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

The bii4africa dataset of faunal and floral population intactness estimates across Africa’s major land uses

Sub-Saharan Africa is under-represented in global biodiversity datasets, particularly regarding the impact of land use on species’ population abundances. Drawing on recent advances in expert elicitation to ensure data consistency, 200 experts were convened using a modified-Delphi process to estimate ‘intactness scores’: the remaining proportion of an ‘intact’ reference population of a species group in a particular land use, on a scale from 0 (no remaining individuals) to 1 (same abundance as the reference) and, in rare cases, to 2 (populations that thrive in human-modified landscapes). The resulting bii4africa dataset contains intactness scores representing terrestrial vertebrates (tetrapods: ±5,400 amphibians, reptiles, birds, mammals) and vascular plants (±45,000 forbs, graminoids, trees, shrubs) in sub-Saharan Africa across the region’s major land uses (urban, cropland, rangeland, plantation, protected, etc.) and intensities (e.g., large-scale vs smallholder cropland). This dataset was co-produced as part of the Biodiversity Intactness Index for Africa Project. Additional uses include assessing ecosystem condition; rectifying geographic/taxonomic biases in global biodiversity indicators and maps; and informing the Red List of Ecosystems

The bii4africa dataset of faunal and floral population intactness estimates across Africa’s major land uses

Sub-Saharan Africa is under-represented in global biodiversity datasets, particularly regarding the impact of land use on species’ population abundances. Drawing on recent advances in expert elicitation to ensure data consistency, 200 experts were convened using a modified-Delphi process to estimate ‘intactness scores’: the remaining proportion of an ‘intact’ reference population of a species group in a particular land use, on a scale from 0 (no remaining individuals) to 1 (same abundance as the reference) and, in rare cases, to 2 (populations that thrive in human-modified landscapes). The resulting bii4africa dataset contains intactness scores representing terrestrial vertebrates (tetrapods: ±5,400 amphibians, reptiles, birds, mammals) and vascular plants (±45,000 forbs, graminoids, trees, shrubs) in sub-Saharan Africa across the region’s major land uses (urban, cropland, rangeland, plantation, protected, etc.) and intensities (e.g., large-scale vs smallholder cropland). This dataset was co-produced as part of the Biodiversity Intactness Index for Africa Project. Additional uses include assessing ecosystem condition; rectifying geographic/ taxonomic biases in global biodiversity indicators and maps; and informing the Red List of Ecosystems

CAREGIVER MENTALIZING OPERATIONALIZED AS MEDIATIONAL LEARNING AMONG CAREGIVERS OF ORPHANS AND VULNERABLE CHILDREN IN SOUTH AFRICA

Parental mentalizing is an important component of caregiving quality that is thought to facilitate sensitive and responsive caregiving and the development of adaptive social cognition and emotion regulation in children, and ultimately to promote children’s mental health and resilience. However, there is less research about parental mentalizing beyond infancy and early childhood, and a lack of observational measures of parental mentalizing for middle childhood and adolescence. Recently, an observational measure of caregiver behavior called Observing Mediational Interactions (OMI), which assesses caregivers’ mediation of children’s learning during dyadic interactions, has been suggested as a behavioral operationalization of caregiver mentalizing. The present study had an overall aim to evaluate the reliability and validity of the OMI as a behavioral measure of parental mentalizing among caregivers during middle childhood. Reliability and construct validity (convergent and discriminant validity) of the OMI were evaluated in a population of caregivers of orphans and vulnerable children (OVC) in South Africa, a particularly at-risk group for mental health difficulties. Children in this study (N = 88) were 7-11 years old and enrolled in one of four community-based organizations (CBOs); caregivers were their CBO careworkers (N = 18). Participants were assessed at three time points (baseline, 6-month, 12-month) as part of a larger intervention trial. Careworker-child dyads filmed an interaction at each timepoint, which was coded using the OMI. To evaluate convergent validity, careworkers completed self-report measures of parental mentalizing and their responses from an interview were also coded for mentalizing. Children also completed a task to assess social cognition. To evaluate discriminant validity, children, their parents, and careworkers completed a measure of child emotional and behavioral difficulties. Reliability for OMI components (affective components and five mediational components: focusing, affecting, expanding, rewarding, regulating) was assessed using intra-class correlations, and adequate reliability was demonstrated in 12 of 18 OMI components across timepoints. Cross-sectional associations between OMI components and convergent and discriminant validity measures were mostly non-significant. However, significant negative associations between Expanding and Regulating behaviors and measures of parental mentalizing, and significant positive associations between affective components and measures of parental mentalizing, point to directions for future research.Psychology, Department o

