Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Adherence to treatment after coronary bypass surgery: Psychological aspects

Poor adherence to treatment is a problem of great importance and striking magnitude. Its consequences are increased health care costs and poor health outcomes. It defined\ud the objective of this research, which is the study of psychological characteristics of patients\ud with different degrees of adherence to rehabilitation treatment after coronary bypass surgery. Ninety male and female patients with CHD, aged 46---71, were examined. The study was carried\ud out using the questionnaire of ways of coping and the technique for diagnosing the types\ud of attitude toward the disease, and the study of medical history. The analysis of the types of attitude toward the disease revealed that adherent patients show higher values on the harmonious\ud type; patients with poor adherence show higher values on the apathetic, as well as the melancholic type of attitude toward illness. This study shows that wide range of psychological\ud characteristics is significant for the definition of adherence to treatment. It is essential to consider the patient’s personality and his characteristics, such as attitude toward the disease,\ud because they influence the adherence and, therefore, the effectiveness of therapy in the postoperative period.\ud \ud La escasa adherencia a la terapia es un problema de gran importancia ampliamente extendido. Sus consecuencias son el aumento de costes del tratamiento y su baja eficacia.\ud El objetivo de la investigación fue el estudio de las características psicológicas de pacientes\ud con diferentes grados de adherencia al tratamiento de rehabilitación después de la cirugía de derivación coronaria. Se recogieron datos clínicos de 90 pacientes de ambos sexos con cardiopatía coronaria, sometidos a cirugía de derivación coronaria, con edades comprendidas entre 46-71 a˜nos. Los cuestionarios administrados fueron el cuestionario de estilos de afrontamiento y la técnica de diagnóstico de tipos de actitud hacia la enfermedad. Además se realizó un estudio\ud del historial médico. Se reveló que los pacientes adherentes mostraban puntuaciones más altas en el tipo ‘‘armonioso’’ de actitud hacia la enfermedad, y los pacientes con escasa adherencia, en los tipos ‘‘apático’’ y ‘‘melancólico’’. El estudio confirma que las características psicológicas son significativas para la definición de la adherencia. Es imprescindible tener en cuenta tanto la personalidad del paciente y sus características como su actitud hacia la enfermedad, ya que ésta influye en la adherencia y, por lo tanto, la eficacia de la terapia en el periodo postoperatorio

Enabling brief assessments of alexithymia: psychometric properties of the Russian version of the Perth Alexithymia Questionnaire-Short Form (PAQ-S) and its correlates with ill-being and well-being

Abstract Alexithymia is a trait involving deficits in emotion processing. As an important risk factor for a wide range of psychopathologies, its assessment is important in both research and clinical practice. Originally developed in English, the Perth Alexithymia Questionnaire-Short Form (PAQ-S) is a 6-item self-report measure of alexithymia, with its brevity designed to enable alexithymia assessments in a wide range of settings. In the present research, we aimed to introduce the first Russian version of the PAQ-S and examine its psychometric properties. Our sample consisted of 203 Russian-speaking adults aged 18–74 years, recruited from the general community in Russia. The PAQ-S’s factor structure was verified with confirmatory factor analysis. Convergent and divergent validity was assessed via relationships with psychopathology symptoms and well-being. Internal consistency reliability was evaluated. The Russian version of the PAQ-S demonstrated strong factorial validity, with support for the intended 1-factor structure as an overall marker of alexithymia. The PAQ-S total scale score showed good internal consistency reliability. As expected, its convergent and divergent validity was also supported. PAQ-S scores were significant predictors of higher ill-being (anxiety, depression, and stress) and lower well-being, thus demonstrating the high clinical relevance of the alexithymia construct as measured by the PAQ-S. There were no gender differences in PAQ-S scores, and alexithymia was higher in younger people and those with less education. Overall, the Russian PAQ-S therefore demonstrated strong psychometric properties as a brief and robust measure of overall alexithymia, performing similarly to other language versions

Психологические детерминанты адаптированности в вузе студентов-первокурсников медицинского факультета в период пандемии COVID-19

