SEARCH · Search PubMed

Results for “Proxy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources

PubMedDate not supplied

[A case of Munchausen syndrome by proxy with digestive symptoms and severe growth retardation].

A case of Munchausen syndrome by proxy in an infant presenting with recurrent vomiting and severe failure to thrive is described. Only very few cases of this syndrome have been reported in the italian literature in comparison to those described in the Anglo-Saxon countries. The factitious symptoms and signs fabricated or induced by parents lead to unnecessary medical investigation, hospital admissions and treatment. The Authors emphasize the difficulties in reaching a diagnosis and the risks of this potentially very dangerous behaviour in terms of morbidity and mortality. Since only one third of parents recover following psychotherapy, the offending parent should be sometimes separated from the child and promptly reported and closely supervised by the legal Authorities. Bizarre and otherwise peculiar, unexplained symptoms should always suggest the possibility of the Munchausen syndrome by proxy.

Child Abuse↗

PubMed1995

[Munchausen syndrome by proxy].

The term "Munchausen by proxy" denotes a special form of factitious disorder and a rare kind of child abuse. We present the case of a 12-year-old boy, whose mother's manipulations culminated in his immobilization in a wheelchair and the implantation of a pacemaker. Problems of diagnosis and clinical management of Munchausen by proxy are discussed.

Adult↗

PubMed1994

[Significance of "abnormal reaction susceptibility" of adolescents in Munchausen by proxy syndrome. Simulation, folie à deux, induced artefact disease or what else?].

There are very few publications about the induction of emotional disturbances in Munchausen by proxy syndrome, although we see these children in our clinical work. While the pathology of the inducing mothers has been described quite well, the equally important question of pathological reactions of the child, which is a major factor at least in adolescents, has not yet been discussed. We present an unusual case of induced borderline psychosis and discuss the above mentioned aspect in relation to several psychopathological concepts, particularly Erikson's identity diffusion and folie à deux. We conclude that the concept of a simple induction of the disturbance in adolescents, which has been used so far, is insufficient. According to the authors the importance of the reactions discussed in this paper reaches far beyond Munchausen by proxy syndrome. The same reactions can for example be seen also in cases of sexual abuse. A bigger sample of patients needs to be investigated to confirm our considerations.

Adolescent↗

PubMed1996

[Münchhausen syndrome by proxy: a challenge for medicine].

In Münchhausen syndrome by proxy, a subject, usually a mother, pretends her child has a serious medical disorder. After simulating ficticious symptoms, or even producing clinical signs such as convulsions, fever, bleeding, vomiting, diarrhea or skin eruptions, the mother repeatedly takes her child to different hospitals for care. During hospitalization, the mother shows great concern for the child and is highly cooperative with the health care team. The consequences may be unwarrented, often invasive, investigations and therapy with a very high risk of morbidity and mortality. The underlying psychopathological structure is difficult to apprehend. Narcissic fragility and borderline personality are the must frequent, but passive-dependent hysteric personality or sadomasochist behavior can be found and depression is often associated. The main, if not the sole, benefit for the mother lies in the leading role she plays during the repeated hospitalizations in front of the admizing medical staff. Rare cases of adult-adult Münchhausen syndrome by proxy have also been reported. Physicians should be aware of this syndrome in order to avoid unintentional participating in this morbid scenario by performing useless invasive examinations or by prescribing dangerous medication. Psychiatric treatment and sometimes legal action are required to avoid this particular kind of child abuse.

Child↗

PubMed1998

[Munchausen syndrome by proxy: report of one case with epilepsy].

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

Antidepressive Agents, Tricyclic↗

PubMed1998

Induction, identification or folie à deux? Psychodynamics and genesis of Munchausen syndromes by proxy and false allegations of sexual abuse in adolescents.

