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Chang (; ) and Eng (; ) Bunker (May 11, 1811 – January 17, 1874) were Thai-American conjoined twin brothers whose condition and birthplace became the basis for the term "Siamese twins".
Ladan and Laleh Bijani (in Persian: ) (January 17, 1974 – July 8, 2003) were Iranian conjoined twin sisters. They were joined at the head and died immediately after their complicated surgical separation. Coincidentally, the twins were born 100 years to the day of the deaths of Chang and Eng Bunker, also conjoined twins, famously known as the "original" Siamese twins.
Mary and Eliza Chulkhurst (or Chalkhurst), commonly known as the Biddenden Maids, were a pair of conjoined twins supposedly born in Biddenden, Kent, England, in the year 1100. They are said to have been joined at both the shoulder and the hip, and to have lived for 34 years. It is claimed that on their death they bequeathed five plots of land to the village, known as the Bread and Cheese Lands. The income from these lands was used to pay for an annual of food and drink to the poor every Easter. Since at least 1775, the dole has included Biddenden cakes, hard biscuits imprinted with an image of two conjoined women.
Although the annual distribution of food and drink is known to have taken place since at least 1605, no records exist of the story of the sisters prior to 1770. Records of that time say that the names of the sisters were not known, and early drawings of Biddenden cakes do not give names for the sisters; it is not until the early 19th century that the names "Mary and Eliza Chulkhurst" were first used.
Edward Hasted, the local historian of Kent, has dismissed the story of the Biddenden Maids as a folk myth, claiming that the image on the cake had originally represented two poor women and that the story of the conjoined twins was "a vulgar tradition" invented to account for it, while influential historian Robert Chambers accepted that the legend could be true but believed it unlikely. Throughout most of the 19th century little research was carried out into the origins of the legend. Despite the doubts among historians, in the 19th century the legend became increasingly popular and the village of Biddenden was thronged with rowdy visitors every Easter. In the late 19th century historians investigated the origins of the legend. It was suggested that the twins had genuinely existed but had been joined at the hip only rather than at both the hip and shoulder, and that they had lived in the 16th rather than the 12th century.
In 1907, the Bread and Cheese Lands were sold for housing, and the resulting income allowed the annual dole to expand considerably, providing the widows and pensioners of Biddenden with cheese, bread and tea at Easter and with cash payments at Christmas. Biddenden cakes continue to be given to the poor of Biddenden each Easter, and are sold as souvenirs to visitors.
"'Conjoined twins" are identical twins joined in utero. An extremely rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in Southeast Asia and Africa. Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1.
Two contradicting theories exist to explain the origins of conjoined twins. The more generally accepted theory is "fission", in which the fertilized egg splits partially. The other theory, no longer believed to be the basis of conjoined twinning, is fusion, in which a fertilized egg completely separates, but stem cells (which search for similar cells) find like-stem cells on the other twin and fuse the twins together. Conjoined twins share a single common chorion, placenta, and amniotic sac, although these characteristics are not exclusive to conjoined twins as there are some monozygotic but non-conjoined twins who also share these structures in utero.
The most famous pair of conjoined twins was Chang and Eng Bunker (Thai: อิน-จัน, In-Chan) (1811–1874), Thai brothers born in Siam, now Thailand. They traveled with P.T. Barnum's circus for many years and were labeled as the Siamese twins. Chang and Eng were joined at the torso by a band of flesh, cartilage, and their fused livers. In modern times, they could have been easily separated. Due to the brothers' fame and the rarity of the condition, the term "Siamese twins" came to be used as a synonym for conjoined twins.
In Chinese alchemy, elixir poisoning refers to the toxic effects from elixirs of immortality that contained metals and minerals such as mercury and arsenic. The official "Twenty-Four Histories" record numerous Chinese emperors, nobles, and officials who ironically died from taking elixirs in order to prolong their lifespans. The first emperor to die from elixir poisoning was likely Qin Shi Huang (d. 210 BCE) and the last was Yongzheng (d. 1735). Despite common knowledge that immortality potions could be deadly, fangshi and Daoist alchemists continued the elixir-making practice for two millennia.
