Factors Predicting Successful Suicide Among Adolescents:Multiple Attempts And Index Methods, A Retrospective Cohort Study

Background: While suicide among adolescents has emerged as a significant social problem, few studies have examined the relationship between changes in suicide methods and suicide success following multiple attempts. This study aimed to investigate the relationship between changing suicide methods and successful suicide among adolescents after repeated attempts.Methods: This retrospective study analyzed the psychiatric history of patients (n=227) between 10 and 18 years of age who visited a pediatric emergency center between January 2007 and February 2021 for suicide attempts. Results: Out of a total of 227 patients, 80 achieved successful suicide attempts, including emergency hospitalization or death. A significant association was observed between successful suicide in patients with multiple attempts who chose drug intoxication (DI) as the index method (p=0.010) and patients with multiple attempts who chose DI as a suicide method (p=0.001). No statistically significant outcomes for changing methods and number of suicide attempts were evident.Conclusions: This study emphasizes the importance of identifying index methods as well as suicide methods among adolescent patients with multiple suicide attempts. This study identified predictors affecting the successful suicide of adolescents. Identifying the index method and the changed method among adolescent patients with multiple suicide attempts are significant predictors of successful suicide. Identifying the index method and changed method of suicide is expected to help in interviewing adolescents with multiple suicide attempts.

704 OBSERVATIONAL MEDICAL TREATMENT OR SURGERY FOR GIANT PARAOESOPHAGEAL HIATAL HERNIA IN ELDERLY PATIENTS.

Giant paraoesophageal hernias (GPHH) occur frequently in the elderly, account for about 5–10% of all hiatal hernias. Up to now persists the controversy between expectant medical treatment versus surgical treatment, regarding which is the most appropriate option depending on the presence or absence of symptoms. The aim of this study is to assess whether an indication for surgical repair of PHH is possible in older patients adequately evaluated before surgerymptoms. Methods Patients and method: Prospective study including patients hospitalized from January 2015 to December 2019 with GPHH more than 70 years old, comparing 2 group of patients which were separated in: Group A including a cohort of 23 patient in whom observational and conservative was indicated by gastroenterologist and Group B includes 66 patients in whom elective laparoscopic hiatal hernia repair was indicated at the moment of its diagnosis. Results Charlson’s score and ASA II or III were more frequent in group A. Emergency hospitalization was exclusively seen in group A and elective surgery in Group B. Symptomatic patients were seen in both groups (86.9 and 86.4% respectively). Symptoms period before the hospitalization was more prolonged in group A (21.8 + 7.8 vs 6.2 + 3.5 years) (p = 0.001). Symptoms of acute complications were seen frequently in Group A UCI and hospital stay were significantly more prolonged in Group A due to sepsis, emergency surgery and complications. In hospital mortality occurred in 5/23 patients (21.7%) in group A vs 1/66 patients (1.5%), Group B. Conclusion

MONITORING OF REFUSALS IN EMERGENCY AND PLANNED HOSPITALIZATION FOR PATIENTS WHO APPLIED TO THE ADMISSION DEPARTMENT OF JSC "CENTRAL CLINICAL HOSPITAL"

В данной статье представлены количественно-качественные характеристики сравнительного анализа причин отказов в госпитализации плановым и экстренным пациентам. Отражена работа кардиологической службы «Команда сердца» и параклинических подразделений многопрофильного стационара при поступлении пациентов с подозрением на острый коронарный синдром (далее - ОКС), важность своевременной дифференциальной диагностики и выбора дальнейшей тактики ведения больного. Отражены дефекты в дифференциальной диагностике и оказании медицинской помощи пациентам, нуждающимся в плановой и экстренной госпитализации, на уровне структур первичной медико-санитарной помощи. Представлены данные по количеству и причинам отказов в плановой госпитализации пациентам, направленным по Порталу бюро госпитализации. This article presents the quantitative and qualitative characteristics of a comparative analysis of the reasons for refusal to hospitalize planned and emergency patients. The work of the cardiological service "Team of the Heart" and paraclinical units of a multidisciplinary hospital upon admission of patients with suspected acute coronary syndrome (hereinafter - ACS), the importance of timely differential diagnosis and the choice of further tactics of patient management are reflected. Defects in differential diagnosis and provision of medical care to patients in need of planned and emergency hospitalization are reflected at the level of primary health care structures. The data on the number and reasons of refusals in planned hospitalization to patients referred to the Hospitalization Bureau Portal are presented.

Effect of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Weight on Emergency Hospitalization and 30‐Day Mortality in the General Population

Background Variability in blood pressure, glucose concentration, cholesterol concentration, or body weight is associated with a wide range of health outcomes. We hypothesized that high variability in metabolic parameters is associated with an increased risk of emergency hospitalization and mortality. Methods and Results Using a nationally representative database from the Korean National Health Insurance System, 8 049 228 individuals who underwent 3 or more health examinations during 2005 to 2010 were followed up until the end of 2016. Variability in fasting blood glucose and total cholesterol concentrations, systolic blood pressure, and body weight was measured using the variability independent of the mean (VIM). High variability was defined as the highest quartile of variability. Subjects were classified according to the number of high variability parameters. The end points of the study were emergency hospitalization and 30‐day mortality. There were 733 387 emergency hospitalizations (9.1%) during a median follow‐up of 5.6±1.2 years. For each metabolic parameter, an incrementally higher risk of emergency hospitalization was observed for higher VIM quartile groups than for the lowest quartile group. Compared with the group with low variability for all 4 parameters, the group with high variability for all 4 parameters had a significantly higher risk for emergency hospitalization (hazard ratio [HR], 1.58; 95% CI, 1.54–1.61) and 30‐day mortality (HR, 2.44; 95% CI, 1.62–3.69), after adjusting for possible confounding factors. Conclusions High variability in metabolic parameters was associated with increased risk of emergency hospitalization and short‐term mortality.

