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This review focuses on the features of pseudotumor cerebri in the pediatric age group. There is no sex predilection in children, and obesity does not appear to be an important factor. Infants and young children may present with irritability, apathy, or somnolence, rather than headache. Dizziness and ataxia may also occur. Papilledema is infrequently noted in pediatric patients if the fontanelles are open or the sutures are split. Pre-adolescents appear more likely than adults or adolescents to have manifestations of their pseudotumor cerebri other than headache and papilledema, including lateral rectus pareses, vertical strabismus, facial paresis, back and neck pain. Among the etiologies that are particularly pertinent to children are tetracycline therapy, malnutrition or renutrition, and the correction of hypothyroidism. Children with pseudotumor cerebri are at risk for visual loss and their visual function must be closely monitored. Surgical intervention is imperative when vision is threatened.
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PMID:Pediatric pseudotumor cerebri (idiopathic intracranial hypertension). 147 50

A cross-sectional study was conducted to clarify the relationship between type A behavior pattern and life styles on 669 male and 60 female workers belonging to a financing company. A self-administered questionnaire was used to collect information on type A behavior pattern (including 11 questions), medical parameters and recent well-being. Principal component analysis was made to select the three major components concerning type A behavior pattern. The first component score represented overall irritability, the second score relaxation, and the third score etiology of irritability. After these component scores were adjusted to age, the following findings were observed. Smoking habits and heavy alcohol intake showed a significant correlation with a high score in the first principal component. General feeling during the past month and fatigability were related to the first and second principal component scores, respectively. Discouragement, bad arousal, little worth of living and apathy were negatively related to the second principal component score. Total cholesterol showed a positive correlation with the second principal component score (r = 0.140, p less than 0.01) in males and obesity index had a positive correlation with the second component score (r = 0.259, p less than 0.01) in females. Other medical parameters including high density lipoprotein, systolic and diastolic blood pressure did not demonstrate any significant correlation with principal component scores. It is important that recognition of type A behavior pattern may be applied to health education programs.
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PMID:[Type A behavior pattern in health education]. 362 20

The clinical syndromes described with lesions of the hypothalamus are summarized in Table 9.5-9.7. The anterior hypothalamic syndrome consists of insomnia and loss of thirst regulatory mechanisms. In occasional larger lesions which interrupt the output from the supraoptic and paraventricular nuclei, diabetes insipidus has been noticed. In the tuberal region of the hypothalamus the most prominent findings are those that are caused by the disruption of the final common pathway to the pituitary. This results in endocrinopathy, most often the syndrome originally reported by Frohlich, with failure of sexual maturation and obesity. In the tuberal region, differences between lesions of the medial and lateral portions are quite marked. Medial lesions result in obesity while bilateral lesions result in anorexia and emaciation. The diencephalic syndrome of infancy with it's severe emaciation in young years and obesity in later years clearly indicates a different organizational pattern in the neonatal hypothalamus. Emotional disorders may be seen with lesions either in the medial or lateral hypothalamus at the tuberal level. Finally, in the posterior hypothalamic region, which includes the greatest effector apparatus, hypersomnia, apathy, and poikilothermia have been reported. Emotional disturbances and the Wernicke-Korsakoff syndrome also seemed to be associated with lesions in this area. The hypothalamus remains the single most important integrator of vegetative and endocrinologic regulation of the body. Cushing said of the hypothalamus, "here in this hidden spot, almost to be covered with a thumb nail, lies the very main spring of primitive existence: vegetative, emotional and reproductive".
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PMID:Surgical syndromes of the hypothalamus. 727 50

Until recently, there was little empirical data regarding the psychological impact of screening for type 2 diabetes. There is now some progress in this area, as evidenced by emerging population based studies reporting on the effects of screening for type 2 diabetes on perceived health status and well-being. Recent studies from our own and other groups show that the diagnosis type 2 diabetes has no substantial adverse or positive effect on the participants' perceived health status and well-being after notification of the test result. Importantly, screening-detected type 2 diabetes patients beforehand perceive their risk for type 2 diabetes to be low, despite the presence of risk factors, such as obesity, hypertension and a family history, and overall report low levels of diabetes-related symptom distress. Yet, screening-detected type 2 diabetes patients were bothered more by symptoms of hyperglycaemia and fatigue in the first year following diagnosis type 2 diabetes than non-diabetics. On the basis of research to date, we conclude that screening for type 2 diabetes in the general population has no serious psychological side effects. Whether lack of emotional response to screening, is because of unawareness or indifference, needs further investigation. Future studies should be aiming towards a better understanding of how to raise the awareness and understanding of type 2 diabetes and its risk factors in high-risk individuals, while avoiding or minimizing negative effects, such as emotional distress and denial. The growing number of younger people developing type 2 diabetes warrants further research into labeling effects of an early diagnosis.
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PMID:The psychological impact of screening for type 2 diabetes. 1614 14