Islamophobia is an intense fear or hatred of, or prejudice against, the Islamic religion or Muslims, especially when seen as a geopolitical force or the source of terrorism.
The term was first used in the early 20th century and it emerged as a neologism in the 1970s, then it became increasingly salient during the 1980s and 1990s, and it reached public policy prominence with the report by the Runnymede Trust's Commission on British Muslims and Islamophobia (CBMI) entitled "Islamophobia: A Challenge for Us All" (1997). The introduction of the term was justified by the report's assessment that "anti-Muslim prejudice has grown so considerably and so rapidly in recent years that a new item in the vocabulary is needed".
The causes and characteristics of Islamophobia are still debated. Some commentators have posited an increase in Islamophobia resulting from the September 11 attacks, some from multiple terror attacks in Europe and the United States, while others have associated it with the increased presence of Muslims in the United States and in the European Union. Some people also question the validity of the term. The academics S. Sayyid and Abdoolkarim Vakil maintain that Islamophobia is a response to the emergence of a distinct Muslim public identity globally, the presence of Muslims is in itself not an indicator of the degree of Islamophobia in a society. Sayyid and Vakil maintain that there are societies where virtually no Muslims live but many institutionalized forms of Islamophobia still exist in them.
In 1996, they traveled to Germany, trying to convince doctors there to separate them; the German doctors however declined to operate, saying that the risk of separation surgery would be too high for both of them.
In November 2002, after meeting Dr. Keith Goh, the Bijani sisters travelled to Singapore to undergo the controversial operation. Even though they were warned by the doctors that the surgery to separate them would still be very risky, the sisters were very determined. Their decision to go ahead with the operation caused an international media blitz.
After eight months in Singapore, doing extensive psychiatric and legal evaluations, they underwent surgery on July 6, 2003, under the care of a large team of international specialists at Raffles Hospital, composed of 28 surgeons (including neurosurgeon Ben Carson) and more than 100 support staff working in shifts. A specially-designed chair was required that allowed the operation to be performed with both sisters in a sitting position.
The attempt to separate the twins turned out to be very difficult, because their brains not only shared a major vein (the superior sagittal sinus), but had fused together. The separation was achieved on July 8, 2003, but it was announced then that the twins were in critical condition, both having lost a large volume of blood due to complications of the operation.
The separation stage of the surgery completed at 13:30 (Singapore time, UTC +8), but there was significant blood loss during the blood vessel repairing process, and Ladan died at around 14:30 on the operating table; her sister Laleh died about 90 minutes later. Their deaths were announced by the chairman of Raffles Hospital, Dr. Loo Choon Yong.
Conjoined twins are typically classified by the point at which their bodies are joined. The most common types of conjoined twins are:
- Thoraco-omphalopagus (28% of cases): Two bodies fused from the upper chest to the lower chest. These twins usually share a heart, and may also share the liver or part of the digestive system.
- Thoracopagus (18.5%): Two bodies fused from the upper thorax to lower belly. The heart is always involved in these cases. As of 2015, separation of a genuinely shared heart has not offered survival to two twins; a designated twin may survive if allotted the heart, sacrificing the other twin.
- Omphalopagus (10%): Two bodies fused at the lower abdomen. Unlike thoracopagus, the heart is never involved in these cases; however, the twins often share a liver, digestive system, diaphragm and other organs.
- Parasitic twins (10%): Twins that are asymmetrically conjoined, resulting in one twin that is small, less formed, and dependent on the larger twin for survival.
- Craniopagus (6%): Fused skulls, but separate bodies. These twins can be conjoined at the back of the head, the front of the head, or the side of the head, but not on the face or the base of the skull.
Other less-common types of conjoined twins include:
- Syncephalus: One head with a single face but four ears, and two bodies.
- Cephalothoracopagus: Bodies fused in the head and thorax. In this type of twins, there are two faces facing in opposite directions, or sometimes a single face and an enlarged skull.
