Syndrome In Young People Research Articles

Development of a User-Friendly Self-Screening Tool for Assessing Metabolic Syndrome Risk in Youths from Economically Challenged Regions.

Metabolic syndrome increases the risk of heart disease and diabetes. Early identification and management are crucial, especially in economically challenged regions with limited healthcare access. To develop nomograms for individualized risk estimation for metabolic syndrome in young people from low-income regions. We assessed 496 college students from two Brazilian cities with Gini indices ≤0.56. Of these, 69.9% were female, 65.1% were younger than 20 years, 71.8% were non-white, and 64.3% were enrolled in health-related courses. For external validity, we assessed metabolic syndrome in a subset of 375 students. We found 10 variables associated with abdominal obesity by logistic regression: age, biological sex, physical education facilities, enrollment in sports competitions during elementary school, grade retention, physical education as the preferred subject, physical education classes per week, and enrollment in sports training in secondary school (score A); adherence to 24 h movement behaviors (B score); and body weight (score C). We designed three nomograms (for scores A, B, and C), all of which showed acceptable performance according to the area under the receiver operating characteristic curve (≥0.70) and calibration (Hosmer-Lemeshow test, p > 0.05). In the external validation, we observed higher predictive capability for the A and B scores, while the C score had lower but still acceptable predictive ability. User-friendly self-reported data accurately predict metabolic syndrome among youths from economically challenging areas.

Clinical variants of the metabolic syndrome in young people living in the Khanty-Mansiysk autonomous region – Yugra

Currently the “rejuvenation” and an increase in the number of components of the metabolic syndrome (MS) determine its clinical significance in the earlier development of diabetes mellitus, cardiovascular diseases and related complications. Aim of the study was to investigate the features of the MS clinic picture in a population of young men and womenliving in the Khanty-Mansiysk autonomous region – Yugra.Material and methods. The study included 863 young people between 18 and 44 years of age, including 344 men and women with MS and 519 people in the comparison group. Studied subgroups are represented by non-indigenous men and women living in urban and rural areas, and indigenous rural residents. The analysis of MS clinical and laboratory parameters was carried out and its clinical variants in ethnic groups were identified.Results and its discussion. According to the results of the survey of young people with metabolic syndrome, it was revealed that the combination of abdominal obesity and two components of MS were most common in young people with MS (in 50.0 % men and in 55.5 % women). The study defined regression models for each MS group and threshold values for waist circumference were set, which changes in lipid and carbohydrate metabolism were predicted.Conclusions. In groups with MS, hypertriglyceridemia was determined as its most common component. The study identified the most frequent association of abdominal obesity with hyper-LDL cholesterol and hypertriglyceridemia in patients with metabolic syndrome, in ethnic groups, this combination is more common in indigenous rural men (53.3 %) and in non-indigenous urban women (54.3 %).

Comparative Efficacy of Mitchell's and Benson's Relaxation Techniques in Alleviating Pain and Improving Quality of Life Among Patients With Premenstrual Syndrome: A Randomized Controlled Trial.

Background Most women of reproductive age suffer physical discomfort or distress in the weeks before menstruation. Even though symptoms are typically not severe enough to impede daily activities seriously, they occasionally can. Physical problems like breast discomfort and bloating can also be a problem. The most irritating symptoms are those that affect mood and behaviour. Women of reproductive age experience premenstrual syndrome frequently, necessitating study into non-pharmacological methods for symptom reduction. Methodology The objective of the study was to evaluate and compare the clinical efficacy of Benson's relaxation technique to Laura Mitchell's physiological approach in patients with premenstrual syndrome. Study design was comparative parallel experimental study with patient-reported questionnaire data (online) collected before and post-intervention in tertiary hospital setting. Participants were 70 adult females aged 18 to 35 with premenstrual syndrome. Patients were administered Benson's relaxation technique once a day for a month versus Mitchell's relaxation technique once a day for a month.Both techniques were first taught for one session followed by home program to be performed by patients.The premenstrual syndrome questionnaire and a numerical pain rating scale were used to quantify premenstrual symptoms pre and post-intervention. Results The result revealed significant (p<0.01) improvement in premenstrual symptoms in both groups following the intervention. However, Bensons' relaxation technique was found to be more significant while alleviating the premenstrual symptoms. Conclusions When it comes to lowering the intensity of premenstrual syndrome in young people, Benson's relaxation method is superior to Mitchell's. Both approaches should be entrenched as a regular practice and can be employed on patients to improve their menstrual well-being.