Perceived pubertal timing and borderline personality pathology in female adolescent inpatients

Borderline personality pathology typically onsets during adolescence. An important consideration in understanding adolescent psychopathology is pubertal development. Perceived pubertal timing is one facet of puberty that is especially relevant to adolescent psychopathology, especially when timing is perceived to be early. Despite links between early pubertal timing and core features of borderline personality disorder, and between early pubertal timing and disruptions in the interpersonal context, perceived pubertal timing has yet to be studied in relation to adolescent borderline pathology. This preliminary study aimed to test the association between perceived pubertal timing and borderline symptoms in adolescent girls, controlling for internalizing and externalizing pathology. Forty-two female adolescent inpatients (ages 12–15, Mage = 14.02, 81% White) completed measures of perceived pubertal development and borderline symptoms and a diagnostic interview. Results indicated that earlier perceived pubertal timing was uniquely associated with higher borderline symptoms even when internalizing and externalizing disorders were covaried. </jats:p

Interpersonal Problems in Parents and Adolescent Borderline Personality Disorder Features

Research shows that parental personality pathology is associated with borderline personality disorder features and internalizing/externalizing symptoms in offspring. However, studies have been limited by DSM-IV–based assessments of parental personality pathology. The authors leveraged evidence that interpersonal problems described by the Interpersonal Circumplex align with Criterion A of the DSM-5 Alternative Model for Personality Disorders and therefore used a measure of interpersonal problems to capture parental personality pathology. The authors hypothesized that parental interpersonal problems would be associated with a latent variable of borderline features in adolescent offspring. They also examined whether this relation with offspring borderline features existed above and beyond relations with offspring internalizing/externalizing symptoms, age, and gender. The sample included 524 inpatient adolescents (Mage = 15.31, 62.4% female) and their parents (80.5% female). Parental interpersonal problems demonstrated unique relationships with adolescent borderline features and externalizing symptoms, but not internalizing symptoms. Implications of the results, limitations, and future directions are discussed. </jats:p

XVII Rapporto di monitoraggio delle azioni formative realizzate nell'ambito del diritto dovere

Il presente volume documenta lo stato dell’arte dei percorsi di Istruzione e Formazione Professionale, relativamente all’a.f. 2017-18. L’analisi presente nel testo è suddivisa in due parti: la prima riguarda l’intero sistema IeFP mentre la seconda descrive specificamente gli interventi formativi realizzati in modalità duale. I dati provengono da due rilevazioni distinte. La prima, a titolarità congiunta del Ministero del Lavoro e delle Politiche Sociali e del Ministero dell’Istruzione, è la diciassettesima rilevazione sui percorsi IeFP, realizzata, come ogni anno, grazie alla collaborazione dei i referenti regionali e delle P.A. La seconda rilevazione comprende il dettaglio dei dati relativi ai percorsi IeFP svolti in modalità duale, a seguito dell’Intesa del 24 settembre 2015 e dei successivi protocolli tra Ministero del Lavoro e delle Politiche Sociali e le singole Amministrazioni Regionali.PON-SPAOil presente volume documenta lo stato dell’arte dei percorsi di istruzione e formazione professionale, relativamente all’a.f. 2017-18. l’analisi presente nel testo è suddivisa in due parti: la prima riguarda l’intero sistema iefp mentre la seconda descrive specificamente gli interventi formativi realizzati in modalità duale. i dati provengono da due rilevazioni distinte. la prima, a titolarità congiunta del ministero del lavoro e delle politiche sociali e del ministero dell’istruzione, è la diciassettesima rilevazione sui percorsi iefp, realizzata, come ogni anno, grazie alla collaborazione dei i referenti regionali e delle p.a. la seconda rilevazione comprende il dettaglio dei dati relativi ai percorsi iefp svolti in modalità duale, a seguito dell’intesa del 24 settembre 2015 e dei successivi protocolli tra ministero del lavoro e delle politiche sociali e le singole amministrazioni regionali. monitoraggio dei percorsi di istruzione e del sistema duale nella iefp: a.f. 2017-2018 emmanuele crispolti francesca penner claudia spigol