17,825 research outputs found
Mid-childhood bone mass after exposure to repeat doses of antenatal glucocorticoids: a randomized trial
No full textBACKGROUND AND OBJECTIVE: Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity, but could have adverse effects on skeletal development. We assessed whether exposure to repeat antenatal betamethasone alters bone mass in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids. METHODS: Women were randomized to a single dose of betamethasone or placebo, ≥7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at <32 weeks’ gestation. In this follow-up study, children underwent whole-body dual-energy radiograph absorptiometry at 6 to 8 years’ corrected age. RESULTS: Of 212 eligible childhood survivors, 185 were studied (87%; 91 repeat betamethasone group; 94 placebo [single course] group). Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar whole-body bone mineral content (median repeat betamethasone: 553 g, interquartile range: 442–712 g; placebo: 567 g, interquartile range: 447–750 g; geometric mean ratio: 0.99; 95% confidence interval: 0.94–1.03, P = .55) and bone area (median repeat betamethasone 832 cm2, interquartile range: 693–963 cm2; placebo: 822 cm2, interquartile range: 710–1020 cm2; geometric mean ratio: 0.99, 95% confidence interval: 0.92–1.07, P = .75). CONCLUSIONS: Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not alter bone mass in mid-childhood.Christopher J.D. McKinlay, Wayne S. Cutfield, Malcolm R. Battin, Stuart R.
Dalziel, Caroline A. Crowther, Jane E. Harding for the ACTORDS Follow-up Grou
UK Alcohol Treatment trial: client-treatment matching effects
No full textAim
To test a priori hypotheses concerning client–treatment matching in the treatment of alcohol problems and to evaluate the more general hypothesis that client–treatment matching adds to the overall effectiveness of treatment.
Design
Pragmatic, multi-centre, randomized controlled trial (the UK Alcohol Treatment Trial: UKATT) with open follow-up at 3 months after entry and blind follow-up at 12 months. Setting Five treatment centres, comprising seven treatment sites, including National Health Service (NHS), social services and joint NHS/non-statutory facilities.
Treatments
Motivational enhancement therapy and social behaviour and network therapy.
Measurements
Matching hypotheses were tested by examining interactions between client attributes and treatment types at both 3 and 12 months follow-up using the outcome variables of percentage days abstinent, drinks per drinking day and scores on the Alcohol Problems Questionnaire and Leeds Dependence Questionnaire.
Findings
None of five matching hypotheses was confirmed at either follow-up point on any outcome variable.
Conclusion
The findings strongly support the conclusion reached in Project MATCH in the United States that client–treatment matching, at least of the kind examined, is unlikely to result in substantial improvements to the effectiveness of treatment for alcohol problems. Possible reasons for this failure to support the general matching hypothesis are discussed, as are the implications of UKATT findings for the provision of treatment for alcohol problems in the United Kingdom
Meningiomas occurring during long-term survival after treatment for childhood cancer
No full textChildhood cancer is rare but improvements in treatment over the past five decades have resulted in a cohort of more than 30,000 long-term survivors of childhood cancer in the UK with more added annually. These long-term survivors are at risk of late effects of cancer treatment which replace original tumour recurrence as the leading cause of premature death. Second neoplasms are a particular risk and in the central nervous system meningiomas occur increasingly with increased radiation dose to central nervous system tissue and length of time after exposure, resulting in a 500-fold increase above that expected in the normal population by 40 years of follow up. This multidisciplinary author group and others met to discuss the issue. Our pooled information, and consensus that screening should only follow symptoms, was published online by the Royal College of Radiologists in 2013. We outline here the current knowledge and management of these neoplasms secondary to childhood cancer treatment
Psychotic symptoms in young adults exposed to childhood trauma - A 20 year follow-up study
No full textChildhood adversity has been shown to increase the risk of psychotic symptoms in adult life. However, there are no previous studies looking at the association between experiencing a natural disaster during childhood and the development of psychotic symptoms in young adulthood. Eight hundred and six bushfire-exposed children and 725 control children were evaluated following the 1983 South Australian bushfires. Five hundred and twenty nine (65.6%) of the bushfire group and 464 (64%) controls participated in a follow up study 20 years later. Childhood data on emotional and behavioural disorders and dysfunctional parenting was available. The adult assessment included the Australian National Health and Well-Being psychosis screen and detailed information about trauma, childhood adversity and alcohol and cannabis abuse. 5.6% of subjects responded positively to the psychosis screen and 2.6% responded positively to a further probe question. Psychotic symptoms were more common in subjects exposed to a greater number of traumas, and were associated with higher rates of childhood adversity, emotional and behavioural disturbance, dysfunctional parenting, and alcohol and cannabis abuse. Subjects exposed to bushfires as children did not have a greater risk of psychosis. Our results indicate that exposure to multiple traumas, rather than a single major trauma, increases the risk of later psychosis.Cherrie Galletly, Miranda Van Hooff, Alexander McFarlan
Do UK based weight management programmes cause weight loss maintenance in adults? A systematic review