Dynamic Changes Of Physiological And Psychological Parameters Of Young Persons As Asthenia Risk Factors

Asthenic syndrome is the most important problem of the modern stage of development of human society, which is the most important component of many pathological conditions or risk factors for diseases. The purpose of the study is to determine some physiological and psychological parameters in young people in dynamics at different levels of intellectual load and evaluate their role in the formation of asthenic syndrome. Materials and Methods: The study involved 160 3rd year students of the Medical Institute of Moscow State University. N.P. Ogarev, divided into four groups according to the type of higher nervous activity (HNA), based on the indicators "Extraversion / Introversion" and "Neuroticism", determined by the Eysenck scale. We assessed the characteristics of emotional balance, functional parameters of autonomic regulation, features of cognitive functions in young people in different periods of training load. Results: the indicator of neuroticism correlated with the severity of asthenic syndrome in young people. Persons with a high level of neuroticism more often revealed maladjustment of mental processes, a decrease in cognitive functions, and an increase in emotional instability during the period of intense intellectual loads. After a period of increased intellectual load, asthenia occurs significantly more often in females. Features of autonomic regulation have little effect on the development of asthenia. The exceptions were individuals with a high level of neuroticism. In these groups, the stress of hemodynamic mechanisms was occurred frequently.

Role of monocytes in the development of psychovegetative disorders in young people with undifferentiated connective tissue dysplasia

Background:The immune system plays an important role in the development of neuropathology. Dysfunction of monocytes/macrophages can contribute to environmental health and the development of neuroinflammatory and neurodegenerative diseases. Two subpopulations of monocytes are distinguished, namely, anti-inflammatory and activated pro-inflammatory monocytes, producing cytokines interleukin (IL)-1, IL-6, IL-2, IL-8, and tumor necrosis factor (TNF)-α, which are involved in immune inflammation in mental diseases. Violations of cellular, phagocytic, and/or humoral immunity are often found in patients with undifferentiated connective tissue dysplasia (UCTD). Monocytes are assumed to be involved in the development of psychovegetative disorders in patients and connective tissue insufficiency. Aim:To study the relationship between the number of monocytes and pro-inflammatory cytokines (IL-1, IL-6, and TNF-α) in the peripheral blood with possible non-psychotic diseases and autonomic dysfunction syndrome in UCTD in young people. Materials and methods:We examined 95 people aged 18–22 years. Neuropsychological examination, general clinical blood tests, pro-inflammatory cytokines (IL-1, IL-6, TNF-α), markers of neurodegeneration (neuron-specific enolase) and cerebral ischemia (antibodies to NR2) were sent. Results:An increase in the absolute monocyte count in the peripheral blood is accompanied by a lesser severity of psychovegetative, ischemic, and neurodegenerative cases. An inverse correlation was found between the level of monocytes in the peripheral blood and the number of UCTD indicators, a direct correlation between UCTD and autonomic dysfunction syndrome (ADS), asthenic condition, personal anxiety, depression, neurosis, Internet addiction, and headache research index for everyday life. Severe UCTD leads to a change in the proportion of monocytes in the use of the pro-inflammatory subpopulation, which is probably one of the reasons for the numerous non-psychotic diseases and autonomic nervous system diseases in these patients. Conclusion:An increase in the pro-inflammatory monocyte count in severe UCTD plays an important role in the development of psychovegetative disorders. The correction of the dysplastic process can become an important role in the prevention and detection of various neurological and non-psychotic diseases, such as ADS and anxiety–depressive syndrome in young people.