When dealing with Munchausen syndrome by proxy as well as with false allegations of sexual abuse, we normally were confronted with complex family dynamics especially between mother and child. To date there are no scientific discussions on the importance of these dynamics for the development of manifest symptoms in the child and regarding the child's contribution. The descriptions of the Munchausen syndrome by proxy stressed the maternal pathology from which the child's symptoms seemed to be derivable by the concept of simple induction. Regarding false allegations of sexual abuse, especially in divorce proceedings, even publications on the motives of the inducing parents were rare. This paper presents considerations on the object relation dynamics as well as on the intrapsychic dynamics of the children and adolescents in question. Related forensic psychiatric problems are discussed.

Adolescent↗

PubMed2006

Growing up and moving on in rheumatology: parents as proxies of adolescents with juvenile idiopathic arthritis.

OBJECTIVE: To examine agreement about physical health, functional ability, and health-related quality of life (HRQOL) between adolescents with juvenile idiopathic arthritis (JIA) and their parents. METHODS: The study group comprised 303 adolescent-parent dyads who completed individual questionnaires, including the Childhood Health Assessment Questionnaire with visual analog scales for pain and general well-being, and the Juvenile Arthritis Quality of Life Questionnaire. Agreement was determined using the Bland and Altman method. RESULTS: Approximately half of the adolescent-parent dyads showed clinically acceptable agreement for pain, general well-being, functional disability, and HRQOL. Where discrepancies occurred, there were similar numbers of parental overestimation and underestimation, with the exception that parents rated functional ability worse than did adolescents. Parents were also consistent with respect to overestimation or underestimation, irrespective of the health domain in question. Agreement was associated with better disease-related outcome variables, but was not significantly influenced by demographic factors. Agreement between adolescents and parents was dependent on the level of disease outcome and the health domain under scrutiny, and was less for moderate disease outcomes (as compared with mild or severe) and less visible phenomena (e.g., pain, global well-being). CONCLUSION: There is a wide variation in agreement between adolescents with JIA and their parents that is dependent on which health-related variable is under scrutiny. Proxy report is likely to be valid for adolescents with JIA at either the mild or severe end of the spectrum and/or for the visible manifestations of the disease. Consideration of both adolescent and parent-proxy reports is therefore important in future research.

Adolescent↗

PubMed2004

Parent proxy-reported health-related quality of life and fatigue in pediatric patients diagnosed with brain tumors and acute lymphoblastic leukemia.

BACKGROUND: Pediatric patients with brain tumors (BT) are often excluded from health-related quality of life (HRQOL) studies even though they experience more severe disease and treatment-related sequelae than children with other types of cancer. Parent proxy assessments of HRQOL allow for greater inclusion of children who are developmentally immature, physically ill, or cognitively impaired. METHODS: Parents of children ages 2-18 years who were diagnosed at Childrens Hospital Los Angeles and Children's Hospital San Diego with BT (n = 86) or acute lymphoblastic leukemia (ALL; n = 170) evaluated their children's HRQOL over the previous week using the parent-proxy versions of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core scales, the PedsQL 3.0 Acute Cancer Module, and the PedsQL Multidimensional Fatigue scales. Multiple regression analyses were used to determine the independent effect of the child's diagnosis on HRQOL. Separate analyses were conducted for patients receiving treatment, patients who had not received treatment for < 12 months, and patients who had not received treatment for > or = 12 months. RESULTS: Patients with BT exhibited more problems than patients with ALL in the physical, social, psychosocial, school, cognitive, and fatigue domains of HRQOL. The Core Physical Health, Core Psychosocial Health, and Fatigue Total scores for patients with BT demonstrated peak improvements for children who had not received treatment for < 12 months and sharp declines for children who had not received treatment for > or = 12 months. The Core Physical Health and Fatigue Total scores for patients with ALL were highest (better HRQOL) for those who had not received treatment for > or = 12 months. CONCLUSIONS: Pediatric patients and survivors of BT experienced more fatigue and HRQOL problems than patients with ALL, and HRQOL differed by treatment status.

Adolescent↗

PubMed2004

Health-related quality of life evaluation by proxy in Parkinson's disease: approach using PDQ-8 and EuroQoL-5D.