- Xiphopagus: Two bodies fused in the xiphoid cartilage, which is approximately from the navel to the lower breastbone. These twins almost never share any vital organs, with the exception of the liver. A famous example is Chang and Eng Bunker.
- Ischiopagus: Fused lower half of the two bodies, with spines conjoined end-to-end at a 180° angle. These twins have four arms; one, two, three or four legs; and typically one external set of genitalia and anus.
- Omphalo-Ischiopagus: Fused in a similar fashion as ischiopagus twins, but facing each other with a joined abdomen akin to omphalopagus. These twins have four arms, and two, three, or four legs.
- Parapagus: Fused side-by-side with a shared pelvis. Twins that are dithoracic parapagus are fused at the abdomen and pelvis, but not the thorax. Twins that are diprosopic parapagus have one trunk and two faces. Twins that are dicephalic parapagus have one trunk and two heads, and have two (dibrachius), three (tribrachius), or four (tetrabrachius) arms.
- Craniopagus parasiticus: Like craniopagus, but with a second bodiless head attached to the dominant head.
- Pygopagus (Iliopagus): Two bodies joined at the pelvis.
- Rachipagus: Twins joined along the dorsal aspect (back) of their bodies, with fusion of the vertebral arches and the soft tissue from the head to the buttocks
A white elephant (also albino elephant) is a rare kind of elephant, but not a distinct species. Although often depicted as snow white, their skin is normally a soft reddish-brown, turning a light pink when wet. They have fair eyelashes and toenails. The traditional "white elephant" is commonly misunderstood as being albino, but the Thai term "chang samkhan", actually translates as 'auspicious elephant', being "white" in terms of an aspect of purity.
White elephants are only nominally white. Of those currently kept by the Burmese rulers—General Than Shwe regards himself as the heir of the Burmese kings—one is grey and the other three are pinkish, but all are officially white. The king of Thailand also keeps a number of white elephants, eleven of which are still alive. Former U.S. Vice President Spiro Agnew once presented a white elephant to King Norodom Sihanouk of Cambodia.
Albinos are much more rare among African elephants than in Asia. They are reddish-brown or pink, and may suffer blindness or skin problems from sun exposure.
According to tradition Mary and Eliza Chulkhurst, or Chalkhurst, were born to relatively wealthy parents in Biddenden, Kent, in the year 1100. The pair were said to be conjoined at both the shoulder and the hip. They grew up conjoined, and are said to have "had frequent quarrels, which sometimes terminated in blows". At the age of 34, Mary Chulkhurst died suddenly. Doctors proposed to separate the still-living Eliza from her sister's body but she refused, saying "as we came together we will also go together", and died six hours afterwards. In their wills, the sisters left five pieces of land in the Biddenden area comprising around in total to the local church, with the income from these lands (claimed to have been 6 guineas per annum at the time of their death) to provide an annual dole of bread, cheese and beer to the poor every Easter. Henceforward, the lands were to be known as the Bread and Cheese Lands.
The etymology of English elixir derives from Medieval Latin "", from Arabic ("al-ʾiksīr"), probably from Ancient Greek ("xḗrion" "a desiccative powder for wounds"). "Elixir" originated in medieval European alchemy meaning "A preparation by the use of which it was sought to change metals into gold" (elixir stone or philosopher's stone) or "A supposed drug or essence with the property of indefinitely prolonging life" (elixir of life). The word was figuratively extended to mean "A sovereign remedy for disease. Hence adopted as a name for quack medicines" (e.g., Daffy's Elixir) and "The quintessence or soul of a thing; its kernel or secret principle". In modern usage, "elixir" is a pharmaceutical term for "A sweetened aromatic solution of alcohol and water, serving as a vehicle for medicine" ("Oxford English Dictionary", 2nd ed., 2009). Outside of Chinese cultural contexts, English "elixir poisoning" usually refers to accidental contamination, such as the 1937 Elixir sulfanilamide mass poisoning in the United States.
