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Major retroperitoneal mucinous cystadenocarcinoma in pregnancy : circumstance document.
Conclusion The Activ8 is a valid instrument to quantify a defined set of body postures and movements. Because of the smaller time difference, the thigh location is preferred for research purposes. © The Author(s) 2020.Background Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. AS1842856 Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity. Methods The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hostry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography. Discussion This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring. Trial registration ClinicalTrials.gov NCT03086161, retrospectively registered. © The Author(s) 2020.Background Rehabilitation is effective for multiple sclerosis, but is it value for money? Objectives To evaluate functional outcomes, care needs and cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis (MS). Methods A multicentre cohort study of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Data included all adults with MS (n = 1007) admitted for specialist inpatient (Level 1 or 2) rehabilitation in England, 2010-2018. Outcome measures Dependency/care needs Northwick Park Dependency Scale/Care Needs Assessment, Functional independence UK Functional Assessment Measure (UK FIM+FAM). Cost-efficiency. Patients were analysed in three dependency groups (High/Medium/Low). Results All groups showed significant reduction in dependency between admission and discharge on all measures (paired t-tests p  less then  0.001). Mean reduction in care costs/week was greatest in the most dependent patients High £519 (95% CI 447-597), Medium £148 (76-217), Low £36 (12-83). Despite longer stays, time taken to offset the cost of rehabilitation was shortest in the most dependent patients High 12.9 (12.0-14.1) months; Medium 29.3 (21.3-51.8); Low 76.8 (0-36.1). Item-level changes corresponded with clinical experience. Conclusions Specialist rehabilitation provided good value for money in patients with MS, yielding improved outcomes and substantial savings in ongoing care costs, especially in high-dependency patients. © The Author(s) 2020.Background Ocrelizumab, an anti-CD20 humanized monoclonal antibody, reduced disease progression in pivotal trials of patients with relapsing (OPERA I, OPERA II) and primary progressive (ORATORIO) multiple sclerosis (MS). These effects may be particularly important among patients with increased disability. Objective In this post hoc exploratory analysis, we evaluated the efficacy of ocrelizumab on disability progression among a subgroup of patients with MS who had increased baseline disability levels (Expanded Disability Status Scale scores ≥4.0) in the pivotal trials. Methods During the double-blind period, patients received ocrelizumab 600 mg intravenously every 24 weeks for 96 weeks in the OPERA trials (versus interferon β-1a 44 μg subcutaneously three times per week) and for 120 weeks in ORATORIO (versus placebo). Kaplan-Meier and Cox survival analyses were used to assess disability outcome measures. Results Baseline demographic, disease, and treatment characteristics were generally comparable across treatment groups in patients with increased disability from the OPERA and ORATORIO trials. Ocrelizumab treatment numerically, and in some instances significantly, reduced confirmed disability progression versus the comparator in these patients. Conclusions In patients with increased baseline disability, ocrelizumab reduced the risk of confirmed disability progression versus interferon β-1a in patients with relapsing-onset MS and versus placebo in patients with progression-onset MS. © The Author(s) 2020.Objective To understand the therapeutic processes associated with the helpfulness of an online relational agent intervention, Manage Your Life Online (MYLO). Methods Fifteen participants experiencing a mental health related problem used Manage Your Life Online for 2 weeks. At follow-up, the participants each identified two helpful and two unhelpful questions posed by Manage Your Life Online within a single intervention session. Qualitative interviews were conducted and analyzed using thematic and content analysis to gain insight into the process of therapy with Manage Your Life Online. Results MYLO appeared acceptable to participants with a range of presenting problems. Questions enabling free expression, increased awareness, and new insights were key to a helpful intervention. The findings were consistent with the core processes of therapeutic change, according to Perceptual Control Theory, a unifying theory of psychological distress. Questions that elicited intense emotions, were repetitive, confusing, or inappropriate were identified as unhelpful and were associated with disengagement or loss of faith in Manage Your Life Online. Conclusions The findings provide insight into the likely core therapy processes experienced as helpful or hindering and outlines further ways to optimize acceptability of Manage Your Life Online. © The Author(s) 2020.