Patient- and caregiver-based scores were compared and agreement levels ascertained to determine the reliability of proxy evaluation of Parkinson's Disease (PD) patients' health-related quality of life (HRQoL) using the EuroQoL and PD questionnaire (PDQ)-8. Of 72 patient-caregiver pairs, 64 (88.88%) returned the questionnaires. The degree of agreement varied for individual dimensions. Proxy evaluation of PD patients' HRQoL showed limitations mainly with assessments using the EuroQoL and especially in patients with severe disease and depression.

Adolescent↗

PubMed2025

Protective Effects of Genetic Proxies of Cognitive Reserve in Parkinson's Disease: A Longitudinal Multi-Cohort Study.

BACKGROUND: Resilience factors are crucial in the progression of neurodegenerative diseases. However, it remains unclear whether a genetic predisposition to cognitive reserve influences clinical heterogeneity in the prognosis of Parkinson's disease (PD). OBJECTIVES: The aim is to evaluate the utility of polygenic scores (PGSs) for cognitive reserve proxies, including intelligence (INT), educational attainment (EA), and occupational attainment (OA), in predicting the clinical progression of PD. METHODS: Genetic and clinical data for progression of PD (progression to Hoehn and Yahr stage ≥3, progression to a Montreal Cognitive Assessment score ≤24, and occurrence of psychosis) were obtained from the Accelerating Medicine Partnership Parkinson's Disease database. We conducted multivariate Cox regression analysis, adjusting for relevant covariates, including years of education, variants in APOE, GBA1, LRRK2, and other cognitive reserve-related PGSs. RESULTS: All cognitive reserve-related PGSs significantly reduced the risk of cognitive decline, and EA-PGS (hazard ratio [HR], 0.550; 95% confidence interval [CI], 0.447-0.676; P < 0.001) remained significant after controlling for INT-PGS and OA-PGS. EA-PGS (HR, 0.805; 95% CI, 0.672-0.964; P = 0.019) was significantly associated with better motor prognosis after controlling for other PGSs. OA-PGS was linked to a decreased risk of developing psychosis in PD and remained significant after adjusting for others (HR, 0.784; 95% CI, 0.631-0.975; P = 0.029). CONCLUSIONS: Genetic proxies of cognitive reserve are associated with a reduced risk of cognitive decline, motor progression, and development of psychosis in PD. These findings may enhance our understanding of individual differences in resilience in progression of PD. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Humans↗

PubMed1998

Proxy-perceived prior health status and hospital outcome among the critically ill: is there any relationship?

OBJECTIVES: To measure the health status of critically ill patients prior to hospital admission and to study the relationship between prior health status (PHS) and hospital mortality. DESIGN: 523 patients admitted to the intensive care department from October 1994 to June 1995 were included consecutively in the study. Health status 3 months prior to admission was assessed retrospectively by proxies using the EuroQol 5D (EQ-5D) and the Karnofsky Performance Status Scale (KF). Patients were classified into four admission categories: trauma injury, scheduled surgery, unscheduled surgery and other medical conditions. SETTING: Department of Intensive Medicine, University Hospital of Bellvitge, Barcelona, Spain. PATIENTS: 84 trauma injury patients, 239 scheduled surgery patients, 57 unscheduled surgery patients and 143 patients with other medical conditions. INTERVENTIONS: The descriptive system and visual analogue scale (VAS) of the EQ-5D and the K.F. MEASUREMENTS AND MAIN RESULTS: Using proxy responses we found that trauma injury patients had the best PHS and scheduled surgery patients the worst. There were statistically significant differences in mean VAS scores and all EQ-5D dimensions, except self-care, when trauma injury patients or scheduled surgery patients were compared with the other admission categories. No significant differences were found on these variables between unscheduled surgery patients and medical patients. We found no statistically significant differences in PHS health status between patients who died and those who survived, either within each admission category or in the sample as a whole. CONCLUSIONS: The PHS of critically ill patients varied according to admission category. Given the instruments used and population studied, there was no association between PHS and hospital outcome.

Adult↗

PubMed1986

Munchausen syndrome by proxy.