"Dān" 丹 "cinnabar; vermillion; elixir; alchemy" is the keyword for Chinese immortality elixirs. The red mineral cinnabar ("dānshā" 丹砂 lit. "cinnabar sand") was anciently used to produce the pigment vermilion ("zhūhóng" 朱紅) and the element mercury ("shuǐyín" 水銀 "watery silver" or "gǒng" 汞).
According to the "ABC Etymological Dictionary of Old Chinese", the etymology of Modern Standard Chinese "dān" from Old Chinese "*tān" (< *"tlan" ?) 丹 "red; vermillion; cinnabar", "gān" 矸 in "dāngān" 丹矸 from *"tân-kân" (< *"tlan-klan" ?) "cinnabar; vermillion ore", and "zhān" from *"tan" 旃 "a red flag" derive from Proto-Kam-Sui *"h-lan" "red" or Proto-Sino-Tibetan *"tja-n" or *"tya-n" "red". The *"t-" initial and *"t-" or *"k-" doublets indicate that Old Chinese borrowed this item. (Schuessler 2007: 204).
Although the word "dan" 丹 "cinnabar; red" frequently occurs in oracle script from the late Shang Dynasty (ca. 1600-1046 BCE) and bronzeware script and seal script from the Zhou Dynasty (1045-256 BCE), paleographers disagree about the graphic origins of the logograph 丹 and its ancient variants 𠁿 and 𠕑. Early scripts combine a 丶 dot or ⼀ stroke (depicting a piece of cinnabar) in the middle of a surrounding frame, which is said to represent:
- "jǐng" 井 "well" represents the mine from which the cinnabar is taken" ("Shuowen Jiezi")
- "the crucible of the Taoist alchemists" (Léon Wieger )
- "the contents of a square receptacle" (Bernhard Karlgren)
- "placed in a tray or palette to be used as red pigment" (Wang Hongyuan 王宏源)
- "mineral powder on a stretched filter-cloth" (Needham and Lu).
Many Chinese elixir names are compounds of "dan", such as "jīndān" 金丹 (with "gold") meaning "golden elixir; elixir of immortality; potable gold" and "xiāndān" 仙丹 (with "Daoist immortal") "elixir of immortality; panacea", and "shéndān" 神丹 (with "spirit; god") "divine elixir". "Bùsǐ zhī yào" 不死之藥 "drug of deathlessness" was another early name for the elixir of immortality. Chinese alchemists would "liàndān" 煉丹 (with "smelt; refine") "concoct pills of immortality" using a "dāndǐng" 丹鼎 (with "tripod cooking vessel; cauldron") "furnace for concocting pills of immortality". In addition, the ancient Chinese believed that other substances provided longevity and immortality, notably the "língzhī" 靈芝 ""Ganoderma" mushroom".
The transformation from chemistry-based "waidan" 外丹 "external elixir/alchemy" to physiology-based "neidan" 內丹 "internal elixir/alchemy" gave new analogous meanings to old terms. The human body metaphorically becomes a "ding" "cauldron" in which the adept forges the Three Treasures (essence, life-force, and spirit) within the "jindan" Golden Elixir within the "dāntián" 丹田 (with "field") "lower part of the abdomen".
In early China, alchemists and pharmacists were one in the same. Traditional Chinese Medicine also used less concentrated cinnabar and mercury preparations, and "dan" means "pill; medicine" in general, for example, "dānfāng" 丹方 semantically changed from "prescription for elixir of immortality" to "medical prescription". "Dan" was lexicalized into medical terms such as " dānjì" 丹劑 "pill preparation" and "dānyào" 丹藥 "pill medicine".
The Chinese names for immortality elixirs have parallels in other cultures and languages, for example, Indo-Iranian "soma" or "haoma", Sanskrit "amrita", and Greek "ambrosia".
A bezoar is a mass found trapped in the gastrointestinal system, though it can occur in other locations. A pseudobezoar is an indigestible object introduced intentionally into the digestive system.
