dr. James H. Cassedy, NLM History of Medicine Division)El Nino-Southern Oscillation: El Nino-Southern Oscillation or ENSO is a cycle of extreme alternating warm El Niño and cold La Nina events which is the dominant year-to-year climate pattern on Earth. Both terms refer to large-scale changes in sea-surface temperature across the eastern tropical Pacific. ENSO is associated with a heightened risk of certain vector-borne diseases. (From http://www.elnino.noaa.gov/lanina_new_faq.html, accessed 5/12/2020)Legal Guardians: A legal concept for individuals who are designated to act on behalf of persons who are considered incapable of acting in their own behalf, e.g., minors and persons found to be not mentally competent.Geology: The science of the earth and other celestial bodies and their history as recorded in the rocks. It includes the study of geologic processes of an area such as rock formations, weathering and erosion, and sedimentation. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed)Patients: Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Animal Shells: The hard rigid covering of animals including MOLLUSCS; TURTLES; INSECTS; and crustaceans.Archaeology: The scientific study of past societies through artifacts, fossils, etc.Geography: The science dealing with the earth and its life, especially the description of land, sea, and air and the distribution of plant and animal life, including humanity and human industries with reference to the mutual relations of these elements. (From Webster, 3d ed)Living Wills: Written, witnessed declarations in which persons request that if they become disabled beyond reasonable expectation of recovery, they be allowed to die rather than be kept alive by extraordinary means. (Bioethics Thesaurus)Climate: The longterm manifestations of WEATHER. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed)Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, or eating.Observer Variation: The failure by the observer to measure or identify a phenomenon accurately, which results in an error. Sources for this may be due to the observer's missing an abnormality, or to faulty technique resulting in incorrect test measurement, or to misinterpretation of the data. Two varieties are inter-observer variation (the amount observers vary from one another when reporting on the same material) and intra-observer variation (the amount one observer varies between observations when reporting more than once on the same material).Parents: Persons functioning as natural, adoptive, or substitute parents. The heading includes the concept of parenthood as well as preparation for becoming a parent.Ecosystem: A functional system which includes the organisms of a natural community together with their environment. (McGraw Hill Dictionary of Scientific and Technical Terms, 4th ed)Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Self Report: Method for obtaining information through verbal responses, written or oral, from subjects.Family: A social group consisting of parents or parent substitutes and children.Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.United StatesPsychometrics: Assessment of psychological variables by the application of mathematical procedures.Fecal Impaction: Formation of a firm impassable mass of stool in the RECTUM or distal COLON.Fossils: Remains, impressions, or traces of animals or plants of past geological times which have been preserved in the earth's crust.Isochores: Large regions of the GENOME that contain local similarities in BASE COMPOSITION.Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.Advance Care Planning: Discussions with patients and/or their representatives about the goals and desired direction of the patient's care, particularly end-of-life care, in the event that the patient is or becomes incompetent to make decisions.Bias (Epidemiology): Any deviation of results or inferences from the truth, or processes leading to such deviation. Bias can result from several sources: one-sided or systematic variations in measurement from the true value (systematic error); flaws in study design; deviation of inferences, interpretations, or analyses based on flawed data or data collection; etc. There is no sense of prejudice or subjectivity implied in the assessment of bias under these conditions.Visual Analog Scale: A subjective psychometric response scale used to measure distinct behavioral or physiological phenomena based on linear numerical gradient or yes/no alternatives.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Residence Characteristics: Elements of residence that characterize a population. They are applicable in determining need for and utilization of health services.Terminal Care: Medical and nursing care of patients in the terminal stage of an illness.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Outcome Assessment (Health Care): Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).Seasons: Divisions of the year according to some regularly recurrent phenomena usually astronomical or climatic. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed)Rain: Water particles that fall from the ATMOSPHERE.Informed Consent: Voluntary authorization, by a patient or research subject, with full comprehension of the risks involved, for diagnostic or investigative procedures, and for medical and surgical treatment.Geologic Sediments: A mass of organic or inorganic solid fragmented material, or the solid fragment itself, that comes from the weathering of rock and is carried by, suspended in, or dropped by air, water, or ice. It refers also to a mass that is accumulated by any other natural agent and that forms in layers on the earth's surface, such as sand, gravel, silt, mud, fill, or loess. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed, p1689)Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness.Nursing Homes: Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.Censuses: Enumerations of populations usually recording identities of all persons in every place of residence with age or date of birth, sex, occupation, national origin, language, marital status, income, relation to head of household, information on the dwelling place, education, literacy, health-related data (e.g., permanent disability), etc. The census or "numbering of the people" is mentioned several times in the Old Testament. Among the Romans, censuses were intimately connected with the enumeration of troops before and after battle and probably a military necessity. (From Last, A Dictionary of Epidemiology, 3d ed; Garrison, An Introduction to the History of Medicine, 4th ed, p66, p119)Geriatric Psychiatry: A subspecialty of psychiatry concerned with the mental health of the aged.Geological Phenomena: The inanimate matter of Earth, the structures and properties of this matter, and the processes that affect it.Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches.Solar Activity: Any type of variation in the appearance of energy output of the sun. (NASA Thesaurus, 1994)Child Advocacy: Promotion and protection of the rights of children; frequently through a legal process.Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income.Small-Area Analysis: A method of analyzing the variation in utilization of health care in small geographic or demographic areas. It often studies, for example, the usage rates for a given service or procedure in several small areas, documenting the variation among the areas. By comparing high- and low-use areas, the analysis attempts to determine whether there is a pattern to such use and to identify variables that are associated with and contribute to the variation.History, 15th Century: Time period from 1401 through 1500 of the common era.Animal Distribution: A process by which animals in various forms and stages of development are physically distributed through time and space.Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group.Paleontology: The study of early forms of life through fossil remains.Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression.Models, Theoretical: Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.GreenlandAsphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life.Oceans and Seas: A great expanse of continuous bodies of salt water which together cover more than 70 percent of the earth's surface. Seas may be partially or entirely enclosed by land, and are smaller than the five oceans (Atlantic, Pacific, Indian, Arctic, and Antarctic).Time Factors: Elements of limited time intervals, contributing to particular results or situations.Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals.Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.History, 17th Century: Time period from 1601 through 1700 of the common era.Cedrela: A plant genus of the family MELIACEAE. Members contain cedrelanolide.Cognitive Reserve: Capacity that enables an individual to cope with and/or recover from the impact of a neural injury or a psychotic episode.Self Disclosure: A willingness to reveal information about oneself to others.Race Relations: Cultural contacts between people of different races.Infant, Newborn: An infant during the first month after birth.Family Characteristics: Size and composition of the family.Environmental Monitoring: The monitoring of the level of toxins, chemical pollutants, microbial contaminants, or other harmful substances in the environment (soil, air, and water), workplace, or in the bodies of people and animals present in that environment.Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time.Rhizophoraceae: A plant family of the order Rhizophorales, subclass Rosidae, class Magnoliopsida, that includes mangrove trees.Spouses: Married persons, i.e., husbands and wives, or partners. Domestic partners, or spousal equivalents, are two adults who have chosen to share their lives in an intimate and committed relationship, reside together, and share a mutual obligation of support for the basic necessities of life.History, Ancient: The period of history before 500 of the common era.History, 18th Century: Time period from 1701 through 1800 of the common era.History, 16th Century: Time period from 1501 through 1600 of the common era.Child Abuse: Abuse of children in a family, institutional, or other setting. (APA, Thesaurus of Psychological Index Terms, 1994)Atlantic OceanGreat BritainLogistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Tropical Climate: A climate which is typical of equatorial and tropical regions, i.e., one with continually high temperatures with considerable precipitation, at least during part of the year. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed)Atmosphere: The gaseous envelope surrounding a planet or similar body. (From Random House Unabridged Dictionary, 2d ed)Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.Satellite Communications: Communications using an active or passive satellite to extend the range of radio, television, or other electronic transmission by returning signals to earth from an orbiting satellite.Acer: A plant genus of the family ACERACEAE, best known for trees with palmately lobed leaves.Law Enforcement: Organized efforts to insure obedience to the laws of a community.Ice Cover: A thick mass of ICE formed over large regions of land; RIVERS; LAKES; ponds; or SEAWATER.Electric Wiring: An arrangement of wires distributing electricity.Conservation of Natural Resources: The protection, preservation, restoration, and rational use of all resources in the total environment.Canada: The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.Interviews as Topic: Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.Life Support Care: Care provided patients requiring extraordinary therapeutic measures in order to sustain and prolong life.North AmericaPopulation Dynamics: The pattern of any process, or the interrelationship of phenomena, which affects growth or change within a population.Models, Statistical: Statistical formulations or analyses which, when applied to data and found to fit the data, are then used to verify the assumptions and parameters used in the analysis. Examples of statistical models are the linear model, binomial model, polynomial model, two-parameter model, etc.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Child Welfare: Organized efforts by communities or organizations to improve the health and well-being of the child.BaltimoreTerminally Ill: Persons with an incurable or irreversible illness at the end stage that will result in death within a short time. (From O'Leary et al., Lexikon: Dictionary of Health Care Terms, Organizations, and Acronyms for the Era of Reform, 1994, p780)Biodiversity: The variety of all native living organisms and their various forms and interrelationships.Mothers: Female parents, human or animal.