Munchausen syndrome by proxy is a form of child abuse in which a disorder of the child is fabricated by a parent. Although often considered rare, it may have been overlooked frequently in the past. The reported cases of children with Munchausen syndrome by proxy range in age from infancy to 8 years. Their "illnesses" consist of fabricated histories, inflicted physical findings, altered laboratory specimens, and induced disorders. The perpetrator usually is the child's mother, who may have Munchausen syndrome. Consequences of the syndrome may include painful tests, frequent hospitalizations, potentially harmful treatment, and death. The diagnosis can be made when medical and social histories are characteristic of the syndrome and clinical findings are absent, suggestive of induced illness, or resolve upon separation of the child and parent. Suspicion of the syndrome should be discussed with the family once the safety of the child is insured, and the case should be reported under the child abuse reporting law of the state. Social, family, and medical histories must be obtained and verified, and court intervention should be considered. Four patients who illustrate typical features of the syndrome are described.

Child↗

PubMed1990

Munchausen syndrome by proxy: a family affair.

Munchausen syndrome by proxy is an unusual form of child abuse: a child presents with an illness that has been factitiously produced by a parent, typically the mother. A case of chronic illicit insulin administration to a one-year-old girl is described. Despite temporary separation of the child from the mother and long-term psychiatric intervention, factitious illnesses continued, including urine specimen contamination, laxative-induced diarrhea, suspected bladder catheterization, and suspected poisoning. Retrospective review of the medical records of the mother and two siblings demonstrated previously unrecognized evidence of factitious illnesses. The medical records contained evidence of 30 separate episodes of suspected or documented factitious illness in these four members of the same family. This unique family illustrates the significant morbidity of Munchausen syndrome by proxy and a poor response to psychiatric treatment.

Child Abuse↗

PubMed1988

The effects of a suspected case of Munchausen's syndrome by proxy on a pediatric nursing staff.

Munchausen's syndrome by proxy is a relatively new diagnosis for a unique form of child abuse that involves a parent who creates or feigns illness in his or her child, and presents a "sick child" to the medical profession for assessment and treatment. Typically, while creating or feigning the child's illness, the parent usually appears to be "ideal" (i.e., especially attentive, caring, supportive, and close to the medical staff). The present study assessed the effects of a suspected case of Munchausen's syndrome by proxy on 20 pediatric nurses in a large midwestern children's hospital. After the child had left the hospital, the staff was given a ten-item open-ended questionnaire covering how they felt about the case, how the case affected their interactions with other parents, and how they professionally and personally coped with the physician's presumptive diagnosis. Only 10% of the staff had had previous experience with such a case, and 55% had not even heard of such a diagnosis. More than 70% of the staff felt they were professionally and personally unprepared for the case. Their initial reaction to the suspected diagnosis ranged from shock and disbelief to nausea and anger. The majority of the staff had perceived the parent as supportive, loving, and concerned. Yet, now they were confronted with information that suggested that the parent had nearly killed the child while on the unit, in order to keep that child in the hospital. Although almost every nurse eventually accepted the diagnosis, they felt their relationships with parents in general had changed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Knowledge of medical history information among proxy respondents for deceased study subjects.

Proxy respondents were interviewed for 96 decedents in an occupational cohort. A second respondent was interviewed for 59 decedents. Medical records were reviewed to validate questionnaire information. The percentage of respondents who answered "don't know" (non-response) to questions about medical condition ranged from 5% (cancer and heart disease) to 17% (ulcers). Non-response rates were lowest among spouses, intermediate among children, parents, and siblings, and highest among other relatives and friends. Among 41-55 pairs, depending on the condition, agreement between paired respondents was excellent (kappa > 0.75) for ulcers, cancer, diabetes, and lung disease. A higher percentage of medical records was obtained for decedents with spouse respondents and for decedents with more recent dates of death. Sixty percent or more of the medical records were obtained for patients with cancer (n = 30), heart disease (n = 26), stroke (n = 9), and liver disease (n = 10). The positive predictive value of the proxy respondent information for these conditions was 93, 81, 78, and 60%, respectively.