If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool. To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes--(1) underwriting on weight is allowed and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in bodyweight, and reduced social welfare. Using data on medical expenditures and bodyweight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate.
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PMID:Health insurance and the obesity externality. 1954 56

Childhood obesity is a major health concern. Inactivity is a major cause of this epidemic. The Healthy Active Living Committee of the Canadian Paediatric Society sampled 1866 paediatricians across Canada to assess members' knowledge of healthy active living (HAL), how they currently use HAL materials, what new materials would be most useful, and who would be most likely to carry the messages forward. The survey had only a 16% response rate. The results are published to help educate members, demonstrate the apparent lack of interest in a decidedly important area (and give reasons for this apathy), provide members with information on HAL materials, and update members on HAL committee actions since the survey was sent.
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PMID:Healthy active living: A goal or a mirage? A survey of Canadian paediatricians. 1965 1

Previous studies demonstrate that people high in delusional ideation exhibit a data-gathering bias on inductive reasoning tasks. The current study set out to investigate the factors that may underpin such a bias by examining healthy individuals, classified as either high or low scorers on the Peters et al. Delusions Inventory (PDI). More specifically, whether high PDI scorers have a relatively poor appreciation of sample size and heterogeneity when making statistical judgments. In Expt 1, high PDI scorers made higher probability estimates when generalizing from a sample of 1 with regard to the heterogeneous human property of obesity. In Expt 2, this effect was replicated and was also observed in relation to the heterogeneous property of aggression. The findings suggest that delusion-prone individuals are less appreciative of the importance of sample size when making statistical judgments about heterogeneous properties; this may underpin the data gathering bias observed in previous studies. There was some support for the hypothesis that threatening material would exacerbate high PDI scorers' indifference to sample size.
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PMID:Subclinical delusional ideation and appreciation of sample size and heterogeneity in statistical judgment. 2018 86

The authors have combined experience of over forty years working within the NHS and private hospitals as registered operating department practitioners. It is widely accepted that obesity is a growing problem in the populations of all developed and, increasingly, developing countries. It is also agreed that this sector of the population present specific challenges when required to undergo general anaesthesia. What is not so evident is a universal approach to assessing, predicting and overcoming these challenges. Furthermore, where there is the presentation of a clearly high risk patient, there can be limitations in optimizing the environment for reasons such as saving time, a lack of resources or sheer apathy. This article reviews the challenges, assessment and solutions available to the clinician faced with a high BMI patient with particular reference to the technique of ramping.
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PMID:The obese patient. Anaesthetic issues: airway and positioning. 2086 Jan 90

Considerable epidemiological, experimental and clinical data have amassed showing that the risk of developing disease in later life is dependent on early life conditions, mainly operating within the normative range of developmental exposures. This relationship reflects plastic responses made by the developing organism as an evolved strategy to cope with immediate or predicted circumstances, to maximize fitness in the context of the range of environments potentially faced. There is now increasing evidence, both in animals and humans, that such developmental plasticity is mediated in part by epigenetic mechanisms. However, recognition of the importance of developmental plasticity as an important factor in influencing later life health-particularly within the medical and public health communities-is low, and we argue that this indifference cannot be sustained in light of the growing understanding of developmental processes and the rapid rise in the prevalence of obesity and metabolic disease globally.
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PMID:The role of developmental plasticity and epigenetics in human health. 2142 38

An important development within the last decades is the consideration of the patient's perspective and the acknowledgement that the majority of patients are able to judge their state of well-being. Several self-report scales such as the "The Subjective Well-being under Neuroleptics Scale" (SWN) have been established. Additionally to their beneficial impact, current antipsychotics have considerable limitations. Antipsychotic-related side effects, such as extrapyramidalmotor symptoms, weight gain and obesity, apathy and anhedonia have an important influence on the patient's wellbeing. Evidence suggests that the so-called neuroleptic-induced deficit syndrome under antipsychotics might be caused by the inhibition of the dopaminergic reward system. A reduced activation of the ventral striatum, including the nucleus accumbens is associated with negative symptom severity. Second-generation antipsychotics (henceforth SGA) block striatal D2 receptors less and show a weaker binding to D2 receptors, have interactions with several other neurotransmitters and inhibit to a lesser degree the reward functions compared to first-generation antipsychotics (henceforth FGA). This may support the reduction of negative symptoms, contributes to a higher subjective well-being, a better medication adherence and thereby an improved therapeutic outcome. The involvement of the patient and the consideration of his/her subjective wellbeing will be a major aspect in the development of new treatment strategies in schizophrenia and has a significant impact on the adherence and the long-term prognosis.
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PMID:Subjective well-being of patients with schizophrenia as a target of drug treatment. 2228 57


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