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Attitude to Health: Public attitudes toward health, disease, and the medical care system.History, Medieval: The period of history from the year 500 through 1450 of the common era.Environment: The external elements and conditions which surround, influence, and affect the life and development of an organism or population.Household Articles: Various material objects and items in the home. It includes temporary or permanent machinery and appliances. It does not include furniture or interior furnishings (FURNITURE see INTERIOR DESIGN AND FURNISHINGS; INTERIOR FURNISHINGS see INTERIOR DESIGN AND FURNISHINGS).Oxygen Isotopes: Stable oxygen atoms that have the same atomic number as the element oxygen, but differ in atomic weight. O-17 and 18 are stable oxygen isotopes.Incidence: The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.Animals, ZooClimate Change: Any significant change in measures of climate (such as temperature, precipitation, or wind) lasting for an extended period (decades or longer). It may result from natural factors such as changes in the sun's intensity, natural processes within the climate system such as changes in ocean circulation, or human activities.Body Size: The physical measurements of a body.EnglandBiomass: Total mass of all the organisms of a given type and/or in a given area. (From Concise Dictionary of Biology, 1990) It includes the yield of vegetative mass produced from any given crop.Educational Status: Educational attainment or level of education of individuals.Population Surveillance: Ongoing scrutiny of a population (general population, study population, target population, etc.), generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy.Homicide: The killing of one person by another.Suburban Health: The status of health in suburban populations.Poverty Areas: City, urban, rural, or suburban areas which are characterized by severe economic deprivation and by accompanying physical and social decay.Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly.Death: Irreversible cessation of all bodily functions, manifested by absence of spontaneous breathing and total loss of cardiovascular and cerebral functions.Stroke: A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)Confounding Factors (Epidemiology): Factors that can cause or prevent the outcome of interest, are not intermediate variables, and are not associated with the factor(s) under investigation. They give rise to situations in which the effects of two processes are not separated, or the contribution of causal factors cannot be separated, or the measure of the effect of exposure or risk is distorted because of its association with other factors influencing the outcome of the study.Republic of BelarusEffect Modifier, Epidemiologic: Factors that modify the effect of the putative causal factor(s) under study.Matched-Pair Analysis: A type of analysis in which subjects in a study group and a comparison group are made comparable with respect to extraneous factors by individually pairing study subjects with the comparison group subjects (e.g., age-matched controls).Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.Income: Revenues or receipts accruing from business enterprise, labor, or invested capital.Biological Evolution: The process of cumulative change over successive generations through which organisms acquire their distinguishing morphological and physiological characteristics.Severity of Illness Index: Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.Ecology: The branch of science concerned with the interrelationship of organisms and their ENVIRONMENT, especially as manifested by natural cycles and rhythms, community development and structure, interactions between different kinds of organisms, geographic distributions, and population alterations. (Webster's, 3d ed)Parent-Child Relations: The interactions between parent and child.Feeding Behavior: Behavioral responses or sequences associated with eating including modes of feeding, rhythmic patterns of eating, and time intervals.Global Warming: Increase in the temperature of the atmosphere near the Earth's surface and in the troposphere, which can contribute to changes in global climate patterns.Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations.BostonHousing: Living facilities for humans.EuropeOdds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases.Extinction, Biological: The ceasing of existence of a species or taxonomic groups of organisms.Water Movements: The flow of water in enviromental bodies of water such as rivers, oceans, water supplies, aquariums, etc. It includes currents, tides, and waves.Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.Arctic Regions: The Arctic Ocean and the lands in it and adjacent to it. It includes Point Barrow, Alaska, most of the Franklin District in Canada, two thirds of Greenland, Svalbard, Franz Josef Land, Lapland, Novaya Zemlya, and Northern Siberia. (Webster's New Geographical Dictionary, 1988, p66)Seawater: The salinated water of OCEANS AND SEAS that provides habitat for marine organisms.Community Medicine: A branch of medicine concerned with the total health of the individual within the home environment and in the community, and with the application of comprehensive care to the prevention and treatment of illness in the entire community.Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney.Statistics as Topic: The science and art of collecting, summarizing, and analyzing data that are subject to random variation. The term is also applied to the data themselves and to the summarization of the data.Morbidity: The proportion of patients with a particular disease during a given year per given unit of population.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Neuropsychological Tests: Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury.Sick Role: Set of expectations that exempt persons from responsibility for their illness and exempt them from usual responsibilities.CaliforniaResearch Subjects: Persons who are enrolled in research studies or who are otherwise the subjects of research.