Abstract: Introduction. The successful adaptation of university students determines their participation in educational activities, their effectiveness, and a positive attitude toward the chosen profession. The novelty of the research is to study the adaptability of students in the transition to new, often unusual, forms of education (online, distance) against the backdrop of an increase in the general level of anxiety during the COVID-19 pandemic. Such difficulties significantly affected students of medical specialities, the development of which implies the formation of competencies in practical activities. Methods. The study involved students of medical (N = 93) and economic (control group, N = 111) faculties. The following methods were used: “Method of Research of Students Adaptability in the Higher Educational Establishment” by T. D. Dubovitskaya, A. V. Krylova, “The Satisfaction with Life Scale” by E. Diener, “Test of neuropsychic adaptation” by I. N. Gurvich, “Educational strategies” by S. N. Kostromina, T. A. Dvornikova, “Students’ educational motivation diagnostic inventory” by N. C. Badmaeva, “The Big Five Inventory” adapted by D. P. Yanichev, “The State-Trait Anxiety Inventory (STAI)” adapted by A. P. Bizyuk et al. (Part 2). Results and Discussion. The psychological characteristics of the Faculty of Medicine first-year students, contributing to the adaptability at the university during the COVID-19 pandemic, include a high level of extraversion, willingness to cooperate, the presence of professional motives for learning and motivation to achieve success, a high level of neuropsychic adaptation, orientation to memorizing educational material and a disinclination to planning educational activities. For students of the Faculty of Economics, such predictors were a great life satisfaction, a high level of extraversion, a low level of anxiety, motives for creative self–realization and a desire for planning in training. Students of the Faculty of Medicine with a high level of adaptability, in comparison with highly adapted students of the Faculty of Economics, have more pronounced professional motives and more often resort to the strategy of repeating educational material. Such differences may be due to both the peculiarities of the organization of the educational process and the specifics of the chosen speciality.Введение. Успешная адаптация студентов в университете обуславливает вовлеченность в учебную деятельность, ее эффективность, положительное отношение к выбранной профессии. Новизной исследования является изучение адаптированности студентов в ситуации перехода на новые, зачастую непривычные, формы обучения (онлайн, дистанционная) на фоне повышения общего уровня тревожности в период пандемии COVID-19. Такие трудности особенно затронули студентов медицинских специальностей, освоение которых подразумевает формирование компетенций в практической деятельности. Методы. В исследовании приняли участие студенты медицинского (N&nbsp;=&nbsp;93) и экономического (контрольная группа, N&nbsp;=&nbsp;111) факультетов. Были использованы следующие методики: «Адаптированность студентов в вузе» Т.&nbsp;Д.&nbsp;Дубовицкой, А.&nbsp;В.&nbsp;Крыловой, «Удовлетворенность жизнью» Э.&nbsp;Динера, «Тест нервно-психической адаптации» И.&nbsp;Н.&nbsp;Гурвича, «Учебные стратегии» С.&nbsp;Н.&nbsp;Костроминой, Т.&nbsp;А.&nbsp;Дворниковой, «Методика для диагностики учебной мотивации студентов» Н.&nbsp;Ц.&nbsp;Бадмаевой, «Большая пятерка» Д.&nbsp;П.&nbsp;Яничева, «Интегративный тест тревожности» А.&nbsp;П.&nbsp;Бизюка с соавт. (2&nbsp;часть). Результаты и их обсуждение. К психологическим особенностям студентов первого курса медицинского факультета, способствующим адаптированности в вузе в период пандемии COVID-19, относятся: высокий уровень экстраверсии, готовность к сотрудничеству, наличие профессиональных мотивов учебной деятельности и мотивации достижения успеха, высокий уровень нервно-психической адаптации, ориентация на запоминание учебного материала и несклонность к планированию учебной деятельности. У студентов экономического факультета – это удовлетворенность жизнью, высокий уровень экстраверсии, низкий уровень тревожности, мотивы творческой самореализации и стремление к планированию в обучении. Студенты медицинского факультета с высоким уровнем адаптированности, по сравнению с высоко адаптированными студентами экономического факультета, имеют более выраженные профессиональные мотивы и чаще прибегают к стратегии повторения учебного материала. Такие различия могут быть обусловлены как особенностями организации образовательного процесса, так и спецификой выбранной специальности

Event rates and incidence of Post-COVID-19 condition in hospitalised SARS-CoV-2 positive children and young people and controls across different pandemic waves: exposure-stratified prospective cohort study in Moscow (StopCOVID)

BackgroundLong-term health outcomes in children and young people (CYP) after COVID-19 infection are not well understood and studies with control groups exposed to other infections are lacking. This study aimed to investigate the incidence of post-COVID-19 condition (PCC) and incomplete recovery in CYP after hospital discharge and compare outcomes between different SARS-CoV-2 variants and non-SARS-CoV-2 infections.MethodsA prospective exposure-stratified cohort study of individuals under 18 years old in Moscow, Russia. Exposed cohorts were paediatric patients admitted with laboratory-confirmed COVID-19 infection between April 2 and December 11, 2020 (Wuhan variant cohort) and between January 12 and February 19, 2022 (Omicron variant cohort). CYP admitted with respiratory and intestinal infections, but negative lateral flow rapid diagnostic test and PCR-test results for SARS-CoV-2, between January 12 and February 19, 2022, served as unexposed reference cohort. Comparison between the 'exposed cohorts' and 'reference cohort' was conducted using 1:1 matching by age and sex. Follow-up data were collected via telephone interviews with parents, utilising the long COVID paediatric protocol and survey developed by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). The WHO case definition was used to categorise PCC.ResultsOf 2595 CYP with confirmed COVID-19, 1707 (65.7%) participated in follow-up interviews, with 1183/1707 (69%) included in the final 'matched' analysis. The median follow-up time post-discharge was 6.7 months. The incidence of PCC was significantly higher in the Wuhan variant cohort (89.7 cases per 1000 person-months, 95% CI 64.3-120.3) compared to post-infection sequalae in the reference cohort (12.2 cases per 1000 person-months, 95% CI 4.9-21.9), whereas the difference with the Omicron variant cohort and reference cohort was not significant. The Wuhan cohort had higher incidence rates of dermatological, fatigue, gastrointestinal, sensory, and sleep manifestations, as well as behavioural and emotional problems than the reference cohort. The only significant difference between Omicron variant cohort and reference cohort was decreased school attendance. When comparing the Wuhan and Omicron variant cohorts, higher incidence of PCC and event rates of fatigue, decreased physical activity, and deterioration of relationships was observed. The rate of incomplete recovery was also significantly higher in the Wuhan variant cohort than in both the reference and the Omicron variant cohorts.ConclusionsWuhan variant exhibited a propensity for inducing a broad spectrum of physical symptoms and emotional behavioural changes, suggesting a pronounced impact on long-term health outcomes. Conversely, the Omicron variant resulted in fewer post-infection effects no different from common seasonal viral illnesses. This may mean that the Omicron variant and subsequent variants might not lead to the same level of long-term health consequences as earlier variants