Typology and Factorial Conditioning of Suicidal Behavior of Adolescents

The problem of suicidal behavior of an individual continues to remain relevant, due to the increase in the number of suicides among people of different ages, on the one hand, and insufficient information about the factors of suicidal behavior of an individual. The purpose of the study is to identify the factors that determine the formation of a certain type of personality who committed suicidal attempts in adolescence. In order to identify the types of adolescent suicides, there was conducted a survey of 20 doctors in psychiatric clinical hospitals in Moscow. The survey results were processed using cluster analysis. To identify the factorial conditioning of suicidal behavior of each personality type, a complex of psychodiagnostic techniques was used, focused on the study of the characteristics of the emotional, value-semantic and behavioral spheres of the personality. The obtained empirical data were processed with the help of factor analysis. Three clusters have been identified that combine similar personality characteristics of suicides. It was specified that among adolescents there are the following personality types: “militant” (22%), “sacrifice” (54%) and “self-deprecating” (24%). Each type of adolescent suicide is due to the characteristics of the emotional, value-semantic and behavioral spheres of their personality. To develop targeted programs for the prevention of suicidal behavior among adolescents, it is necessary to take into account the results of the study, since such programs should be aimed at blocking the factors that form a certain type of suicide

Typology and Factorial Conditioning of Suicidal Behavior of Adolescents

The problem of suicidal behavior of an individual continues to remain relevant, due to the increase in the number of suicides among people of different ages, on the one hand, and insufficient information about the factors of suicidal behavior of an individual. The purpose of the study is to identify the factors that determine the formation of a certain type of personality who committed suicidal attempts in adolescence. In order to identify the types of adolescent suicides, there was conducted a survey of 20 doctors in psychiatric clinical hospitals in Moscow. The survey results were processed using cluster analysis. To identify the factorial conditioning of suicidal behavior of each personality type, a complex of psychodiagnostic techniques was used, focused on the study of the characteristics of the emotional, value-semantic and behavioral spheres of the personality. The obtained empirical data were processed with the help of factor analysis. Three clusters have been identified that combine similar personality characteristics of suicides. It was specified that among adolescents there are the following personality types: “militant” (22%), “sacrifice” (54%) and “self-deprecating” (24%). Each type of adolescent suicide is due to the characteristics of the emotional, value-semantic and behavioral spheres of their personality. To develop targeted programs for the prevention of suicidal behavior among adolescents, it is necessary to take into account the results of the study, since such programs should be aimed at blocking the factors that form a certain type of suicide

Typology and Factorial Conditioning of Suicidal Behavior of Adolescents

The problem of suicidal behavior of an individual continues to remain relevant, due to the increase in the number of suicides among people of different ages, on the one hand, and insufficient information about the factors of suicidal behavior of an individual. The purpose of the study is to identify the factors that determine the formation of a certain type of personality who committed suicidal attempts in adolescence. In order to identify the types of adolescent suicides, there was conducted a survey of 20 doctors in psychiatric clinical hospitals in Moscow. The survey results were processed using cluster analysis. To identify the factorial conditioning of suicidal behavior of each personality type, a complex of psychodiagnostic techniques was used, focused on the study of the characteristics of the emotional, value-semantic and behavioral spheres of the personality. The obtained empirical data were processed with the help of factor analysis. Three clusters have been identified that combine similar personality characteristics of suicides. It was specified that among adolescents there are the following personality types: “militant” (22%), “sacrifice” (54%) and “self-deprecating” (24%). Each type of adolescent suicide is due to the characteristics of the emotional, value-semantic and behavioral spheres of their personality. To develop targeted programs for the prevention of suicidal behavior among adolescents, it is necessary to take into account the results of the study, since such programs should be aimed at blocking the factors that form a certain type of suicide