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Marine Biology: The study of the origin, structure, development, growth, function, genetics, and reproduction of organisms which inhabit the OCEANS AND SEAS.Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes, and the genital tract in the male. Common urological problems include urinary obstruction, URINARY INCONTINENCE, infections, and UROGENITAL NEOPLASMS.Depression: Depressive states usually of moderate intensity in contrast with major depression present in neurotic and psychotic disorders.SwedenEpidemiologic Methods: Research techniques that focus on study designs and data gathering methods in human and animal populations.Chronic Disease: Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)Rural Population: The inhabitants of rural areas or of small towns classified as rural.Wetlands: Environments or habitats at the interface between truly terrestrial ecosystems and truly aquatic systems making them different from each yet highly dependent on both. Adaptations to low soil oxygen characterize many wetland species.Exotropia: A form of ocular misalignment where the visual axes diverge inappropriately. For example, medial rectus muscle weakness may produce this condition as the affected eye will deviate laterally upon attempted forward gaze. An exotropia occurs due to the relatively unopposed force exerted on the eye by the lateral rectus muscle, which pulls the eye in an outward direction.Sex Distribution: The number of males and females in a given population. The distribution may refer to how many men or women or what proportion of either in the group. The population is usually patients with a specific disease but the concept is not restricted to humans and is not restricted to medicine.Geographic Information Systems: Computer systems capable of assembling, storing, manipulating, and displaying geographically referenced information, i.e. data identified according to their locations.Greenhouse Effect: The effect of GLOBAL WARMING and the resulting increase in world temperatures. The predicted health effects of such long-term climatic change include increased incidence of respiratory, water-borne, and vector-borne diseases.Cognition: Intellectual or mental process whereby an organism obtains knowledge.Urban Health: The status of health in urban populations.Mortality: All deaths reported in a given population.Fisheries: Places for cultivation and harvesting of fish, particularly in sea waters. (from McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed)Phylogeny: The relationships of groups of organisms as reflected by their genetic makeup.Poisoning: A condition or physical state produced by the ingestion, injection, inhalation of or exposure to a deleterious agent.Lakes: Inland bodies of still or slowly moving FRESH WATER or salt water, larger than a pond, and supplied by RIVERS and streams.ChicagoContinental Population Groups: Groups of individuals whose putative ancestry is from native continental populations based on similarities in physical appearance.Cognition Disorders: Disturbances in mental processes related to learning, thinking, reasoning, and judgment.Disability Evaluation: Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workmen's compensation benefits.European Continental Ancestry Group: Individuals whose ancestral origins are in the continent of Europe.Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided.Human Experimentation: The use of humans as investigational subjects.Morals: Standards of conduct that distinguish right from wrong.Population Density: Number of individuals in a population relative to space.Anthozoa: A class in the phylum CNIDARIA, comprised mostly of corals and anemones. All members occur only as polyps; the medusa stage is completely absent.Altitude: A vertical distance measured from a known level on the surface of a planet or other celestial body.Predatory Behavior: Instinctual behavior pattern in which food is obtained by killing and consuming other species.Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable.Data Interpretation, Statistical: Application of statistical procedures to analyze specific observed or assumed facts from a particular study.
Roy Meadow: Sir Samuel Roy Meadow (born 1933) is a retired British paediatrician, who first came to public prominence following a 1977 academic paper describing a phenomenon dubbed Munchausen Syndrome by Proxy (MSbP). For his work, ‘The Captive Mother’, he was awarded the prestigious Donald Paterson prize of the British Paediatric Association in 1968; in 1980 when a second professorial chair in paediatrics was inaugurated at St James’s University Hospital, Leeds, he was invited to accept it; in 1998, he was knighted for services to child health.Flightless birdTime-trade-off: Time-Trade-Off (TTO) is a tool used in health economics to help determine the quality of life of a patient or group. The individual will be presented with a set of directions such as:Generalizability theory: Generalizability theory, or G Theory, is a statistical framework for conceptualizing, investigating, and designing reliable observations. It is used to determine the reliability (i.Large Combustion Plant Directive: The Large Combustion Plant Directive (LCPD, 2001/80/EC) is a European Union directive which requires member states of the European Union to legislatively limit flue gas emissions from combustion plant having thermal capacity of 50 MW or greater. The directive applies to fossil-fuel power stations, and other large thermal plant such as petroleum refineries and steelworks.John Martin (Governor of Kansas): John Alexander Martin (March 10, 1839 – October 2, 1889) was the 10th Governor of Kansas.Shared parenting: Shared parenting refers to a collaborative arrangement in child custody or divorce determinations in which both parents have the right and responsibility of being actively involved in the raising of the child(ren). The term is often used as a synonym for joint physical custody, but the exact definitions vary, with different jurisdictions defining it in different ways, and different sources using the term in different ways.Closed-ended