There are several varieties of bezoar, some of which have inorganic constituents and others organic. The term has both a modern (medical, scientific) and a traditional usage.
The diagnostic criteria for Dorian Gray syndrome are:
- Signs of dysmorphophobia
- Arrested development (inability to mature)
- Using at least two different medical-lifestyle products and services:
- Hair-growth restoration (e.g. finasteride)
- Antiadiposita to lose weight (e.g. orlistat)
- Anti-impotence drugs (e.g. sildenafil)
- Anti-depressant drugs (e.g. fluoxetine)
- Cosmetic dermatology (e.g. laser resurfacing)
- Cosmetic surgery (e.g. a face-lift, liposuction)
Strictly speaking, penetration occurs when a projectile enters a target without passing through it and "perforation" occurs when the projectile completely passes through the target, but the word "penetration" is commonly used to refer to either.
Penetration into a "semi-infinite" or "massive" target is penetration (in the strict sense of the word) of targets so thick that the level of penetration is not affected by the target's thickness. There is a "transition region" between semi-infinite penetration and perforation, in which the target is not perforated but the projectile, as it nears the back face of the target, meets reduced resistance and is capable of penetrating a greater distance than it would in a semi-infinite target. This effect is variously named the back or rear surface, plate, or face effect and is also present when perforation occurs.
A penetrating projectile may cause the target to break into multiple pieces, spewing from both the front and back of the target, themselves at high velocity. These pieces are collectively referred to as spall. Spall can be generated even if a perforation is not achieved (the projectile fails to pass through the target), generated instead by the shock wave generated by the impact of the projectile.
Bombs designed for great penetration into the earth or for perforation of hardened targets are known as bunker busters.
In 1870, Chang suffered a stroke and his health declined over the next four years. He also began drinking heavily (Chang's drinking did not affect Eng as they did not share a circulatory system). Despite his brother's ailing condition, Eng remained in good health. Shortly before his death, Chang was injured after falling from a carriage. He then developed a severe case of bronchitis. On January 17, 1874, Chang died while the brothers were asleep. Eng awoke to find his brother dead and cried, "Then I am going". A doctor was summoned to perform an emergency separation, but he was too late. Eng died approximately three hours later.
An autopsy revealed that Chang had died of a cerebral blood clot but Eng's cause of death remains uncertain. Doctors of the time theorized that Eng died of shock due to fear of his impending death. They based that theory on the fact that Eng's bladder had distended with urine and his right testicle had retracted. Two North Carolina neurologists, Dr. Paul D. Morte and Dr. E. Wayne Massey, reviewed the case and concluded that Chang likely died of pulmonary edema and heart failure. They also dismissed the claim that Eng died of shock and attributed the muscle cramping that caused his testicle to retract to "acrocyanosis from induced vasospasm and microthrombi due to disseminated intravascular coagulation, the tissue factor released from necrotic tissue and the endotoxin from sepsis activating coagulation cascade".
Sarah Anne Bunker (Eng's widow) died on April 29, 1892, and Adelaide Bunker (Chang's widow) died on May 21, 1917.
Obesity in North Africa and the Middle East is a notable health issue. In 2005, the World Health Organization measured that 1.6 billion people were overweight and 400 million were obese. It estimates that by the year 2015, 2.3 billion people will be overweight and 700 million will be obese. The Middle East, including the Arabian Peninsula, Eastern Mediterranean, Turkey and Iran, and North Africa, are no exception to the worldwide increase in obesity. Subsequently, some call this trend the New World Syndrome. The lifestyle changes associated with the discovery of oil and the subsequent increase in wealth is one contributing factor.
Urbanization has occurred rapidly and has been accompanied by new technologies that promote sedentary lifestyles. Due to accessibility of private cars, television, and household appliances, the population as a whole is engaging in less physical activity. The rise in caloric and fat intake in a region where exercise is not a defining part of the culture has added to the overall increased percentages of overweight and obese populations. In addition, women are more likely to be overweight or obese due to cultural norms and perceptions of appropriate female behavior and occupations inside and outside of the home.