No full textThe aim of this dissertation was to examine whether UK based weight management programmes promote weight loss maintenance (follow up of 12 months to assess effectiveness of intervention in weight loss) in adults through the process of a systematic review. The World Health Organisation (WHO) has described obesity as a "global epidemic". Weight management comprises two phases; weight loss and weight loss maintenance. The latter phase is the true goal for obesity and the most difficult element of weight management to achieve. However much less is know about this as compared with the weight loss phase. There is little purpose in committing time and money to reducing obesity if the weight is regained. This is counter-productive and weight loss maintenance is essential to combat the obesity epidemic. Searches were made for relevant information from a variety of scientific online databases and journals,. Seven articles met the inclusion criteria and were analysed in the review. All studies incorporated a multi-component (diet, exercise, behaviur modification) intervention approach. All control and internvetion groups reported weight loss at 12 months when compared with baseline. All groups recieved an intervention. One study reported a significant difference (P<0.05) between groups. Four studies reported on at least one component (diet, physical activity, behaviour modification) however there was not enough information to conclude whether they complied with national guidelines (NICE CG43 and SIGN 115). High attrition rates and loss to follow up are problematic for each study except one. Analysis on an intention to treat basis was common however this is problematic and there are alternative methods which may be more suitable for dealing with missing data
Long-term weight loss effects on all cause mortality in overweight/obese populations
No full textThis systematic review assesses the long-term effectiveness of weight loss on all cause mortality in overweight/obese people. Medline, Embase and Cinahl were searched (1966–2005). Cohort studies and trials on participants with Body Mass Index ¡Ý25 kg/m2, with weight change and mortality with ¡Ý 2 years follow-up were included finally identifying 11 papers based on 8 studies. There may be gender differences in the benefits for all cause mortality. The impact of weight loss in men on mortality was not clear with some studies indicating weight loss to be detrimental, while a recent cohort study showed benefits, if it were a personal decision. Other studies with no gender separation had similarly mixed results. However, one study indicated that overweight/obese women with obesity related illness, who lost weight intentionally within one year, had significantly reduced mortality rates of 19% -25%. In contrast, studies of overweight/obese diabetics irrespective of gender, showed significant benefit of intentional weight loss on mortality in a metaanalysis, HR=0.75(0.67- 0.83). There is some evidence that intentional weight loss has long-term benefits on all cause mortality for women and more so for diabetics. Long-term effects especially for men are not clear and need further investigation.National Health Service (NHS) R&D Health Technology Assessment Board
Mid-term follow-up outcomes of 2-staged hybrid coronary revascularization compared with off-pump coronary artery bypass for patients with multivessel coronary artery disease
No full textIntroduction : Two-staged hybrid coronary revascularization (HCR) is a novel procedure in selected patients with multivessel coronary artery disease. However, few studies are available on the mid-term or long-term outcomes of this 2-staged procedure as compared to off-pump coronary artery bypass (OPCAB).
Aim: To compare in-hospital and mid-term follow-up outcomes of 2-staged HCR with OPCAB in patients with multivessel coronary artery disease.
Material and methods: The present retrospective study analyzed the data from 73 patients who underwent the 2-staged HCR (HCR group) during 2012–2014 at the heart center. Three hundred and eighty-three patients who underwent conventional OPCAB by the same surgeon were selected for the comparative analysis performed on in-hospital and mid-term follow-up outcomes between the two groups.
Results : No significant difference was observed in the preoperative outcome between the two groups. The HCR group had a shorter operation duration (152.9 ±43.8 vs. 262.6 ±51.8 min, p < 0.05), less bleeding (558.6 ±441.3 vs. 1035.5 ±613.3 ml, p < 0.05), shorter mechanical ventilation (9.4 ±7.4 vs. 19.0 ±18.3 h, p < 0.05), and less blood transfusion (12 (16.4%) vs. 200 (52.2%), p < 0.05). The mean follow-up duration was 25.0 ±9.6 months in the HCR group and 22.8 ±10.6 months in the OPCAB group. The incidence of major adverse cardiac or cerebrovascular events (MACCE) was similar in both groups (4 (5.5%) vs. 10 (2.8%), p = 0.408). The estimated 3-year survival was similar in both groups (log-rank χ 2 = 1.041, p = 0.308).
Conclusions : The 2-staged HCR is a safe and effective surgical procedure and may offer similar mid-term follow-up outcomes to OPCAB
Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms.
No full textCulture and Counseling
No full textCulture is a group\u27s way of life. It is visible and invisible, cognitive and affective, conscious and unconscious, and much more. There are at least five sources of it. They are the universal, ecological, national, regional, and racio-ethnic tributaries. Interactively, they shape and influence all human behavior, including counseling. In this chapter, the ways culture as a whole impacts the counseling relationship, diagnosis, treatment plan, follow-up, and payment is discussed
Parent-mediated social communication therapy for young children with autism (PACT):long-term follow-up of a randomised controlled trial
No full textBACKGROUND: It is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction.METHODS: PACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2-4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42-5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827.FINDINGS: 121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI -0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI -0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI -0·23 to 0·53).INTERPRETATION: The results are the first to show long-term symptom reduction after a randomised controlled trial of early intervention in autism spectrum disorder. They support the clinical value of the PACT intervention and have implications for developmental theory.FUNDING: Medical Research Council.</p
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