question: A closed-ended question is a question format that limits respondents with a list of answer choices from which they must choose to answer the question.Dillman D.St. Herman's Blue Hole National Park: St. Herman's Blue Hole National Park is a national park located just off the Hummingbird Highway in Cayo District of Belize, near Belmopan, the capital city.Nina ArvesenTerri (film)Index of geology articles: This is a list of all articles related to geology that cannot be readily placed on the following subtopic pages:Pinna carneaComputational archaeology: Computational archaeology describes computer-based analytical methods for the study of long-term human behaviour and behavioural evolution. As with other sub-disciplines that have prefixed 'computational' to their name (e.Health geography: Health geography is the application of geographical information, perspectives, and methods to the study of health, disease, and health care.Wills Sainte Claire: Wills Sainte Claire was an automobile brand manufactured by the C. H.Hadley Centre for Climate Prediction and Research: 140px|rightBristol Activities of Daily Living Scale: The Bristol Activities of Daily Living Scale (BADLS) is a 20-item questionnaire designed to measure the ability of someone with dementia to carry out daily activities such as dressing, preparing food and using transport.Parent structure: In IUPAC nomenclature, a parent structure, parent compound, parent name or simply parent is the denotation for a compound consisting of an unbranched chain of skeletal atoms (not necessarily carbon), or consisting of an unsubstituted monocyclic or polycyclic ring system.EcosystemSelf-rated health: Self-rated health (also called Self-reported health, Self-assessed health, or perceived health) refers to both a single question such as “in general, would you say that you health is excellent, very good, good, fair, or poor?” and a survey questionnaire in which participants assess different dimensions of their own health.List of Parliamentary constituencies in Kent: The ceremonial county of Kent,David Budescu: David Budescu is a psychologist and academic. He is the Anne Anastasi Professor of Psychometrics and Quantitative Psychology at Fordham University.Impaction (animals): Impaction occurs in reptiles when they consume something that they cannot digest. Common causes of impaction are rocks and sand, which might be accidentally consumed when the reptile attacks its prey.Large ornamented Ediacaran microfossil: Large ornamented Ediacaran microfossils (LOEMs) are microscopic acritarchs, usually over 100 μm in diameter, which are common in sediments of the Ediacaran period, . They largely disappear from the Ediacaran fossil record before , roughly coeval with the origin of the Ediacara biota.Isochore (genetics): In genetics, an isochore is a large region of DNA (greater than 300 kb) with a high degree uniformity in guanine (G) and cytosine (C): G-Information bias (epidemiology): Information bias}}QRISK: QRISK2 (the most recent version of QRISK) is a prediction algorithm for cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood pressure, smoking status and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with body mass index, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.Regression dilution: Regression dilution, also known as regression attenuation, is the biasing of the regression slope towards zero (or the underestimation of its absolute value), caused by errors in the independent variable.Neighbourhood: A neighbourhood (Commonwealth English), or neighborhood (American English), is a geographically localised community within a larger city, town, suburb or rural area. Neighbourhoods are often social communities with considerable face-to-face interaction among members.Four Seasons Baltimore and Residences: Four Seasons Hotel Baltimore is currently a 22 story highrise hotel complex building which opened on November 14, 2011. The building's construction began back in 2007 and went through several changes.The Rain Rain Rain Came Down Down Down: "The Rain Rain Rain Came Down Down Down" is a narrative song from the Walt Disney musical film featurette, Winnie the Pooh and the Blustery Day. The song is also incorporated into the 1977 musical film The Many Adventures of Winnie the Pooh which is an amalgamation of three Winnie-the-Pooh featurettes including "Blustery Day".Nankai Trough gas hydrate site: Nankai Methane Hydrate Site (or Japanese Methane Hydrate R&D Program at Nankai, Nankai Trough Methane Hydrate Site) is located in the Nankai Trough, Japan.Familial British dementia: Familial British dementia is a form of dementia. It was first reported by Cecil Charles Worster-Drought in 1933 and is therefore also known as Worster-Drought syndrome.Home of the future: The home of the future, similar to the office of the future, is a concept that has been popular to explore since the early 20th century, or perhaps earlier. There have been many exhibits, such as at World's Fairs and theme parks, purporting to show how future homes will look and work, as well as standalone model "homes of the future" sponsored by builders, developers, or technology companies.Abbreviated mental test score: The abbreviated mental test score (AMTS) was introduced by Hodkinson in 1972 rapidly to assess elderly patients for the possibility of dementia. Its uses in medicine have become somewhat wider, e.List of geological phenomena: A geological phenomenon is a phenomenon which is explained by or sheds light on the science of geology.Peat swamp forest: Peat swamp forests are tropical moist forests where waterlogged soil prevents dead leaves and wood from fully decomposing. Over time, this creates a thick layer of acidic peat.Sunspots (economics): In economics, the term sunspots (or sometimes "a sunspot") usually refers to an extrinsic random variable, that is, a random variable that does not affect economic fundamentals (such as endowments, preferences, or technology). Sunspots can also refer to the related concept of extrinsic uncertainty, that is, economic uncertainty that does not come from variation in economic fundamentals.Child Rights Taskforce – AustraliaRelative index of inequality: The relative index of inequality (RII) is a regression-based index