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

Typology and Factorial Conditioning of Suicidal Behavior of Adolescents

The problem of suicidal behavior of an individual continues to remain relevant, due to the increase in the number of suicides among people of different ages, on the one hand, and insufficient information about the factors of suicidal behavior of an individual. The purpose of the study is to identify the factors that determine the formation of a certain type of personality who committed suicidal attempts in adolescence. In order to identify the types of adolescent suicides, there was conducted a survey of 20 doctors in psychiatric clinical hospitals in Moscow. The survey results were processed using cluster analysis. To identify the factorial conditioning of suicidal behavior of each personality type, a complex of psychodiagnostic techniques was used, focused on the study of the characteristics of the emotional, value-semantic and behavioral spheres of the personality. The obtained empirical data were processed with the help of factor analysis. Three clusters have been identified that combine similar personality characteristics of suicides. It was specified that among adolescents there are the following personality types: “militant” (22%), “sacrifice” (54%) and “self-deprecating” (24%). Each type of adolescent suicide is due to the characteristics of the emotional, value-semantic and behavioral spheres of their personality. To develop targeted programs for the prevention of suicidal behavior among adolescents, it is necessary to take into account the results of the study, since such programs should be aimed at blocking the factors that form a certain type of suicide.El problema de la conducta suicida de un individuo sigue siendo relevante, debido al aumento del número de suicidios entre personas de diferentes edades, por un lado, y la información insuficiente sobre los factores de la conducta suicida de un individuo. El propósito del estudio es identificar los factores que determinan la formación de cierto tipo de personalidad que cometió intentos suicidas en la adolescencia. Para identificar los tipos de suicidios de adolescentes, se realizó una encuesta a 20 médicos en hospitales clínicos psiquiátricos en Moscú. Los resultados de la encuesta se procesaron mediante análisis de conglomerados. Para identificar el condicionamiento factorial de la conducta suicida de cada tipo de personalidad, se utilizó un complejo de técnicas de psicodiagnóstico, enfocadas al estudio de las características de las esferas emocional, valor-semántica y conductual de la personalidad. Los datos empíricos obtenidos se procesaron con la ayuda de análisis factorial. Se han identificado tres grupos que combinan características de personalidad similares a los suicidas. Se precisó que entre los adolescentes existen los siguientes tipos de personalidad: “militante” (22%), “sacrificio” (54%) y “autocrítico” (24%). Cada tipo de suicidio adolescente se debe a las características de las esferas emocional, valor-semántica y conductual de su personalidad. Para desarrollar programas focalizados para la prevención de conductas suicidas entre adolescentes, es necesario tener en cuenta los resultados del estudio, ya que dichos programas deben estar dirigidos a bloquear los factores que forman un determinado tipo de suicidi

The Interrelationship between Coping Strategies and Socio-Psychological Competency of University Students’ Personality

In contemporary society characterized by socio-economic and political instability, the problem of studying the factors and mechanisms that contribute to the constructive resolution of life difficulties and counteracting their negative consequences is very important. This paper contains the results of an empirical study of the characteristics and relationships of students’ coping behavior with different levels of their socio-psychological competency. The research methods comprised the following: theoretical analysis, empirical research (testing), qualitative analysis of the obtained data, mathematical and statistical data processing (SPSS Statistics, Excel). The characteristics of indicators of socio-psychological competency were determined with the use of the technique for assessing socio-communicative competency, as well as a questionnaire that reveals the possibility of using socio-psychological skills by a person in difficult life situations. To study coping behavior, the following were used: “The ways of coping questionnaire” and “The youth coping scale”. The validity and reliability of the research results was ensured by the initial methodological positions, the use of tested tools, representativeness of the research sample, as well as mathematical processing of data with the help of software package for statistical analysis. The conclusions have been drawn that the basis of constructive mechanisms to overcome difficult life situations is a high level of formation of professional skills and abilities, introversion, motivation to achieve success, high intellectual development, moral standards, a high level of development of communication skills. It is these mechanisms that make it possible to resolve problem situations and tasks at work in a productive way. Their absence or a low level of development contributes to the dominance of situational methods of overcoming difficult life situations that impede professional formation and personal development.En la sociedad contemporánea caracterizada por la inestabilidad socio-económica y política, el problema de estudiar los factores y mecanismos que contribuyen a la resolución constructiva de las dificultades de la vida y contrarrestar sus consecuencias negativas es muy importante. Este artículo contiene los resultados de un estudio empírico de las características y relaciones de la conducta de afrontamiento de los estudiantes con diferentes niveles de su competencia socio-psicológica. Los métodos de investigación comprendieron los siguientes: análisis teórico, investigación empírica (testing), análisis cualitativo de los datos obtenidos, procesamiento de datos matemáticos y estadísticos (SPSS Statistics, Excel). Las características de los indicadores de competencia socio-psicológica se determinaron con el uso de la técnica de evaluación de la competencia socio-comunicativa, así como un cuestionario que revela la posibilidad de utilizar habilidades socio-psicológicas por parte de una persona en situaciones difíciles de la vida. Para estudiar el comportamiento de afrontamiento, se utilizaron los siguientes: “Cuestionario de formas de afrontamiento” y “La escala de afrontamiento de los jóvenes”. La validez y confiabilidad de los resultados de la investigación fue asegurada por las posiciones metodológicas iniciales, el uso de herramientas probadas, la representatividad de la muestra de investigación, así como el procesamiento matemático de los datos con la ayuda de un paquete de software para análisis estadístico. Se han extraído las conclusiones de que la base de los mecanismos constructivos para superar situaciones difíciles de la vida es un alto nivel de formación de habilidades y habilidades profesionales, introversión, motivación para alcanzar el éxito, alto desarrollo intelectual, estándares morales, un alto nivel de desarrollo de las habilidades comunicativas. . Son estos mecanismos los que permiten resolver situaciones problemáticas y tareas en el trabajo de forma productiva. Su ausencia o bajo nivel de desarrollo contribuye al dominio de métodos situacionales de superación de situaciones difíciles de la vida que impiden la formación profesional y el desarrollo personal

Treatment of Multisystem Inflammatory Syndrome in Children

BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research