Saint Louis University

The role of body weight-related factors in suicidality in adolescents remains debatable. This study aimed to examine whether (1) overweight/obesity and weight perception are associated with suicidality and self-harm, and (2) whether depression and peer victimization mediate these associations.

Using data from a nationally representative Australian adolescent cohort (N = 2858), we employed logistic regression analyses to explore associations between body weight at the age of 16-17, weight perception at the age of 16-17, and suicidal or self-harm thoughts or behaviors at the age of 18-19. Mediation analysis was used to evaluate the mediating role of depression and being bullied in the relationship between body weight-related factors and suicidal and self-harm thoughts or behaviors.

The results suggest that overweight and obesity were not significantly associated with suicidal and self-harm thoughts or behaviors after adjusting for other covariates. However, body weight-based discrimination and negative weight perceptions were associated with suicidal or self-harm outcomes. Further, bullying and depression were found to jointly account for approximately 28-46 % of the total effect on suicidal or self-harm thoughts/behaviors.

The reliance on self-reported data, particularly for sensitive topics such as self-harm and suicidal thoughts and behaviors, may introduce reporting bias, as individuals may underreport these behaviors due to discomfort surrounding privacy or judgement.

Stress due to weight perception may exert a larger impact than body weight on adolescent suicide or self-harm risk. Mitigating the impact of depression and bullying should be prioritized for suicide preventions for youths with weight issues.

Vascular surgery residents face a high degree of burnout, despite the identification of modifiable risk factors. Business organizations have used the psychosocial work environment including workplace fit and "sense of purpose" to assess employee satisfaction and productivity. We sought to evaluate the effect of these factors on burnout in vascular surgery trainees.

An electronic questionnaire was sent to all US vascular surgery fellowship and residency program directors to distribute to their trainees. This survey included 15 questions compiled from the Danish Psychosocial Work Environment Questionnaire, Meaning of Life Questionnaire, and Oldenburg Burnout Inventory to assess the psychosocial work environment, sense of purpose, burnout, as well as demographic information. Univariate analysis was performed to identify factors associated with sense of purpose, workplace fit, and burnout.

83/319 (26%) trainees at 54 accredited programs completed the questionnaire (ages ranging from 21-50, 26 females (38.2%), 39 males (57.4%)). A total of 43.4% were married, 20.9% had children, and 88.2% had a mentor in vascular surgery. Higher psychosocial work environment inversely correlated to burnout (P < 0.0001) and presence of purpose directly correlated with burnout (P < 0.0001). Male trainees were found to have higher burnout scores (P = 0.04) and less trust between colleagues (P = 0.03). Furthermore, those who has a mentor in vascular surgery had a significant relationship to the presence of purpose (P = 0.007) and higher burnout scores (P = 0.007).

This study shows the utility of examining burnout through a psychosocial lens. Further analysis into these relationships could yield actionable interventions that tackle root causes of burnout.

In the ISCHEMIA Trial, 5,179 patients with stable coronary disease were randomized to initial invasive or conservative management.

PCI was recommended with a SYNTAX score 0 to 22 (low) and CABG with a SYNTAX score ≥33 (high). Either could be recommended for intermediate scores. The composite primary outcome was cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. There were 2 cohorts in this analysis. The descriptive cohort included patients who underwent CABG or PCI within 180 days of randomization and had no primary outcome before revascularization. The comparative cohort excluded patients with prior CABG, single vessel disease, SYNTAX score ≥ 45, and without core laboratory assessment. We focused on the intermediate (23-32) SYNTAX comparative group for which either CABG or PCI could be recommended.

For 1,935 patients in the descriptive cohort (485 CABG, 1,450 PCI), the SYNTAX score was 27.3 ± 11.0 in the CABG group and 15.3 ± 8.6 in the PCI group, P < .0001. Most patients with low SYNTAX scores underwent PCI (87.1%), while most with high SYNTAX scores underwent CABG (72.6%). For the 1,203 patients (385 CABG, 818 PCI) in the comparative cohort, the adjusted 4-year primary event rate was 14.5% for CABG and 13.2% for PCI (difference 1.3%, 95% CI, -4.9% to 7.7%). For the 346 patients (163 CABG, 183 PCI) in the intermediate SYNTAX group, the adjusted 4-year primary event rate was 10.6% for CABG and 18.3% for PCI (difference -7.6%, 95% CI, -16.1% to 0.9%).

Selection of revascularization method resulted in more PCI in the low SYNTAX group and more CABG in the high SYNTAX group. There was no statistical evidence of a difference between PCI and CABG in the intermediate SYNTAX group but the CIs are broad, reflecting uncertainty.

NCT01471522; https://clinicaltrials.gov/ct2/show/NCT01471522.