which summarizes the magnitude of socio-economic status (SES) as a source of inequalities in health. RII is useful because it takes into account the size of the population and the relative disadvantage experienced by different groups.CASY cell counting technology: CASY technology is an electric field multi-channel cell counting system. It was first marketed by Schärfe System GmbH in 1987 under the name CASY1.Greenpoint Renaissance Enterprise Corporation: The Greenpoint Renaissance Enterprise Corporation (GREC) is a consortium of neighborhood organizations in North Brooklyn that serves to facilitate and advocate the activities for city initiatives, as well as coordinate community involvement in the neighborhood of the former Greenpoint Hospital Complex.Lang, Frank.Nested case-control study: A nested case control (NCC) study is a variation of a case-control study in which only a subset of controls from the cohort are compared to the incident cases. 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To avoid the possible confusion with the regular rings and regular local rings of commutative algebra (which are unrelated notions), von Neumann regular rings are also called absolutely flat rings, because these rings are characterized by the fact that every left module is flat.Greenland Provincial Council: The Greenland Provincial Council () was the provincial government of Greenland between 1950, when it was formed from the union of the earlier North and South Greenland Provincial Councils, and 1 May 1979, when it was replaced by the Greenland Home Rule Government and its Parliament (; ).Positional asphyxia: Positional asphyxia, also known as postural asphyxia, is a form of asphyxia which occurs when someone's position prevents the person from breathing adequately. Positional asphyxia may be a factor in a significant number of people who die suddenly during restraint by police, prison (corrections) officers or health care staff.Anoxic event: Oceanic anoxic events or anoxic events (anoxia conditions) refer to intervals in the Earth's past where portions of oceans become depleted in oxygen (O2) at depths over a large geographic area. During some of these events, euxinia develops - euxinia refers to anoxic waters that contain hydrogen sulfide.Temporal analysis of products: Temporal Analysis of Products (TAP), (TAP-2), (TAP-3) is an experimental technique for studyingAge adjustment: In epidemiology and demography, age adjustment, also called age standardization, is a technique used to allow populations to be compared when the age profiles of the populations are quite different.Discoverer 23William Peters (journalist): William Ernest Peters Jr. (July 30, 1921 – May 20, 2007) was an award-winning American journalist and documentary filmmaker who frequently covered race relations in the United States.Kandelia obovata: Kandelia obovata (Traditional Chinese: 水筆仔、秋茄樹) is a species of plant in the Rhizophoraceae family, i.e.Laureen Harper: borderTimeline of historic inventionsEnlightenment Intensive: An Enlightenment Intensive is a group retreat designed to enable a spiritual enlightenment experience within a relatively short time. Devised by Americans Charles (1929–2007) and Ava Berner in the 1960s,http://www.Ippolito de' MediciIn Memory of Celtic Frost: In Memory of... Celtic Frost is a Celtic Frost tribute album released in 1996.National Cancer Research Institute: The National Cancer Research Institute (NCRI) is a UK-wide partnership between cancer research funders, which promotes collaboration in cancer research. Its member organizations work together to maximize the value and benefit of cancer research for the benefit of patients and the public.Water Agriculture and Health in Tropical Area: Water Agriculture and Health in Tropical Area (French, Eau Agriculture Et Sante Et Milieu Tropical (E.A.Stratosphere: The stratosphere is the second major layer of Earth's atmosphere, just above the troposphere, and below the mesosphere. It is stratified in temperature, with warmer layers higher up and cooler layers farther down.Landsat 4Eutypella parasitica: Eutypella canker is a plant disease caused by the fungal pathogen Eutypella parasitica. This disease is capable of infecting many species of maple trees and produces a large, distinguishable canker on the main trunk of the tree.
(1/186) Influence of proxy respondents in children's health interview surveys.
STUDY OBJECTIVES: To study the influence of the proxy respondent on health interview surveys in children. DESIGN: Cross sectional study. SETTING: Children under the age of 15 years drawn from the general population of Catalonia, Spain. PARTICIPANTS: The Catalan Health Interview Survey consisted of a multistage probability sample representative to the population of Catalonia. The sample size was 2433 children younger than 15 years of age. The interviews were answered by proxy respondents (the mother, father, or other carer), with the questionnaire adapted for the proxy respondent. Logistic regression models were used to analyse the relation between the proxy respondent's characteristics and health status and health care utilisation, controlling for the effect of sociodemographic factors. MAIN RESULTS: Proxy respondent's characteristics influenced the reports of chronic conditions and accidents within the last year. Proxy respondents over 55 years (OR = 0.47; 95% CI = 0.26, 0.82), men (OR = 0.69; 95% CI = 0.53, 0.89), the father (OR = 0.66; 95% CI = 0.50, 0.89), and the grandparents (OR = 0.49; 95% CI = 0.26, 0.89), reported a lower rate of chronic conditions. Age of the proxy 55 years or greater (OR = 0.41; 95% CI = 0.20, 0.82), men (OR = 0.70; 95% CI = 0.52, 0.94), fathers (OR = 0.68; 95% CI = 0.49, 0.92), and grandparents (OR = 0.40; 95% CI = 0.18, 0.85) showed a lower probability to report accidents. No variables related to the proxy were associated with physician visits or hospitalisation in the previous year. CONCLUSIONS: Selected characteristics of the proxy respondent can influence responses to health surveys involving children. A minimum set of basic data should be collected from the proxy respondent to evaluate different patterns of response. (+info)
(2/186) Smoking status by proxy and self report: rate of agreement in different ethnic groups.
