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PubMed1998

[Urinary calculi and Munchausen syndrome].

BACKGROUND: Unlike the so-called Munchausen syndrome by proxy, which is a form of child abuse, Munchausen syndrome is seldom reported in pediatric literature. CASE REPORT: Anthony, an 8.5-year-old child, was referred because he passed several urinary stones. Although biological findings and urinary tract ultrasonography were normal, intravenous pyelogram showed a round area of decreased density in front of the anterior urethra, which disappeared from postmicturation X-ray. For a 1 month period, the child passed 20 stones without intense pain. After undergoing an appendectomy, he was readmitted for left lumbar pain which disappeared after passage of a stone. He spent the following 10 months without any complaint. On later re-admission with similar symptoms, Munchausen syndrome was suspected because of the discrepancy arising from the emission of stones on one hand and the absence of nephritic colic, of hematuria and of urinary tract dilatation on the other hand. Diagnosis of Munchausen syndrome was confirmed by chemical analysis which reported that samples were in fact ordinary pebbles and by child's confession, during interrogation without his parents, to having introduced the pebbles into his urinary tracts. CONCLUSION: When unusual clinical features are present in children, it is necessary to evoke the Munchausen syndrome which can be likened to a distress signal revealing the presence of psychological disorders.

Child↗

PubMed1997

Smoking after heart transplantation: an underestimated hazard?

OBJECTIVE: Risk factors for the development of vasculopathy and malignancies as the most important causes of morbidity and mortality after heart transplantation are not well defined. METHODS: Univariate and multivariate Cox regression analysis of the data derived from our 84 survivors of more than 3 months after orthotopic heart transplantation between 1984 and 1996. Measurement of carbonmonoxide-hemoglobin blood levels with an ABL 520 analyzer. RESULTS: Recipient or donor age, the mode of immunosuppression, total-, LDL- and HDL-cholesterol, the HDL/LDL-ratio, triglycerides, hypertension, diabetes mellitus, CMV status and rejection episodes had no independent influence on total mortality or the occurrence of graft vasculopathy or cancer. By means of an intensive questionnaire (in case of deceased patients, by their relatives) and measurement of CO-Hb blood levels we detected a high rate of patients who smoked after transplantation (22/84 = 26%). Four patients confessed smoking after undergoing the blood test. Non-smokers were defined as denying it in the questionnaire and having CO-Mb levels < 2.5% in repeated measurements. All but one were smokers before heart transplantation. Mean consumption was 11 cigarettes per day. Five and 10 years survival was significantly reduced in smokers vs. non-smokers (37 vs. 80% and 10 vs. 74%, respectively, P < 0.0001). Survival curves diverged dramatically after 4 years of observation. Smokers had a higher prevalence of transplant vasculopathy as revealed by coronary angiography and/or autopsy (10/22 smokers vs. 2/62 non-smokers, P < 0.00001) and a higher rate of malignancies (7/22 smokers developed cancer, as compared to 4 cancers in 62 non-smokers, P = 0.0001). The primary site of cancer was the lung in 5/6 smoking and lymphoma in all non-smoking cancer patients. CONCLUSIONS: Our data show that the prevalence of smoking after heart transplantation may be relatively high, especially in former smokers. Repeated measurements of CO-Hb could be helpful in its detection. Despite a relatively low cigarette count, smoking is a major risk factor of morbidity and mortality after heart transplantation (HTx). Approximately 4 years of exposure time is needed to uncover its negative influence. These findings should lead to aggressive smoking screening and weaning programs in every HTx center.

Carboxyhemoglobin↗

PubMed2001

Clay pica has no hematologic or metabolic correlate in chronic hemodialysis patients.

