Disorders In Countries Research Articles

FIVE-YEARS PREVALENCE OF VESTIBULAR DISORDERS, AS SEEN IN A TERTIARY CARE HOSPITAL

Vestibular disorders can affect the peripheral or central vestibular systems, controlling and maintaining balance. Several studies have confirmed the high prevalence rate of vestibular disorders in other countries. To our knowledge, only one study has been conducted on benign paroxysmal positional vertigo in eastern India, and limited knowledge on other vestibular disorders in the country. Hence, the present study was conducted at SRM hospital, Kattankulathur, Chengalpattu District, Chennai, Tamil Nadu, India, to estimate the overall prevalence of vestibular disorders in a tertiary care hospital between January 2016 and December 2020. The prevalence was identified through a register-based study that examined the case files of those who visited SRM Hospital with complaints related to balance and analyzed them in a retrospective manner. The present study found that 392 individuals with vestibular disorders were among the 214,004 clients. Thus, the prevalence of vestibular disorders according to the present study is 0.18 percent. The salient results of the present study were: Adults are more likely to experience vestibular disorders 323 (0.15%) children 1 (0.0004%), and, adolescents 7 (0.003%). Therefore, the prevalence of vestibular disorders is higher in adults than in other age groups. Prevalence of vestibular disorders was higher in women 236 (0.11%) than in men 156 (0.07%). The prevalence of vestibular disorders based on different types reveals that 311 (0.14%) BPPV is the most prevalent type, followed by 30 (0.014%) Menieres and 15 (0.007%) vestibular neuritis. KEYWORDS: vestibular disorder, Prevalence, Tertiary care hospital.

Stigma Levels Toward Psychiatric Patients Among Medical Students-A Worldwide Online Survey Across 65 Countries.

Background: According to epidemiological data, over 450 million people worldwide suffer from mental disorders, presenting one of the major challenges of modern medicine. In their everyday lives, patients, in addition to fighting the disease itself, often struggle with stigmatization. This phenomenon negatively affects both the diagnostic and therapeutic processes, as well as the patients' everyday functioning. This study aimed to assess stigma attitudes toward psychiatry and psychiatric patients among undergraduate medical students.Methods: This study used a Computer-Assisted Web Interview (CAWI), which included the standardized items from the Mental Illness: Clinicians' Attitudes (MICA-2) scale to evaluate stigma. The study was disseminated via the internet to students from medical universities from 65 countries worldwide. Participation was voluntary and anonymous. The study involved 1,216 students from these 65 countries. Most of the sample were women, and most were medical faculty students and students living in cities with more than 500,000 residents. Taking into consideration Gross Domestic Product (GDP) per capita and Human Development Index (HDI) variables, it can be seen that there was a prevalence of medical students from highly developed countries.Results: For the whole sample, the mean MICA-2 score was 40.5 points. Women and medical and nursing students showed more positive attitudes toward psychiatric patients. Students from countries with the highest economic development levels also achieved statistically lower MICA-2 scores. Lower score means a more positive attitude.Conclusion: Stigma toward both psychiatry and psychiatric patients is common among undergraduate medical students. Female students and respondents with a history of mental disorders in countries with high HDI and GDP per capita indices show more favorable attitudes than other medical students. There is a need to further our understanding of the problem of stigmatization, both among the general population and among medical personnel, and to implement and maintain appropriate measures to reduce stigma toward psychiatry.

Structured headache services as the solution to the ill-health burden of headache. 2. Modelling effectiveness and cost-effectiveness of implementation in Europe: methodology

BackgroundHealth economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council’s Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache.MethodsWe developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros).ResultsThe analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere.ConclusionsThis study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations.

Ethyl Acetate Fraction of Amomum villosum var. xanthioides Attenuates Hepatic Endoplasmic Reticulum Stress-Induced Non-Alcoholic Steatohepatitis via Improvement of Antioxidant Capacities.