OBJECTIVE: To examine the rate of agreement between proxy and self report of smoking status in Hispanics compared with other ethnic groups. DESIGN: Data source is the 1990 California Tobacco Survey (CTS) which includes proxy and self reported smoking status. The CTS is a random digit dialed survey conducted in 57,244 households. A sample of 10,011 adults was included in the analyses. MAIN OUTCOME MEASURE: Percentages of agreement and disagreement between self report and report by other member of the household on smoking status. RESULTS: Cohen's kappa coefficients of agreement on smoking status between self report and proxy report was highest in non-Hispanic whites and African Americans (kappa = 0.91), followed by Asian Americans (kappa = 0.82) and Hispanics (kappa = 0.76). Among adults identified as current smokers by proxy, a lower percentage of Hispanics compared with non-Hispanics indicated that they were current smokers (odds ratio (OR) = 3.74, 95% confidence intervals (CI) = 3.28 to 4.20). Furthermore, agreement between proxy and self report was also lower in Hispanics of low acculturation compared with Hispanics with a high level of acculturation (OR = 0.40, 95% CI = 0 to 0.94). CONCLUSIONS: The agreement between self reported and proxy reported smoking status is higher among non-Hispanics compared with Hispanics. Smoking rates in different ethnic groups that are estimated by telephone surveys including proxy and self report might not be comparable. (+info)
(3/186) Validity of rapid estimates of household wealth and income for health surveys in rural Africa.
STUDY OBJECTIVE: To test the validity of proxy measures of household wealth and income that can be readily implemented in health surveys in rural Africa. DESIGN: Data are drawn from four different integrated household surveys. The assumptions underlying the choice of wealth proxy are described, and correlations with the true value are assessed in two different settings. The expenditure proxy is developed and then tested for replicability in two independent datasets representing the same population. SETTING: Rural areas of Mali, Malawi, and Cote d'Ivoire (two national surveys). PARTICIPANTS: Random sample of rural households in each setting (n=275, 707, 910, and 856, respectively). MAIN RESULTS: In both Mali and Malawi, the wealth proxy correlated highly (r>/=0.74) with the more complex monetary value method. For rural areas of Cote d'Ivoire, it was possible to generate a list of just 10 expenditure items, the values of which when summed correlated highly with expenditures on all items combined (r=0.74, development dataset, r=0. 72, validation dataset). Total household expenditure is an accepted alternative to household income in developing country settings. CONCLUSIONS: It is feasible to approximate both household wealth and expenditures in rural African settings without dramatically lengthening questionnaires that have a primary focus on health outcomes. (+info)
(4/186) End-of-life decision making: a qualitative study of elderly individuals.
OBJECTIVE: To identify the desired features of end-of-life medical decision making from the perspective of elderly individuals. DESIGN: Qualitative study using in-depth interviews and analysis from a phenomenologic perspective. SETTING: A senior center and a multilevel retirement community in Los Angeles. PARTICIPANTS: Twenty-one elderly informants (mean age 83 years) representing a spectrum of functional status and prior experiences with end-of-life decision making. MAIN RESULTS: Informants were concerned primarily with the outcomes of serious illness rather than the medical interventions that might be used, and defined treatments as desirable to the extent they could return the patient to his or her valued life activities. Advanced age was a relevant consideration in decision making, guided by concerns about personal losses and the meaning of having lived a "full life." Decision-making authority was granted both to physicians (for their technical expertise) and family members (for their concern for the patient's interests), and shifted from physician to family as the patient's prognosis for functional recovery became grim. Expressions of care, both by patients and family members, were often important contributors to end-of-life treatment decisions. CONCLUSIONS: These findings suggest that advance directives and physician-patient discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions, such as cardiopulmonary resuscitation. We propose a model of collaborative surrogate decision making by families and physicians that encourages physicians to assume responsibility for recommending treatment plans, including the provision or withholding of specific life-sustaining treatments, when such recommendations are consistent with patients' and families' goals for care. (+info)
(5/186) A randomized, controlled trial of advanced care planning discussions during preoperative evaluations.