OBJECTIVE: Clay pica is a form of compulsive ingestion of non-nutritive substances frequently practiced by dialysis patients. Its consequences are unknown. In this study, we evaluated the effect of regular consumption of clay on hematologic and metabolic profiles in hemodialysis patients. DESIGN: A prospective, case-control study with use of structured questionnaire. SETTING: Free-standing hemodialysis units. PATIENTS: One hundred thirty-eight patients on hemodialysis for at least 12 months were interviewed. Thirteen of 138 (9.4%) confessed to clay pica. Ten randomly selected patients with no history of pica served as control. INTERVENTION: Average of all laboratory profiles and interdialytic weight gain (IDWG) over a 3-month period were recorded. Assay of the aluminum (Al), silica (Si), and iron (Fe) content of commercially purchased clay was performed. MAIN OUTCOME MEASURE: Comparison of laboratory profiles and IDWG between cases and control. Estimation of the daily consumption of Al, Fe, and Si from clay and their relationship to the laboratory profiles. RESULTS: There was no statistically significant difference in the levels of Al, albumin, calcium, ferritin, hematocrit, iron saturation, phosphorus, and IDWG between pica cases and control. Iron was significantly higher in pica patients (13.0 +/- 7.9 micromol/L v 7.5 +/- 2.5 micromol/L, P =.04), but potassium was higher among control than pica cases (4.9 +/- 0.7 mmol/L v 4.4 +/- 0.6 mmol/L, P =.07). Estimated metal exposure from daily clay consumption per patient were: Al (1-2 mg), Fe (11-23.5 mg), and Si (2-4.5 g). Multivariate logistic regression analysis failed to show any association between clay consumption and nutrition, anemia, or mineral metabolism (R(2) = 0.0, P =.79). CONCLUSION: Clay pica does not appear to be detrimental to the hematologic and metabolic milieu of hemodialysis patients. The practice should, however, be discouraged, because of potential for ingestion of unknown substances, and reported potential for gastrointestinal complications.

Adult↗

PubMed1993

Preventing and controlling inadvertent IFR (instrument flight rule encounters).

Inadvertent instrument flight rules (IFR) encounters are some of the most harrying conditions a pilot can experience. They also result in the highest percentage of death from helicopter crashes. Yet, inadvertent IFR can be prevented to some degree, and if encountered, it can be conquered and survived. Pilots must have strong identities but also must follow strict rules as to when they can and cannot fly. Training, such as following the "four Cs"--control, climb, course and confess--and instruments can bring pilots through inadvertent IFR successfully, but legal questions remain.

Accidents, Aviation↗

PubMed1997

Sentenced in sorrow: the role of asylum in the Jean Gianini murder defence.

This paper describes the role played by the notion of asylum in the legal battle over confessed murderer Jean Gianini's mental competence and commitment. Gianini was a 16 year old who murdered his former teacher in a small upstate New York town in 1914. His trial was the first in the US to employ the Binet-Simon intelligence test as a defence and featured a clash of expert witnesses whose credibility was based upon their residence and work in asylums. The verdict of 'not guilty due to criminal imbecility' was due to the defence team's successful portrayal of the asylum as a punishing prison from which the defendant would never be released.

Commitment of Persons with Psychiatric Disorders↗

PubMed2001

The evolution of intelligence: adaptive specializations versus general process.