ON THE PRESENCE OF EVA SYNDROME IN YOUNG PEOPLE WITHOUT ELEVATED BLOOD PRESSURE

Objective: The problem of early vascular aging or EVA syndrome is intensively studied. While it remains unclear what is primary - an increase in blood pressure (BP) or an increase in vascular stiffness (VS) due to the primary pathology of the arterial wall? The Objective is to assess the possibility of the presence of cases of isolated EVA syndrome against the background of normotension among young people (YP). Design and method: 275 YP (95 boys and 180 girls) aged from 18 to 25 years were examined on basis of the StSMU Health Center as part of the National Preventive Project University - Health Territory. Angiological screening was performed using the VaSera VS-1500 device (Fukuda Denshi, Japan), which allows us to evaluate such an VS indicator as cardio-ankle vascular index (CAVI). The examined patients were divided into terciles according to this indicator, taking into account gender, which made it possible to distinguish carriers of elevated (upper CAVI-tercile), normal (middle CAVI-tercile) and favorable (lower CAVI-tercile) VS. The upper tercile is correlated with EVA syndrome. 4 groups were formed: 1gr. - increased VS; 2gr. - increased VS and arterial hypertension -prehypertension (AH-PH); 3gr. - AH-PH; 4gr. - favorable VS and normotension. Carriers of hereditary connective tissue disorders were excluded from the study for a reason an increase in their VS due to genetically determined angiopathy with an imbalance of elastin and collagen fibers in arterial wall. Results: It was found that 14.7% (14) fell into the first group among boys, and 20.6% (37) of their total number among girls (P = 0.098). In the second and third groups there were 11.6% (11) and 47.4% (45) boys, and 5.0% (9) and 16.1% (29) girls with P = 0.041 and P = 0.028. Cases with favorable VS in combination with normotension (control) were revealed among boys and girls 11.8% (10) and 21.1% (38), respectively (P = 0.037). Conclusions: Our data indicate possibility of the development of isolated EVA syndrome in YP without presence of elevated office BP. Such results are useful to use when conducting screening activities among YP to perform more individualized preventive interventions among them.

Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis

SummaryBackgroundYoung people with psychosis are at high risk of developing cardiometabolic disorders; however, there is no suitable cardiometabolic risk prediction algorithm for this group. We aimed to develop and externally validate a cardiometabolic risk prediction algorithm for young people with psychosis.MethodsWe developed the Psychosis Metabolic Risk Calculator (PsyMetRiC) to predict up to 6-year risk of incident metabolic syndrome in young people (aged 16–35 years) with psychosis from commonly recorded information at baseline. We developed two PsyMetRiC versions using the forced entry method: a full model (including age, sex, ethnicity, body-mass index, smoking status, prescription of a metabolically active antipsychotic medication, HDL concentration, and triglyceride concentration) and a partial model excluding biochemical results. PsyMetRiC was developed using data from two UK psychosis early intervention services (Jan 1, 2013, to Nov 4, 2020) and externally validated in another UK early intervention service (Jan 1, 2012, to June 3, 2020). A sensitivity analysis was done in UK birth cohort participants (aged 18 years) who were at risk of developing psychosis. Algorithm performance was assessed primarily via discrimination (C statistic) and calibration (calibration plots). We did a decision curve analysis and produced an online data-visualisation app.Findings651 patients were included in the development samples, 510 in the validation sample, and 505 in the sensitivity analysis sample. PsyMetRiC performed well at internal (full model: C 0·80, 95% CI 0·74–0·86; partial model: 0·79, 0·73–0·84) and external validation (full model: 0·75, 0·69–0·80; and partial model: 0·74, 0·67–0·79). Calibration of the full model was good, but there was evidence of slight miscalibration of the partial model. At a cutoff score of 0·18, in the full model PsyMetRiC improved net benefit by 7·95% (sensitivity 75%, 95% CI 66–82; specificity 74%, 71–78), equivalent to detecting an additional 47% of metabolic syndrome cases.InterpretationWe have developed an age-appropriate algorithm to predict the risk of incident metabolic syndrome, a precursor of cardiometabolic morbidity and mortality, in young people with psychosis. PsyMetRiC has the potential to become a valuable resource for early intervention service clinicians and could enable personalised, informed health-care decisions regarding choice of antipsychotic medication and lifestyle interventions.FundingNational Institute for Health Research and Wellcome Trust.