BACKGROUND: Although many patients and physicians support the concept of advance care planning, only a small percentage of patients actually have the necessary discussion with health care providers. Hospital-based physicians other than primary care providers often are needed to increase physician, patient, and proxy communication about advanced directives. This study evaluated the effectiveness of a 5-10-min discussion designed to foster dialogue between patients and their proxies in a preoperative evaluation clinic. The discussions were lead by anesthesiologists. METHODS: A randomized controlled trial was conducted from September 1998 through May 1999 in a preoperative evaluation clinic at University of California, San Francisco, a tertiary care center. English-speaking patients aged 65 yr or older who were scheduled for elective surgery were randomized to receive a short information session stressing the importance of communication about end-of-life care between the patients and their proxies. Patients randomized to the control group received the standard preoperative anesthesia screening. An admitting counselor questioned all patients (control and intervention) about whether they have an advanced directive as part of the registration process before their arrival in clinic. RESULTS: The intervention significantly increased discussions about end-of-life care between patients and their proxies. Eighty seven percent of patients reported having discussions with their proxies as compared with only 66% of control patients (P = 0.001). The intervention also increased durable power of attorney completion rate to 27% as compared with 10% completion rate by controls. CONCLUSIONS: The preoperative evaluation period can be an opportunity to encourage patient and proxy communication about end-of-life care. (+info)
(6/186) Proxy reporting in the National Population Health Survey.
OBJECTIVES: This article examines the extent of proxy reporting in the National Population Health Survey (NPHS). It also explores associations between proxy reporting status and the prevalence of selected health problems, and investigates the relationship between changes in proxy reporting status and two-year incidence of health problems. DATA SOURCE: Cross-sectional results are based on the 1996/97 NPHS Health file and General file. Longitudinal results are based on 1994/95 respondents who were still residing in households in 1996/97. ANALYTICAL TECHNIQUES: The extent of proxy reporting in the various NPHS files was computed. Prevalence estimates of selected health problems from the two 1996/97 cross-sectional files were compared. Multivariate analyses were used to estimate associations between proxy reporting status and health problems. MAIN RESULTS: For several health conditions, prevalence estimates based on the 1996/97 cross-sectional Health file (where proxy reporting was less common) were significantly higher than estimates derived from the General file. Individuals whose data were proxy-reported in 1994/95 and self-reported in 1996/97 had higher odds of reporting new cases of certain health conditions. (+info)
(7/186) The role of proxies in treatment decisions: evaluating functional capacity to consent to end-of-life treatments within a family context.
Psychology as a profession has entered the arena of palliative and hospice care later in the process than other health care professions. Through the use of Familial Advance Planning Evaluations (FAPEs), however, psychologists can assist individuals and families in facing end-of-life transitions in important ways. Hospice and palliative care philosophy treats the patient and family as the unit of care. End-of-life decision-making is therefore a family matter as well as a normative developmental transition. Yet, little is known about the decision-making process. This paper reviews the literature regarding informed consent, advance care planning, and proxy decision-making and outlines a theoretical model for familial decision-making. Previous models of end-of-life capacity evaluations and family assessments are presented and serve as the basis for a comprehensive assessment of familial decision-making at the end of life. Functional capacity evaluations of individuals at the end of life regarding decisions about life-sustaining medical treatments enable both the individual patient and one identified proxy from his or her family to discuss important issues families may face during medical crises at the end of life. The information gleaned from such evaluations has the potential to assist psychologists and other professionals in designing family-specific interventions to reduce caregiving distress, improve quality of life for dying patients, and ease the transition to bereavement for caregivers. (+info)
(8/186) Family history of cancer and incidence of acute leukemia in adults.
Family history of cancer may represent shared genetic and environmental risk factors for leukemia. The authors examined associations of first-degree family history of cancer with adult acute leukemia incidence by using data on 811 patients (or their proxies) identified at diagnosis and 637 population-based controls in the United States and Canada during 1986-1990. For proxy-interviewed patients, relative risks were elevated for family history of any cancer (relative risk = 1.7, 95% confidence interval (CI): 1.3, 2.4), hematopoietic cancer (relative risk = 1.8, 95% CI: 1.1, 3.0), leukemia (relative risk = 2.4, 95% CI: 1.3, 4.6), and breast cancer (relative risk = 1.7, 95% CI: 1.0, 3.0) but not for colorectal, prostate, or lung cancer. For self-interviewed patients, family history of hematopoietic cancer was inversely associated with leukemia incidence (relative risk = 0.6, 95% CI: 0.4, 1.1). Regardless of patient interview type, history of breast cancer in sisters was positively associated with adult acute leukemia, whereas history of breast cancer in mothers was not. The role of family history of cancer in leukemia etiology is unclear because of differential reporting by patients and proxies. Specifically, self-interviewed patients may underreport cancer in their first-degree relatives. Associations between family history of breast cancer and leukemia incidence may be the result of unmeasured, shared etiologies specific to these cancers. (+info)