Non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatitis (NASH), affects 25% of the global population. Despite the prevalence of NAFLD worldwide, effective therapeutics are currently lacking. Amomum villosum var. xanthioides (Wall. ex Baker) T.L.Wu & S.J.Chen (AX) is a medicinal herb traditionally used for treating digestive tract disorders in countries across Asia. We aimed to examine the pharmacological effects of the ethyl acetate fraction of AX (AXEF) against tunicamycin (TM)-induced ER stress in a NASH mouse model using C57/BL6J male mice. Following TM injections (2 mg/kg), the mice were orally administrated AXEF (12.5, 25, or 50 mg/kg), silymarin (50 mg/kg), or distilled water daily for 5 days, and the outcomes for fatty liver, inflammation, and oxidative stress were measured in serum or liver tissue levels. AXEF drastically attenuated hepatic ER stress-induced NASH as indicated by decreases in lipid droplet accumulations, serum liver enzymes, hepatic inflammations, and cell death signals in the hepatic tissue and/or serum levels. Interestingly, AXEF showed potent antioxidant effects by quenching reactive oxidative stress and its final product lipid peroxide in the hepatic tissue, specifically an increase in metallothionein (MT). To confirm the underlying actions of AXEF, we observed that AXEF increases MT1 gene promoter activities in the physiological levels. Collectively, AXEF showed antioxidant properties on TM-induced ER stress in a NASH mice model through the improvement of MTs.

Risk of first-episode psychosis in migrants to the Republic of Ireland.

Migration is an established risk factor for developing a psychotic disorder in countries with a long history of migration. Less is known for countries with only a recent history of migration. This study aimed to determine the risk for developing a psychotic disorder in migrants to the Republic of Ireland. We included all presentations of first-episode psychosis over 8.5 years to the DETECT Early Intervention for psychosis service in the Republic of Ireland (573 individuals aged 18-65, of whom 22% were first-generation migrants). Psychotic disorder diagnosis relied on SCID. The at-risk population was calculated using census data, and negative binomial regression was used to estimate incidence rate ratios. The annual crude incidence rate for a first-episode psychotic disorder in the total cohort was 25.62 per 100000 population at risk. Migrants from Africa had a nearly twofold increased risk for developing a psychotic disorder compared to those born in the Republic of Ireland (IRR = 1.83, 95% CI 1.11-3.02, p = 0.02). In contrast, migrants from certain Asian countries had a reduced risk, specifically those from China, India, Philippines, Pakistan, Malaysia, Bangladesh and Hong Kong (aIRR = 0.36, 95% CI 0.16-0.81, p = 0.01). Further research into the reasons for this inflated risk in specific migrant groups could produce insights into the aetiology of psychotic disorders. This information should also be used, alongside other data on environmental risk factors that can be determined from census data, to predict the incidence of psychotic disorders and thereby resource services appropriately.

Health Humanities: Dealing with Depression and the Power of Books to help sustain the Journey- Reviews & Inferences

Clinically, Depression can be defined as, “A mental health disorder characterised by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.” The causes may vary from biological, psychological, environmental to lifestyle reasons. The complex interactions between all the above mentioned factors can lead to depression. Life style alterations like loss of a loved one,personal habits etc., can also trigger depression. Psychological and pharmacological remedies exist for different stratas of depression, However, In countries like India there is very less awareness in the view of it. People in the villages still lack the awarenss and blame it on witchcraft or the inhabiting of bad spirits. Inlow- and middle-income families treatment and support services for depression are often inattentive or below advanced. An projected range of 76–85% of people suffer from mental disorders in countries that lack access to the treatment they need. On a clinical angle, there are plenty of perspectives to deal with it depending on the harshness of the finding. It first needs to be understood as a disease that could be cured leading to the aplenty treatment methodologies, though the role of books that deal with depression, and a healthy way out is less comparatively. This research article deals with this particular branch of health humanities and analyses some of the books that could be powerful curatives in dealing with depression. It tries to identify the importance of reading these books and tries to bring an alternative method of dealing with depression on the whole.

Thyroid Function and Nutrient Status in the Athlete.