Heat alert programs should be developed for implementation when hotter than normal temperatures, or a heat wave occurs.
Bezoars had value because they were believed to have the power of a universal antidote against any poison. Tradition held that a drinking glass which contained a bezoar would neutralize any poison poured into it. The word "bezoar" comes from the Persian "pād-zahr" (), which literally means "antidote."
The Andalusian physician Ibn Zuhr (d. 1161), known in the West as Avenzoar, is thought to have made the earliest description of bezoar stones as medicinal items. Extensive reference to bezoars also appears in the "Picatrix", which may have originated earlier.
In 1575, French surgeon Ambroise Paré described an experiment to test the properties of the bezoar stone. At the time, the bezoar stone was deemed to be able to cure the effects of any poison, but Paré believed this was impossible. It happened that a cook at King's court was caught stealing fine silver cutlery and was sentenced to death by hanging. The cook agreed to be poisoned instead. Ambroise Paré then used the bezoar stone to no great avail, as the cook died in agony seven hours after taking poison. Paré had proved that the bezoar stone could not cure all poisons, contrary to popular belief at the time.
Modern examinations of the properties of bezoars by Gustaf Arrhenius and Andrew A. Benson of the Scripps Institution of Oceanography have shown that they could, when immersed in an arsenic-laced solution, remove the poison. The toxic compounds in arsenic are arsenate and arsenite. Each is acted upon differently, but effectively, by bezoar stones. Arsenate is removed by being exchanged for phosphate in the mineral brushite, a crystalline structure found in the stones. Arsenite is found to bond to sulfur compounds in the protein of degraded hair, which is a key component in bezoars.
A famous case in the common law of England ("Chandelor v Lopus", 79 Eng Rep. 3, Cro. Jac. 4, Eng. Ct. Exch. 1603) announced the rule of "caveat emptor" ("let the buyer beware") if the goods they purchased are not in fact genuine and effective. The case concerned a purchaser who sued for the return of the purchase price of an allegedly fraudulent bezoar. (The law report does not discuss how the plaintiff discovered that the bezoar did not work.)
The "Merck Manual of Diagnosis and Therapy" notes that consumption of unripened persimmons has been identified as causing epidemics of intestinal bezoars, and that up to 90% of bezoars that occur from eating too much of the fruit require surgery for removal.
A 2013 review of three databases identified 24 publications presenting 46 patients treated with Coca-Cola for phytobezoars. The cola was administered in doses of 500 mL to up to 3000 mL over 24 hours, orally or by gastric lavage. A total of 91.3% of patients had complete resolution after treatment with Coca-Cola: 50% after a single treatment, others requiring the cola plus endoscopic removal. Doctors resorted to surgical removal in four cases.
The medical condition of being overweight or obesity is defined as "abnormal or excessive fat accumulation that may impair health". It is measured through the Body Mass Index (BMI), defined as a person's weight, in kilograms, divided by the square of the person's height, in meters. If an individual has a BMI of 25–29, he or she is overweight. Having a BMI of 30 or more means an individual is obese. The greater the BMI, the greater the risk of chronic diseases as a result of obesity. These diseases include cardiovascular diseases, diabetes, musculoskeletal disorders, cancer, and premature death.
International Organization for Standardization helps set standards for monitoring environments, analyzing data, and interpreting results.
Growth stunting is identified by comparing measurements of children's heights to the World Health Organization 2006 growth reference population: children who fall below the fifth percentile of the reference population in height for age are defined as stunted, regardless of the reason. The lower than fifth percentile corresponds to less than two standard deviations of the WHO Child Growth Standards median.
As an indicator of nutritional status, comparisons of children's measurements with growth reference curves may be used differently for populations of children than for individual children. The fact that an individual child falls below the fifth percentile for height for age on a growth reference curve may reflect normal variation in growth within a population: the individual child may be short simply because both parents carried genes for shortness and not because of inadequate nutrition. However, if substantially more than 5% of an identified child population have height for age that is less than the fifth percentile on the reference curve, then the population is said to have a higher-than-expected prevalence of stunting, and malnutrition is generally the first cause considered.