Darwin argued that between-species differences in intelligence were differences of degree, not of kind. The contemporary ecological approach to animal cognition argues that animals have evolved species-specific and problem-specific processes to solve problems associated with their particular ecological niches: thus different species use different processes, and within a species, different processes are used to tackle problems involving different inputs. This approach contrasts both with Darwin's view and with the general process view, according to which the same central processes of learning and memory are used across an extensive range of problems involving very different inputs. We review evidence relevant to the claim that the learning and memory performance of non-human animals varies according to the nature of the stimuli involved. We first discuss the resource distribution hypothesis, olfactory learning-set formation, and the 'biological constraints' literature, but find no convincing support from these topics for the ecological account of cognition. We then discuss the claim that the performance of birds in spatial tasks of learning and memory is superior in species that depend heavily upon stored food compared to species that either show less dependence upon stored food or do not store food. If it could be shown that storing species enjoy a superiority specifically in spatial (and not non-spatial) tasks, this would argue that spatial tasks are indeed solved using different processes from those used in non-spatial tasks. Our review of this literature does not find a consistent superiority of storing over non-storing birds in spatial tasks, and, in particular, no evidence of enhanced superiority of storing species when the task demands are increased, by, for example, increasing the number of items to be recalled or the duration of the retention period. We discuss also the observation that the hippocampus of storing birds is larger than that of non-storing birds, and find evidence contrary to the view that hippocampal enlargement is associated with enhanced spatial memory; we are, however, unable to suggest a convincing alternative explanation for hippocampal enlargement. The failure to find solid support for the ecological view supports the view that there are no qualitative differences in cognition between animal species in the processes of learning and memory. We also argue that our review supports our contention that speculation about the phylogenetic development and function of behavioural processes does not provide a solid basis for gaining insight into the nature of those processes. We end by confessing to a belief in one major qualitative difference in cognition in animals: we believe that humans alone are capable of acquiring language, and that it is this capacity that divides our intelligence so sharply from non-human intelligence.

Adaptation, Physiological↗

PubMed1999

A brief history of psychiatry: millennia past and present--part III.

Release of emotion through a variety of means has often been seen as healing. Throughout the centuries many cultures dealt with stress by bringing relief through methods like dancing, ritual, or confession. The idea of discovering not always conscious emotions and their release through talking became important in 19th-century psychological treatments. The 20th century has seen a flowering of psychoanalytical, behavioral, cognitive behavioral, and many other psychotherapies. These have been used in individual, group, or martial/family settings, inpatient and outpatient. There have been disagreements between and among the various schools of psychotherapy. As we approach the next century, therapists of all schools are discussing ways in which each therapy contributes to helping patients and are defining common threads that link all the approaches to psychotherapy.

Cognitive Behavioral Therapy↗

PubMed2003

Taking responsibility for an act not committed: the influence of age and suggestibility.

Inherent in false confessions is a person taking responsibility for an act he or she did not commit. The risk of taking such responsibility may be elevated in juveniles. To study possible factors that influence individuals' likelihood for taking responsibility for something they did not do, participants in a laboratory experiment were led to believe they crashed a computer when in fact they had not. Participants from 3 age groups were tested: 12- and 13-year-olds, 15- and 16-year-olds, and young adults. Half of the participants in each age group were presented with false evidence indicating liability. Additionally, suggestibility was investigated as a potential individual-difference factor affecting vulnerability to admissions of guilt. Results showed that younger and more suggestible participants were more likely than older and less suggestible participants to falsely take responsibility. Implications of these findings for juvenile justice are discussed.

Adolescent↗

PubMed2003

Behavioral confirmation in the interrogation room: on the dangers of presuming guilt.

A two-phased experiment tested the hypothesis that the presumption of guilt that underlies police interrogations activates a process of behavioral confirmation. In Phase I, 52 suspects guilty or innocent of a mock theft were questioned by 52 interrogators led to believe that most suspects were guilty or innocent. Interrogators armed with guilty as opposed to innocent expectations selected more guilt-presumptive questions, used more interrogation techniques, judged the suspect to be guilty, and exerted more pressure to get a confession--particularly when paired with innocent suspects. In Phase II, neutral observers listened to audiotapes of the suspect, interrogator, or both. They perceived suspects in the guilty expectations condition as more defensive--and as somewhat more guilty. Results indicate that a presumption of guilt sets in motion a process of behavioral confirmation by which expectations influence the interrogator's behavior, the suspect's behavior, and ultimately the judgments of neutral observers.

Analysis of Variance↗

PubMed2003

What patient characteristics make clinicians recommend brief treatment?