Cerebrovascular Disorders↗

PubMed2004

Misclassification of exposure is high when interview data on drug use are used as a proxy measure of chronic drug use during follow-up.

BACKGROUND AND OBJECTIVE: In many observational studies, the association between drugs and disease is analyzed with information from a baseline interview. We investigated the magnitude and direction of exposure misclassification by comparing interview data at baseline with prospectively gathered pharmacy data. METHODS: The study population for this study consisted of a cohort of 2,487 participants aged 71 years or older from the Rotterdam Study. Data on drug use were gathered at the baseline interview and through pharmacies during the follow-up period between January 1, 1991, and January 1, 1999. We assessed the sensitivity, specificity, and positive and negative predictive value of interview data as proxy measures of chronic use of calcium channel blockers (CCB) in comparison with longitudinal medication records from the pharmacy. RESULTS: Only 3 of the 206 subjects (1.5%) who reported use at baseline did not use CCBs during follow-up. Of the 2,281 persons who reported no use of CCBs at baseline, however, 354 actually used CCBs during follow-up (15.5%). The difference between interview data and pharmacy records corresponded to a misclassification bias of 0.73 (95%CI: 0.52-1.02). CONCLUSION: Misclassification of exposure was high when interview data were used as a proxy measure of chronic use during follow-up.

Aged↗

PubMed2004

Response of three paleo-primary production proxy measures to development of an urban estuary.

In this study we present a novel comparison of three proxy indicators of paleoproductivity, pigments, biogenic silica (BSi), and cysts of autotrophic dinoflagellates measured in cored sediments from New Bedford Harbor, Massachusetts. In addition to detailed historical reports we use palynological signals of land clearance, changes in the ratio of centric and pennate diatoms, sedimentary organic carbon and stable carbon isotopes to constrain our interpretations. Our study spans the period from prior to European settlement to approximately 1977, during which watersheds were cleared, port development occurred and much of the coastal property became industrialized. The combined effects of nutrient loading from watershed clearance and urban sewage on the estuarine ecosystem shifted not only levels of primary production, but also the nature of the production. Our proxies show that when European colonists first arrived the estuarine production was benthic-dominated, but eventually became pelagic-dominated. Importance of water column production (by diatoms and dinoflagellates) rapidly increased as soil nitrogen was released following forest clearance. Stabilization in rates of forest clearance is reflected as a decline in production. However, population increases in the urbanizing watershed brought new sources of nutrients through direct sewage discharge, apparently again stimulating primary production. We assume that early 20th century changes in sewage discharge and introduction of heavy metals into Harbor waters caused a temporary reduction in primary production. The introduction of a new sewer outfall near the core site and changes in estuarine hydrography due to construction of a hurricane barrier across the mouth of the harbor are reflected by renewed water column production, but decreases in the population of diatoms and dinoflagellates. Fossil pigments suggest renewed water column production in the latest years recorded by our sediment core.

Cities↗

PubMed2006

'Stickiness' and 'inflow' as proxy measures of the relative attractiveness of various sub-sectors of nursing employment.

Workplaces vary in their ability to recruit and retain workers. We introduce two new concepts which can be used as proxy measures of the relative attractiveness of a particular setting, where setting can be defined narrowly (e.g., a particular organization) or broadly (e.g., a sub-sector). "Stickiness" is defined as the transition probability that an employee stays in a given setting; "inflow" as the proportion of new employees. Using a longitudinal dataset of all nurses registered with the College of Nurses of Ontario, Canada 1993-2003, employment site was used to define consistent sectors and sub-sectors. Each nurse was assigned to one sector/sub-sector per year. Stickiness and inflow values were calculated for each sub-sector, and the trends across time were analyzed. Results show that despite shrinkage in the hospital sub-sectors, hospitals remained highly sticky. The expanding sub-sectors, in general, appear relatively unattractive to nurses; they couple medium/low stickiness with high inflow. Considerable variability across sub-sectors was evident. Stickiness and inflow were found to be useful as proxy measures of the relative attractiveness of the various sub-sectors of nursing employment over time. The concepts may be used for other workforces for which linked longitudinal data are available.

Employment↗