Thyroid disease is common in the general population, especially in women, and also may be prevalent among athletes. Autoimmune disorders are the most common cause of thyroid disorders in countries with iodine-fortification programs; however, thyroid dysfunction can be brought on by nutritional factors, including insufficient energy intake and iodine, selenium, iron, and vitamin D deficiency. Additionally, strenuous exercise may be associated with transient alterations in thyroid hormones. While the development of thyroid related disorders has the potential to impact health and peak performance, typical clinical manifestations are highly variable, lack specificity, and are frequently confused with other health problems. The assessment process should focus on anthropometric changes, biochemical tests (thyroid panel), personal and family history, examination for appropriate signs and symptoms, and diet and environmental assessment that includes adequacy of energy, iodine, iron, selenium, and vitamin D intake/status along with excess stress and exposure to environmental contaminants and dietary goitrogens.

A Decade of Collaboration Among International Representatives of the International Cluttering Association

Purpose This article presents a collaborative initiative of members of the Committee of the International Representatives of the International Cluttering Association (ICA) upon celebrating the 10th anniversary of the ICA. Such collaborative efforts are designed to improve communication skills, enlighten lives of people with cluttering, and serve as models for speech therapists and other health care professionals in countries around the globe. Method This initiative began with a seminar at the Inaugural Joint World Congress in Japan in 2018 and continues with an article for this special issue on cluttering based on the contents of the papers presented at the Congress. Sixteen researchers and speech therapists from 15 countries in Africa, Asia, Europe (East and West), America (North and South), and the Middle East have explored the following themes related to cluttering: cluttering awareness, research, professional preparation, intervention, and self-help groups. Results This article adds to the body of international literature on cluttering and illustrates that, for the past 10 years, hypothesis-testing research in cluttering continues to be conducted across language barriers and national boundaries, and interventions that are implemented in some locales are being tested and taught in other parts of the world; furthermore, new cluttering treatments are being disseminated for professional preparation and clinical practices. Conclusions This article demonstrates how global engagement of the ICA's international representatives has led to the exchange of ideas about awareness of cluttering and professional preparation and the best strategies for the treatment of this communication disorder in countries around the world.

Exposure to nature for children with autism spectrum disorder: Benefits, caveats, and barriers.

Autism spectrum disorder (ASD) is the fastest growing developmental disorder in countries across the world. Although recent studies have demonstrated the health benefits of nature for typically developing children and children with attention deficit hyperactivity disorder, it is unclear whether these benefits extend to children with ASD. In this study, we investigated whether benefits associated with exposure to nature could be observed by parents of children diagnosed with ASD. We conducted semi-structured interviews with 22 parents and caregivers of children on the spectrum from two cities in China. Results showed that exposure to nature provided motor-sensory, emotional and social benefits to children with ASD, although some of the identified benefits also come with concerns. Participants identified a wide range of barriers that make exposing their children to nature difficult. Among them, inappropriate behaviors, safety concerns, phobias and issues with the public realm emerged as critical hurdles. These findings suggest that practitioners should consider nature exposure as an intervention strategy, and planners and designers should create places that better accommodate the needs of children with ASD.

Our experience with smartphone and spherical lens for the eye fundus examination during humanitarian project in Africa.

To present the experience of eye fundus photo documentation by using the plus 20 diopters spherical Volk lens and a smartphone with 4.2 Mpix camera and LED flash within the screening project of eye disorders in countries where the standard ophthalmology equipment is not available. Totally 241 patients underwent ophthalmology screening examination. The documentation of the eye fundus included patients with Burkitt lymphoma, Kala Azar, malnutrition with unknown etiology, tuberculosis, HIV positive patients, Usher syndrome and hypertension. This technique as an alternative way of screening will become a standard within examination of patients with eye disorders in outfield regions of developing countries.