Impact of chronic kidney disease on mid-term prognosis of stable angina patients with high-dose or low-dose pitavastatin treatment: REAL-CAD sub-study

Background We previously demonstrated that high-dose (4 mg/day) compared with low-dose (1 mg/day) pitavastatin therapy significantly reduced cardiovascular events in Japanese patients with stable coronary artery disease in the Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study. However, little is known about whether the advantage of high-dose statins over low-dose statins is consistent among non-, mild, and moderate to severe chronic kidney disease (CKD) patients. Purpose The aim of this study was to clarify the effect of high-dose statins on cardiovascular events in Japanese patients with or without CKD. Methods The REAL-CAD study is a prospective, multicenter, randomized, open-label, blinded endpoint, physician-initiated superiority trial. In this sub-analysis of REAL-CAD study, patients were categorized into three groups according to estimated glomerular filtration rate (eGFR). Patients on hemodialysis were excluded in this study. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction (MI), non-fatal ischemic stroke, or unstable angina requiring emergency hospitalization. A secondary composite endpoint was defined as a composite of the primary endpoint event or clinically-indicated coronary revascularization excluding target-lesion revascularization. Results The total population of the REAL-CAD study was 12,413 patients. After exclusion of patients lacking eGFR data, the numbers of patients categorized into non-CKD (eGFR ≥60 mL/min/1.73m2), mild CKD (eGFR; 45–60), and moderate to severe CKD (eGFR <45) were 7,778 (64%), 3,176 (26%), and 1,164 (10%), respectively. The median follow-up period was 3.9 years. The baseline characteristics and medications were well balanced between the two groups in each CKD group. While high-dose compared to low-dose pitavastatin significantly reduced the primary endpoint in non-CKD patients, the effect was not observed in mild CKD and moderate to severe CKD patients (Figure 1). High-dose compared with low-dose pitavastatin did not significantly reduce the secondary composite endpoint in both mild and moderate to severe CKD patients as well. High-dose pitavastatin significantly reduced the risks of MI and any coronary revascularization in non-CKD patients, however, the effects were diminished in mild CKD and moderate to severe CKD patients. There was no significant difference between high-dose and low-dose pitavastatin treatment in the risk of all-cause death, cardiovascular death, ischemic stroke, or unstable angina requiring emergency hospitalization in patients with or without CKD. Conclusion Although high-dose pitavastatin therapy significantly reduced cardiovascular events in non-CKD patients with stable angina compared to low-dose pitavastatin, such beneficial effects had diminished in Japanese patients with mild or moderate to severe CKD patients. Figure 1. Kaplan-Meier Curves for Endpoints Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Clinical Research of Lifestyle-Related Disease of the Public Health Research Foundation

Association between Dialysis Modality and Infectious Diseases: Peritoneal Dialysis versus Hemodialysis

<b><i>Introduction:</i></b> For dialysis patients with end-stage kidney disease, infectious diseases (IDs) are the most common causes of hospitalization and death. However, the association between dialysis modality and IDs remains unclear. We aimed to determine the association between the dialysis modality and IDs. <b><i>Methods:</i></b> This retrospective observational cohort study compared the emergency hospitalization and mortality for IDs between peritoneal dialysis (PD) and hemodialysis (HD) patients. After propensity score matching, the risk factors were evaluated by the Cox proportional hazard regression models. <b><i>Results:</i></b> A total of 260 patients were compared – 130 of 135 PD and 130 of 706 HD patients. When the modality-specific ID (PD-catheter ID/peritonitis- and vascular access-related ID) was excluded, no significant differences in emergency hospitalization and mortality rates for overall IDs were observed between the PD and HD groups. Serum ferritin (HR, 2.17; CI, 1.06–4.43; <i>p</i> = 0.03) and Charlson Comorbidity Index (CCI) (HR, 1.24; CI, 1.01–1.52; <i>p</i> = 0.04) were significant predictors of emergency hospitalization for IDs, whereas age (HR, 1.12; CI, 1.05–1.19; <i>p</i> &#x3c; 0.001), male (HR, 3.38; CI, 1.01–11.3; <i>p</i> = 0.048), serum alkaline phosphatase (ALP) (HR, 6.87; CI, 2.18–21.7; <i>p</i> = 0.001), C-reactive protein (CRP) (HR, 10.7; CI, 3.55–32.1; <i>p</i> &#x3c; 0.001), and CCI (HR, 1.79; CI, 1.27–2.52; <i>p</i> &#x3c; 0.001) were significant predictors of ID mortality. When modality-specific ID was included, the emergency hospitalization rate for overall IDs was higher in the PD groups, and PD was a significant predictor of emergency hospitalization for IDs, whereas no significant difference in mortality rate for overall IDs was found between the PD and HD groups. <b><i>Conclusions:</i></b> ID events were not associated with dialysis modality when modality-specific ID was excluded, whereas the risk of modality-specific IDs was higher in PD than HD. Serum ferritin and ALP as well as age, male sex, CRP, and CCI were the risk factors for ID events.

Tele-Monitoring of Cancer Patients’ Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption

The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%—(I < O)low—were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)low were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption—(I < O)low—was identified in 13 (52%) patients and four (12%) controls (p = 0.002). Cancer patients with (I < O)low had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%—(I < O)high—(p < 0.012). Six (I < O)low patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)low. Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.