Estimation of metabolic factors related to insulin resistance and metabolic syndrome in young people

Civilizational developments occurring during recent decades have resulted in an increased incidence of a variety of metabolic disorders related to insulin resistance in younger people. The determination of decision limits for insulin resistance indices, especially among young people, is a significant challenge in clinical practice. The aim of this study was the estimation of metabolic factors related to their relationship to insulin resistance and metabolic syndrome (MS) features in young, apparently healthy people. Moreover, we evaluated the optimal decision limits for patients with MS identification for HOMA1-IR, HOMA2-IR, HOMA2 obtained from C-peptide concentrations. 349 apparently healthy people aged 18–31 (260 women and 89 men), were enrolled in this study. The present analysis of metabolic, anthropometric and clinical parameters observed them in clusters covering the criteria of MS recognition, but MS in this group was only partially related to insulin resistance. The HOMA1-IR decision limit estimation is likely to became be useful in the prognostication of metabolic disturbances in young, apparently healthy people. A measure of insulin resistance that can provide a reliable early prediction of MS is likely to provide an opportunity for instigating preventive measures of significant clinical utility.

Profile of Acute Coronary Syndrome In Young People: A Hospital Based Observational Study in Western Nepal

Introduction: Acute coronary syndrome is associated with high mortality and morbidity. The incidence of acute coronary events in young is increasing.Objectives: This study aimed at evaluating the profile of acute coronary syndrome in young people in the western part of Nepal.Methodology: A retrospective study was designed. All patients admitted for acute coronary syndromes were taken and data of acute coronary syndrome involving patients aged less than 45 years from April 2015 through December 2017 were collected in a pre-structured proforma and analyzed.Results: There were 712 (489 males and 223 females with M:F=2.19:1) acute coronary syndrome patients admitted during the study period. Only 79 (12.9%) patients were patients &lt;45 years of age. Commonest risk factor of acute coronary syndrome was smoking (69%) followed by dyslipidemia (46.8%), hypertension (45.5%) and diabetes (14%). Out of 79 patients of young acute coronary syndrome, 37 (46.8%) presented with ST elevated myocardial infarction, 16 (20.2%) with non-ST elevated myocardial infarction and 26 (32.9%) with unstable angina. Most common finding in coronary angiography was single vessel disease (35%) –left anterior descending artery being the commonest (53% of single vessel disease), double vessel disease (17.7%), non-critical coronary artery disease (16.4%), triple vessel disease (7.6%) and left main (1.2%). Myocardial bridging was seen in 1.2% and 20% had normal coronaries. Comparison of males and females in different categories of acute coronary showed that males predominate significantly in ST elevated myocardial infarction (odds ratio: 2.99; p=0.03) but there was no significant difference between the males and females presenting either with Non ST elevated myocardial infarction or unstable angina.Conclusion: Acute coronary syndrome in young people was common (12.9%) particularly males with Non ST elevated myocardial infarction. Smoking was the commonest risk factor. Public awareness regarding stoppage of cigarette smoking should be focused to prevent such events especially in the young population. BJHS 2018;3(1)5 : 361-365

Abdominal Fat by Imaging Methods and Metabolic Syndrome in Young People

Metabolic Syndrome is highlighted in the current health mainly due to its increasing prevalence in the world. Its occurrence among adolescents ranges from 2.2% to 51.7%. This set of diseases, when acquired during childhood/adolescence, tends to persist into adulthood. This study aims to present the results of the latest publications that correlated ultrasonography, computed tomography and magnetic resonance imaging with the components of the Metabolic Syndrome in young people. Nine papers were found. Abdominal adipose accumulation has a strong influence on the metabolic disorders of MS, being measurable by imaging methods. It is of crucial importance to deepen the knowledge of the benefits brought by the imaging tests and their relationship with the components of the syndrome so that clinicians and radiologists can use these exams, especially in young people, where an accurate and early diagnosis allows interventions that will influence reducing the risk unfavorable outcomes in adult life. Keywords: Metabolic syndrome X; Intra-abdominal fat; Computed tomography; Magnetic resonance imaging; Ultrasonography Abbreviations: SM: Metabolic Syndrome; TM: Computer Tomography; RM: Magnetic Resonance Imaging; US: Ultrasonography; BVS: Health Virtual Library; CC: Waist Circumference; IMC: Body Mass Index; GAS: Subcutaneous Abdominal Fat; GAV: Visceral Abdominal Fat