There are a number of other possible terms which are also used in order to refer to negative feelings and attitudes towards Islam and Muslims, such as anti-Muslimism, intolerance against Muslims, anti-Muslim prejudice, anti-Muslim bigotry, hatred of Muslims, anti-Islamism, Muslimophobia, demonisation of Islam, or demonisation of Muslims. In German, "Islamophobie" (fear) and "Islamfeindlichkeit" (hostility) are used. The Scandinavian term "Muslimhat" literally means "hatred of Muslims".
When discrimination towards Muslims has placed an emphasis on their religious affiliation and adherence, it has been termed Muslimphobia, the alternative form of Muslimophobia, Islamophobism, antimuslimness and antimuslimism. Individuals who discriminate against Muslims in general have been termed "Islamophobes", "Islamophobists", "anti-Muslimists", "antimuslimists", "islamophobiacs", "anti-Muhammadan", "Muslimphobes" or its alternative spelling of "Muslimophobes", while individuals motivated by a specific anti-Muslim agenda or bigotry have been described as being "anti-mosque", "anti-Shiites". (or "Shiaphobes"), "anti-Sufism" (or "Sufi-phobia") and "anti-Sunni" (or "Sunniphobes").
In summary, key policy interventions for the prevention of stunting are:
- Improvement in nutrition surveillance activities to identify rates and trends of stunting and other forms of malnutrition within countries. This should be done with an equity perspective, as it is likely that stunting rates will vary greatly between different population groups. The most vulnerable should be prioritized. The same should be done for risk factors such as anemia, maternal under-nutrition, food insecurity, low birth-weight, breastfeeding practices etc. By collecting more detailed information, it is easier to ensure that policy interventions really address the root causes of stunting.
- Political will to develop and implement national targets and strategies in line with evidence-based international guidelines as well as contextual factors.
- Designing and implementing policies promoting nutritional and health well-being of mothers and women of reproductive age. The main focus should be on the 1000 days of pregnancy and first two years of life, but the pre-conception period should not be neglected as it can play a significant role in ensuring the fetus and baby's nutrition.
- Designing and implementing policies promoting proper breastfeeding and complementary feeding practice (focusing on diet diversity for both macro and micronutrients). This can ensure optimal infant nutrition as well as protection from infections that can weaken the child's body. Labor policy ensuring mothers have the chance to breastfeed should be considered where necessary.
- Introducing interventions addressing social and other health determinants of stunting, such as poor sanitation and access to drinking water, early marriages, intestinal parasite infections, malaria and other childhood preventable disease (referred to as “nutrition-sensitive interventions”), as well as the country's food security landscape. Interventions to keep adolescent girls in school can be effective at delaying marriage with subsequent nutritional benefits for both women and babies. Regulating milk substitutes is also very important to ensure that as many mothers as possible breastfeed their babies, unless a clear contraindication is present.
- Broadly speaking, effective policies to reduce stunting require multisectoral approaches, strong political commitment, community involvement and integrated service delivery.
The Dorian Gray syndrome arises from the concurring and overlapping clinical concepts of the narcissistic personality, dysmorphophobia, and paraphilia. Psychodynamically, the man afflicted with DGS presents an interplay among his narcissistic tendencies ("timeless beauty"), his arrested development (inability to psychologically mature), and his use of "medical lifestyle" products and services — hair restoration, drugs (for impotence, weight-loss, and mood modification), laser dermatology, and plastic surgery — in order to remain young.
Although the DGS patient displays diagnostic features of said mental disorders, the syndrome describes a common, underlying psychodynamics of mental illness, which is characterized by narcissistic defences against time-dependent maturation, expressed by actively seeking the timeless beauty of youth. The article "Das Dorian Gray syndrom" (2005) reported that approximately 3.0 per cent of the population of Germany present features of the Dorian Gray syndrome.