Guidelines for laboratory diagnosis of factor XIII deficiency

Factor XIII (FXIII) deficiency is an extremely rare hemorrhagic disorder with an approximate worldwide incidence of one per two million. With current tests, diagnosis of this disease can be made more precisely. However, factors such as the number of patients with FXIII deficiency (FXIIID), available diagnostic coagulation tests and the number of molecular studies have affected the diagnosis of FXIIID in different parts of the world. Various laboratory approaches can be used, including screening and diagnosis of the disorder in countries with a relatively high rate of FXIIID and recurrent mutation(s) with a simple polymerase chain reaction-restriction fragment length polymorphism analysis or polymerase chain reaction-sequencing for detection of one or a few specific mutations. In other countries, two different laboratory approaches can be used, depending on available coagulation tests. In less-equipped coagulation laboratories, the clot solubility test remains the only diagnostic test for FXIIID. Even in these countries, at least one referral laboratory should perform FXIII activity and, if possible, confirmation of FXIIID by molecular analysis. In countries with well equipped coagulation laboratories, FXIII activity should be used to screen suspected FXIIID patients; more specific tests such as molecular analysis should be used for confirmation. This study suggests a simple, reliable and flexible algorithm for early diagnosis of FXIIID, and may, with one-time diagnosis of FXIIID, reduce the rate of morbidity and mortality in patients with the disorder.

The effect of ezetimibe on NAFLD

NAFLD has become the most common liver disorder in countries, where obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome are common. The strong association between these conditions and the risk of cardiovascular disease make treatment crucial. Possible interventions for NAFLD target excess body weight, insulin resistance, inflammation, oxidative stress or intestinal lipid absorption. Administration of combination therapy with a statin plus ezetimibe, associated with lifestyle changes, may represent an effective strategy because of the strong reduction in low-density lipoprotein cholesterol levels. Combination therapy is often more effective, especially when complementary mechanisms of action are involved. Ezetimibe is effective and well tolerated in combination with a number of lipid lowering therapies, including statins, orlistat, and insulin-sensitizing agents. There is strong evidence from preclinical models to supporting the use of ezetimibe in this setting. Larger controlled trials are needed to confirm its effectiveness in patients with NAFLD, to establish the most efficacious combinations and to determine whether treatment can reverse fibrosis.

On WHO Guidelines "Fortification of food grade salt"

Issues of implementation of WHO Guidelines on fortification of food grade salt with iodine for the prevention and control of iodine deficiency disorders in countries of Eastern Europe and Central Asia are discussed.

Effect of Exercise on Mental Health in the Physical Dimension, Anxiety and Mental Disorder, Social Dysfunction and Depression

In the last twenty years, a lot of attention to issues of psychology and psychotherapy are associated with physical activity. Due to the increasing rate of mental disorders in country, this study attempts to compare the health of athletes and non-athletes in Beheshti University. Mental Health in schools will also compare. In this study, the health measured using the General Health Questionnaire GHQ-28 has performed. University students participated in this study of 260 patients who were randomly selected to represent the school. Statistical methods are used for the analysis and comparison of two sample t-test. The results show that the significant differences of symptoms of physical, anxiety, sleep disorder, social dysfunction and depression in the two groups were observed between athletes and non-athletes. The college student mental health and physical education than other students in four scales were much more favorable situation.

Self-stigma, perceived discrimination and empowerment among people with a mental illness in six countries: Pan European stigma study

A cross-sectional study including 796 individuals with a psychiatric disorder was conducted in Croatia, Israel, Lithuania, Malta, Romania and Sweden in 2010 aiming to assess correlates of self-stigma. The Internalized Stigma of Mental Illness (ISMI) was used to measure self-stigma, whereas the Boston University Empowerment Scale was used to measure the self-efficacy/self-esteem (SESE) and sense of power/powerlessness (PP). Perceived discrimination and devaluation was measured with the Perceived Devaluation and Discrimination (PDD) Scale. Thirty three percent of participants had moderate-to-high ISMI scores. In multivariable-adjusted analysis, significant ‘predictors’ of high ISMI scores were: age-group of 50–59 years, current employment, lower social contacts, and minimal-to-low SESE and PP scores. Remarkably, no significant association between ISMI and PDD was evident. Furthermore, there was evidence of a significant interaction between SESE and country. Study participants might not be representative to all individuals with mental disorders in countries included in this survey. Our findings indicate that people with psychiatric diseases suffer both self-stigma and perceived discrimination and devaluation. This is one of the very few reports highlighting country differences and diagnosis disparities of self-stigma among individuals with mental illnesses. Between-country differences should be considered and carefully addressed in the process of policy formulation and interventional programs against stigma.