Metabolic syndrome in young people

The prevalence of obesity is on the increase, and consequently metabolic syndrome is also becoming a serious health problem in children and adolescents all over the world. This review attempts to summarize the recent literature on metabolic syndrome in children and adolescents. To date, a standard definition of metabolic syndrome for the pediatric population is not available. Recently, the International Diabetes Federation has proposed a new set of criteria to define metabolic syndrome in children and adolescents aged 6-16 years. The relationships between obesity, insulin resistance and metabolic syndrome may be explained by the pattern of lipid partitioning. Fatty liver plays a central role in the insulin-resistant state in obese adolescents. Although insulin resistance has been proposed as the central factor leading to the abnormalities observed in metabolic syndrome, most definitions of metabolic syndrome use impaired fasting glucose as a marker. Nutrition impairment during both prenatal and early postnatal life can cause metabolic disturbances leading to insulin-resistance, type 2 diabetes, hypertension and cardiovascular disease. Metabolic syndrome prevalence in children and adolescents is on the increase. Therefore, the emphasis in all studies and programs related to metabolic syndrome should be focused on prevention, early detection of metabolic risk factors and interventions that will have a significant impact on future adult health.

Acute coronary syndrome in young Sub-Saharan Africans: A prospective study of 21 cases

BackgroundCoronary heart disease remains the leading cause of death in developed countries. In Africa, the disease continues to rise with varying rates of progression in different countries. At present, there is little available work on its juvenile forms. The objective of this work was to study the epidemiological, clinical and evolutionary aspects of acute coronary syndrome in young Sub-Saharan Africans.MethodsThis was a prospective multicenter study done at the different departments of cardiology in Dakar. We included all patients of age 40 years and below, and who were admitted for acute coronary syndrome between January 1st, 2005 and July 31st, 2007. We collected and analyzed the epidemiological, clinical, paraclinical and evolutionary data of the patients.ResultsHospital prevalence of acute coronary syndrome in young people was 0.45% (21/4627) which represented 6.8% of all cases of acute coronary syndrome admitted during the same period. There was a strong male predominance with a sex-ratio (M:F) of 6. The mean age of patients was 34 ± 1.9 years (range of 24 and 40 years). The main risk factor was smoking, found in 52.4% of cases and the most common presenting symptom was chest pain found in 95.2% of patients. The average time delay before medical care was 14.5 hours. Diagnosis of ST- elevation myocardial infarction in 85.7% of patients and non-ST-elevation myocardial infarction in 14.3% was made by the combination electrocardiographic features and troponin assay. Echocardiography found a decreased left ventricular systolic function in 37.5% of the patients and intraventricular thrombus in 20% of them. Thrombolysis using streptokinase was done in 44.4% of the patients with ST- elevation myocardial infarction. Hospital mortality was 14.3%.ConclusionAcute coronary syndrome is present in young Sub-Saharan Africans. The main risk factor found was smoking.

Intima–media thickness correlates with features of metabolic syndrome in young people with a clinical diagnosis of familial hypercholesterolaemia

Familial hypercholesterolaemia (FH) is a monogenic lipid metabolism disorder characterised by markedly elevated serum low-density lipoprotein (LDL) cholesterol level due to a mutation in the LDL receptor gene. Clinical features of FH include premature atherosclerosis and coronary artery disease. To explore associations between noninvasive markers of atherosclerosis including intima-media thickness (IMT) and pulse wave velocity (PWV) and blood lipids, blood pressure (BP) and obesity in a group of young patients with FH. Study population included 36 patients aged < 35 years with the diagnosis of FH based on the Simon Broome Register criteria, and their 49 relatives who comprised the control group free of FH. Mean IMT values were higher in FH patients than controls (0.60 ± 0.19 vs. 0.53 ± 0.07 mm, respectively, p < 0.05).Mean body mass index (BMI) and waist circumference were similar in patients and controls. The prevalence of carotid atherosclerotic plaques was significantly higher among FH patients (n = 6) than in controls (n = 1) (21.4% vs. 2.6%, p = 0.012). Arterial hypertension was present in 27.8% of patients with FH and 16.3% of subjects in the control group. Systolic blood pressure (SBP) in FH patients correlated significantly with age (r = 0.35), BMI (r = 0.48) and waist circumference (r = 0.47), and diastolic blood pressure (DBP) correlated with BMI (r = 0.42) and waist circumference (r = 0.41). PWV correlated significantly with age (r = 0.44), SBP (r = 0.63) and DBP (r = 0.52). We did not find any correlations between IMT and serum lipids, BP or obesity indices in FH patients. Our findings show a higher rate of arterial hypertension in young FH patients compared to their relatives free of FH, with significant associations between BP and indices of obesity and arterial stiffness. Intensive lipid lowering and antihypertensive therapy along with a reduction in central fat may be considered a mandatory treatment strategy in young FH patients to prevent atherosclerosis and increased arterial stiffness.