OBJECTIVE: Assessing self-rated items that might have an impact on clinicians recommending brief treatment (BT) over unlimited or long-term treatment (ULT). METHOD: On the basis of patient self-report data we compared patients referred by clinicians to BT (n=71) with those referred to ULT (n=145). RESULTS: The final multiple logistic regression model indicates that the chance of being allocated to BT increases with: more satisfaction with support, higher self-esteem, primary education or less, and high desire for support as an intervention. With regard to desire to confess in treatment, low and high scores make the chance of being allocated to BT lower. This is also the case for daily hassles. Finally, some specific target complaints, in particular anxiety, lower the chance of being allocated to BT. CONCLUSION: Using data about patient's complaints and symptoms, stress and support, personality and coping, and request for type of intervention, we built a regression-model that classified 80% of the patients correctly with regard to allocation to BT or ULT.

Adaptation, Psychological↗

PubMed1978

The bogus pipeline as lie detector: two validity studies.

The validity of the bogus pipeline procedure for eliciting truthful responses from subjects in social psychological experiments was tested in two studies. Subjects were illegitimately informed about how to perform well on an experimental test, were tested, and then were asked whether they had possessed this prior information. As compared to subjects responding to pencil-and-paper questions or face-to-face questionning by the experimenter, those in a bogus pipeline condition confessed more often.

Electromyography↗

PubMed1992

Detection measures in real-life criminal guilty knowledge tests.

The present study provides a first attempt to compare the validity of the respiration line length (RLL) and skin resistance response (SRR) amplitude in real-life criminal guilty knowledge tests (GKTs). GKT records of 40 innocent and 40 guilty Ss, for whom actual truth was established by confession, were assessed for their accuracy. When a predefined decision rule was used and inconclusive decisions were excluded, 97.4% of the innocent Ss and 53.3% of the guilty Ss were correctly classified with the SRR measure. For the RLL measure, the respective results were 97.2% and 53.1%. The combination of both measures improved detection of guilty Ss to 75.8% and decreased detection of innocent Ss to 94.1%. The combined measure seems to be a more useful means of identifying guilty suspects than each physiological measure alone. The results elaborate and extend those obtained in a previous field study conducted by Elaad (1990).

Adult↗

PubMed1990

Whither the professions?

I must confess to having been a little surprised at being asked to give The Dental School Founders' and Benefactors' Lecture this year. It is manifest to all that I am not a founder of the School and as chairman of the Health Authority I have not always been perceived to be a benefactor. Nevertheless I accepted your Dean's invitation and I hope my status may improve. There has been some uncertainty in relation to my title 'Whither the professions?' as to whether it expresses a question or an exhortation. It was certainly intended to be a question.

Dentistry↗

PubMed1992

Let there be light--the laser in dentistry.

A damp and dull London day in March somewhat contradicted the title of the meeting of the Odontology Section of the RSM, Let there be light--the laser in dentistry, but there was no doubt, once inside, that the organisers had, with perfect timing, caught the interest of the profession as a Barnes Room packed to capacity was greeted by the president of the section, Margaret Seward. Rather apologetically, she confessed that the film Goldfinger was unavailable, but promised us equal fascination with a galaxy of international experts to guide us through a maze of new developments in laser dentistry.

Dental Instruments↗

PubMed1996

Interrogative suggestibility in opiate users.

The present study investigated interrogative suggestibility in opiate users. A group of patients undergoing a methadone detoxification programme in an in-patient drug treatment unit (Detox group, n = 21), and a group of residents who had come off drugs and were no longer suffering from withdrawal syndrome (Rehab group, n = 19) were compared on interrogative suggestibility and various other psychological factors. Significant differences were found between the two groups, with the Detox group having more physical and psychological problems, and a higher total suggestibility score in comparison with the Rehab group. These findings are discussed in relation to the context of police interrogations and the reliability of confessions made by suspects and witnesses dependent on opiates.