Global mental health: a sustainable post Millennium Development Goal?

The global lifetime prevalence of mental disorders is between 12.2% and 48.6 %, while the burden of disease attributable to neuropsychiatric disorders is more than 13%. Over 70% of this burden lies in low and middle-income countries (LAMICs) and is projected to increase by 2030. Traditionally, mental disorders are seen as contributing significantly to morbidity and less so to mortality. However, suicide is one of the leading causes of death globally for all ages, with nearly 900 000 people taking their own lives each year. Despite these staggering figures, it has been estimated that in LAMICs as many as four out of five people with a severe mental disorder will not receive any form of treatment—known as the ‘treatment gap’. In addition, mental disorders receive little global priority and have not received meaningful visibility, policy attention or funding. The World Economic Forum has estimated that the global impact of mental disorders in the next 20 years due to lost economic output is likely to exceed US$16 trillion. Low income countries spend about 0.5% of their total health spending on mental health, and while middle income countries spend four times as much on mental health (2.4%), the percentage remains pitiful. While the equivalent figure in high income countries (5.1%) is markedly higher, it does not come close to matching the actual burden of mental disorders in these countries. At the policy level, as many as 44% of African countries do not even have a mental health policy while 33% do not have a mental health plan. However, other regions have shown more progress, as described by Caldas de Almeida in this issue of International Health (p. 15). Caldas de Almeida argues that while significant progress has been made in improving mental health services and in developing mental health policy in Latin America and the Caribbean, similar problems of insufficient funding, poor consensus among stakeholders and weak user and family groups exist in the region (p. 15). A not insubstantial portion of the burden of mental disorders in low-income countries is thought to be attributable to many of the failures of human development as targeted through the Millennium Development Goals (MDGs), including poverty, HIV and gender inequality. The evidence on depressive disorders and depressed mood is most well developed in this respect. Yet, global mental health has had difficulty making the case for its centrality across numerous MDGs despite growing evidence that mental ill health and poverty interact in a negative cycle. Lund et al. (p. 43) provide evidence for how implementing the mental health and development model of Basic Needs, an international non-governmental organisation, improved mental health, income generation, quality of life and overall functioning among people living with severe mental illness in rural Kenya. Lund et al. (p. 43) argue that their findings have important implications for integrating the treatment of mental illness with poverty alleviation programmes. Beyond disease burden, mental health is a fundamental component of people’s ability to meet their potential, to engage in meaningful relationships, and to secure and retain gainful employment. As Hanlon shows (p. 4), maternal mental illness has important public health implications with as many as 16% of women experiencing a mental illness during pregnancy and 20% in the postnatal period. While the postnatal figure is high, the prevalence rate of postnatal depression in some contexts may be as high as 34%. Linked to this, is the issue of gender inequality and, specifically, the association between intimate partner violence and common mental disorder. Fisher et al. (p. 29) show how exposure to intimate partner violence in rural Vietnam is associated with increased symptoms of the common perinatal mental disorders of depression and anxiety. Notwithstanding the impact of mental illness on the women, maternal mental illness also has significant impacts on infant

Lack of Knowledge About Hepatitis C Infection Rates Among Patients With Inherited Coagulation Disorders in Countries Under the Eastern Mediterranean Region Office of WHO (EMRO): A Meta-Analysis

