Biomedical subjects

Sandor Fekete

Publications and source records attributed to Sandor Fekete.

7 recordsLinked to original sources

PubMed2006

Multilevel modeling was a convenient alternative to common regression designs in longitudinal suicide research.

BACKGROUND AND OBJECTIVE: The prospective investigation of repetitive nonfatal suicidal behavior is associated with two methodological problems. Due to the commonly used definitions of nonfatal suicidal behavior, clinical samples usually consist of patients with a considerable between-person variability. Second, repeated nonfatal suicidal episodes of the same subjects are likely to be correlated. We examined three regression techniques to comparatively evaluate their efficiency in addressing the given methodological problems. STUDY DESIGN AND SETTING: Repeated episodes of nonfatal suicidal behavior were assessed in two independent patient samples during a 2-year follow-up period. The first regression design modeled repetitive nonfatal suicidal behavior as a summary measure. The second regression model treated repeated episodes of the same subject as independent events. The third regression model represented a hierarchical linear model. RESULTS: The estimated mean effects of the first model were likely to be nonrepresentative for a considerable part of the study subjects. The second regression design overemphasized the impact of the predictor variables. The hierarchical linear model most appropriately accounted for the heterogeneity of the samples and the correlated data structure. CONCLUSION: The nonhierarchical regression designs did not provide appropriate statistical models for the prospective investigation of repetitive nonfatal suicidal behavior. Multilevel modeling provides a convenient alternative.

Adolescent↗

PubMed2006

Development of multiple myeloma in a patient with chronic hepatitis C: A case report and review of the literature.

An association between chronic hepatitis C virus (HCV) infection and essential mixed cryoglobulinaemia and non-Hodgkin lymphoma (NHL) has been suggested. However, a causative role of HCV in these conditions has not been established. The authors report a case of a 50 year-old woman with chronic hepatitis C (CHC) who has been followed up since 1998 due to a high viral load, genotype 1b and moderately elevated liver function tests (LFTs). Laboratory data and liver biopsy revealed moderate activity (grade: 5/18, stage: 1/6). In April 1999, one-year interferon therapy was started. HCV-RNA became negative with normalization of LFTs. However, the patient relapsed during treatment. In September 2002, the patient was admitted for chronic back pain. A CT examination demonstrated degenerative changes. In March 2003, multiple myeloma was diagnosed (IgG-kappa, bone ma-rrow biopsy: 50% plasma cell infiltration). MRI revealed a compression fracture of the 5th lumbar vertebral body and an abdominal mass in the right lower quadrant, infiltrating the canalis spinalis. Treatment with vincristine, adriamycin and dexamethasone (VAD) was started and bisphosphonate was administered regularly. In January 2004, after six cycles of VAD therapy, the multiple myeloma regressed. Thalidomide, as a second line treatment of refractory multiple myeloma (MM) was initiated, and followed by peginterferon-alpha2b and ribavirin against the HCV infection in June. In June 2005, LFTs returned to normal, while HCV-RNA was negative, demonstrating an end of treatment response. Although a pathogenic role of HCV infection in malignant lymphoproliferative disorders has not been established, NHL and possibly MM may develop in CHC patients, supporting a role of a complex follow-up in these patients.

Female↗

PubMed2005

Problem-solving ability and repetition of deliberate self-harm: a multicentre study.

BACKGROUND: While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. METHOD: As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. RESULTS: Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. CONCLUSIONS: The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Adaptation, Psychological↗

PubMed2005

Gender differences in suicide attempters in Hungary: retrospective epidemiological study.

AIM: To determine gender differences in suicidal behavior and investigate the factors associated with suicide attempts. METHODS: In the framework of the WHO/Euro Multicenter Study on Suicidal Behavior, 1,158 suicide attempts have been registered and analyzed retrospectively in Pecs center, Hungary. Descriptive statistics and logistic regression analysis were performed to compare the characteristics of male and female suicide attempters. RESULTS: A "typical" female suicide attempter could be characterized as follows: retired or economically inactive (OR=2.38), widowed (OR=6.55), divorced (OR=1.64), or with depression in her personal history (OR=1.27). Female attempters were mainly repeaters, using the method of self-poisoning, mostly with benzodiazepines. Among men, unemployment, living alone, never having been married, and problems with addiction were the main risk factors, while violent methods characterized the typical attempt In the cases of self-poisoning, men were more likely to take meprobamate or carbamazepine. CONCLUSION: Significant differences were found in the risk factors for suicide attempts between men and women. Since suicide is a multi-causal phenomenon, its therapy and prevention should be complex and gender differences should be taken into consideration while building up our helping strategies.

Adolescent↗

PubMed2004

Life events and psychopathology in a group of suicide attempters.

Researchers examined the incidence of negative life events and associated these events with psychological scales (depression, hopelessness, self-esteem and state-trait anger) in a group of suicide attempters (n = 101) within the framework of the WHO/EURO Multicenter Study on Suicidal Behavior. Certain negative life events (especially relationship problems and physical/mental abuse in childhood) turned out to be the main indicators of severe mental problems in the family of the attempters (e.g. addiction, self-destructive behavior or psychiatric hospitalization). Significant positive correlations were found between the number of events and some psychopathological symptoms like depression, hopelessness, anger and lack of self-esteem. The role of stressful life events in suicidal behavior is emphasized. Particularly traumatic events (e.g. abuse in childhood) may be involved in the development of psychological and/or biological vulnerability (stress-diathesis model) and cognitive dysfunction. Therefore, in the psychotherapy of suicide attempters, it is essential to explore and discuss negative life events.

Adolescent↗

PubMed2004

Changing aspects of psychiatric inpatient treatment. A census investigation in five European countries.

This paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18-60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia.

Adolescent↗

PubMed2002

Why people engage in parasuicide: a cross-cultural study of intentions.

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.

Adolescent↗