Adult↗

PubMed2003

Attitudes and practices regarding circumcision in Turkey.

BACKGROUND: In Turkey, circumcision is a necessity for boys to gain a masculine identity. In contrast to Western societies, where circumcision is performed in the neonatal period, it is performed at older ages in our population, and the timing may affect the psychosocial well-being of males. The person who performs the operation, a physician or a traditional circumciser, may affect their health as well. OBJECTIVE: To provide some information about the practice of circumcision in Turkey, such as timing, by whom and why it is performed in our country, and relation of their fathers' past emotions about their own circumcision to this current practice. METHODS: Questionnaires were filled out in face-to-face interviews with parents of 1235 male children under 16 years of age who attended well-child clinics of Gazi University Hospital and 10 different primary health care centres throughout Ankara, Turkey. RESULTS: Median age of circumcision was found to be 6 years. Only 14.8% of children were circumcised before 1 year of age. The main reasons for circumcision were religious and traditional. The medical benefits of the procedure outweighed the traditional reasons for only 15.2% of the families. The operation was carried out by a traditional circumciser in 13.3% of the children. Most of the fathers who could remember their own emotions about circumcision confessed that they had been frightened. They remembered the procedure as painful. Indeed, the mean age of their sons' circumcision was close to their own circumcision age. CONCLUSIONS: Traditions still play an important role in the timing of circumcision and by whom and why it is performed in Turkey. Changing times and educational levels do not seem to affect the traditional approach to circumcision.

Adolescent↗

PubMed2003

Cultural childbirth practices and beliefs in Zambia.

BACKGROUND: Zambia, one of the world's poorest countries, also has one of the highest maternal mortality rates in the world. Most pregnant women in Zambia (96%) attend antenatal care, while 53% deliver at home. This may be related to socio-economic and cultural factors, but cultural childbirth practices and beliefs in Zambia have been little documented. AIM: The aim of this study was to explore cultural childbirth practices and beliefs in Zambia as related by women accompanying labouring women to maternity units. These social support women were also interviewed about their views on providing companionship to labouring women. METHODS: Thirty-six women accompanying labouring women to urban and rural maternity units in Zambia were interviewed A thematic guide with closed and open-ended questions was used. EPI INFO, an epidemiological statistical software package, was used to analyse the quantitative data; qualitative data were analysed using content analysis. FINDINGS: Eighteen of the women considered themselves to be mbusas, or traditional birth assistants and the rest said that they followed labouring women to maternity units. Those who considered themselves traditional birth assistants advised childbearing women on appropriate cultural childbirth practices and assisted with deliveries at home. They also advised women on the use of traditional medicine, for example, to widen the birth canal and to precipitate labour. If something went wrong during labour, they relied on traditional beliefs and witchcraft to explain the mishap and expected the woman in labour to confess her purported 'bad' behaviour. Twelve of the women were in favour of providing support to labouring women in maternity units and learning about childbirth care from midwives. CONCLUSION: These social support women, including those who considered themselves as mbusas, lacked understanding of the causes of obstetric complications during childbirth, and had inadequate knowledge of the appropriate management of labour. Culturally-specific knowledge from this study should be used to guide policy-makers and health planners in the future development of safe motherhood initiatives in developing countries. Midwives have a unique opportunity to ensure that care given during childbirth is clinically safe and culturally sensitive.

Adolescent↗

PubMed2000

Frederic Wood Jones: his illnesses.

As an inveterate sea traveller Wood Jones never conquered seasickness. An attack of appendix in 1910 is also described. Following another attack in 1913 his appendix was removed. Within 24 h of surgery he was laid low by gout. Gout struck again in 1949. There followed two papers on his disease. In 1920 he confessed that he had had 'lumbago' and sciatica for a long while. He was admitted to Westminster Hospital on 23 March 1954 and died in the same hospital on 29 September of that year.

Anatomy↗