Hepatitis C virus (HCV) infection is a public health problem. HCV alone is responsible for 90% cases of acute hepatitis among multiply transfused patients who are at risk of cirrhosis and hepatocellular carcinoma (HCC). To provide a clear picture of available data, we performed a systematic review of the epidemiological characteristics of HCV infection among patients with inherited coagulation disorders in the countries under the Eastern Mediterranean Region Office (EMRO). Meta-analysis was carried out on the basis of results of electronic and manual search. This analysis included studies in English, French, and Persian that met with the following criteria: (1) appropriate study design: cross-sectional, case-control, and cohort; (2) studies reporting HCV prevalence according to enzyme immune assay; (3) studies in which the sample population was enrolled from EMRO countries. According to the results of the heterogeneity tests, we used fixed-effect/random-effect model for our meta-analysis, with the "Metan" command. We included 30 studies, most of which were from Iran. The mean age of the subjects ranged from 13 to 27.1 years. The majority of the patients were male (range, 81% to 100%). The pooled estimate of HCV infection among patients with inherited coagulation disorders was 48.07% (95% confidence interval [CI], range: 27.39-55.68) in Iran, 36.03% (95% CI, range: 4.466-67.598) in Pakistan, and 48.27% (95% CI, range: 36.12-60.43) in all the EMRO countries taken together. In Iran and other EMRO countries, the HCV infection rate among patients with inherited coagulation disorders is high. Our study shows that there is a lack of knowledge about infections in such patients in most of the EMRO countries. It is the responsibility of health-policy makers to address this knowledge gap and provide safe and adequate treatment for patients in high-risk groups.

Lack of Knowledge About Hepatitis C Infection Rates Among Patients With Inherited Coagulation Disorders in Countries Under the Eastern Mediterranean Region Office of WHO (EMRO): A Meta-Analysis

Lack of Knowledge About Hepatitis C Infection Rates Among Patients With Inherited Coagulation Disorders in Countries Under the Eastern Mediterranean Region Office of WHO (EMRO): A Meta-Analysis

Self‐esteem, depression and eating disordered attitudes: A cross‐cultural comparison between Cypriot and British young women

The evidence suggests that eating disorders in countries that fall outside the Western template are not immune to eating disturbance as previously thought. This cross-cultural study investigated self-esteem, depression in relation to eating disordered attitudes across similarly constituted samples from two different cultures, Cyprus and Great Britain. Results revealed higher rates of eating disordered attitudes and depressive tendencies in Cypriot women. For both samples, a positive relationship was found between depression and eating disordered attitudes and this relationship was found to be significant. This study explores the native influences and possible vulnerability factors which may contribute in the development of eating disturbances in a non-Western country, Cyprus. Implications for future research are discussed.

Comparison of eating disorders and body image disturbances between Eastern and Western countries

Factors associated with the development of eating disorders in countries with non-Western cultures have not been adequately investigated in relation to Westernized countries. We therefore studied 243 girls [age =16.5+/-1.2 (SD)], recruited from schools in India, Tibet, the US and France. They completed the Figure Rating Scale (FRS), the Eating Attitudes Test (EAT), and the Beck Depression Inventory (BDI). The Tibetan group had a lower body mass index (BMI) than the other groups (p<0.0001), which did not differ from each other. All groups differed significantly on socio-economic status (SES), with those living in India having the highest (p<0.0001). Prior to controlling for age, SES, and BMI, there were no significant differences on any psychological measure between the individual countries, or when collapsed by East vs. West. However, after controlling for the same covariates, the Tibetan group selected a significantly larger current (p<0.0001) and ideal body size (p=0.03), compared to all the other countries, and had more body image discrepancy than the American group (p=0.04). After controlling only for BMI, the girls from the East had a larger current and ideal, but no difference on body image discrepancy. Body image discrepancy scores were best predicted by EAT scores and BMI, accounting for 35% of the variance (p<0.0001). EAT scores themselves were best predicted by mother's education, BDI, body image discrepancy, and drug and tobacco use, accounting for 33% of the variance (p<0.0001). Unlike some other studies, we did not observe greater body image discrepancy and eating pathology in Western cultures, whether or not controlling for age, SES, and BMI. There were no differences in eating and depression pathology between those in the US, France, or India. Indeed, the Tibetans, after controlling for their low BMI and SES, had the greatest body image discrepancy.