Pediatric Catatonia: Updating An Old Syndrome in Young People

There has been renewed interest in the demarcation of pediatric catatonia from other pediatric conditions including autism. An update on symptoms, prevalence, evaluation, treatment, risk factors, and experimental models of pediatric catatonia is presented. Recent prevalence rates of pediatric catatonia vary widely across studies, suggesting that catatonia may not be rare in younger patients. Symptoms and diagnostic criteria for pediatric catatonia are the same as in adults. Studies and clinical experience support benzodiazepines and electroconvulsive therapy, including maintenance electroconvulsive therapy, as treatment options. Sometimes catatonia develops after severe psychological trauma. Historical and contemporary clinical and experimental catatonia models are available for future research, focusing on motor circuitry dysfunction, abnormal neurotransmitters, epileptic discharges, genetics, neuroendocrine and immune abnormalities, fear reactions akin to the animal defense strategy of tonic immobility, and developmental risk factors. There have been advances in demarcating pediatric catatonia in a wide variety of patients as a treatable condition that requires prompt identificiation. A model of developmental impairment complements clinical and experimental catatonia models.

Evaluation of Weight Gain and Metabolic Parameters among Adolescent Psychiatric Inpatients: Role of Health Promotion and Life Style Intervention Programs

Objective: The purpose of the current preliminary study was to estimate the nature and occurrence of metabolic abnormalities among adolescent inpatients receiving psychiatric treatment and to pilot a health promotion and life style intervention program. Method: A total of 107 adolescents admitted over a 12-month period were evaluated for physical, clinical and metabolic parameters in two inpatient psychiatric units in Sydney, Australia, where a health promotion and life style intervention program was provided under the leadership of a Sports Psychologist. Results: 46% of subjects were found to be “at risk for adverse health outcome” with one or more metabolic abnormalities and 4.6% qualified for a diagnosis of Metabolic Syndrome meeting 3 or more of the modified criteria for Metabolic Syndrome in young people. 13% of the sample was overweight with abnormal Body Mass Index (BMI). While two thirds recognized the importance of staying physically active, only a quarter were maintaining adequate level of physical activity. Regarding quality of life, only 30 to 40% reported good life and health satisfaction. Conclusion: Our findings suggest that metabolic abnormalities are not uncommon among young psychiatric patients and that they are often missed. Regular monitoring for the presence of metabolic abnormalities and clinical risk factors should be part of the comprehensive management with special focus on preventative programs.

Wolff-Parkinson-White syndrome in young people, from childhood to young adulthood: relationships between age and clinical and electrophysiological findings

PurposeThe aim of the present study was to evaluate the characteristics of electrophysiologic studies (EPS) and radiofrequency ablation (RFA) performed in subjects aged less than 30 years with Wolff-Parkinson-White (WPW) syndrome, particularly pediatric patients under 18 years of age, based on our experience.MethodsTwo hundred and one consecutive patients with WPW syndrome were recruited and divided to 3 groups according to age: group 1, 6 to 17 years; group 2, 18 to 29 years; and group 3, 30 to 60 years. The clinical, electrophysiological, and therapeutic data for these patients were evaluated by a retrospective medical record review.ResultsA total of 73 (36%) of these patients were <30 years of age. Although there were more males than females in group 2 (male:female, 31:11), there was no sex difference in group 1 (male:female, 16:15). Left accessory pathway was detected less frequently in group 1 (32%, 10/31) than in group 2 (57%, 24/42) and group 3 (63%, 81/128) (P=0.023 and P=0.002, respectively).ConclusionThe present study describes several different electrophysiological characteristics in children and adolescents with WPW syndrome. Therefore, when EPS and RFA are performed in children and adolescence with WPW syndrome, we recommend that these characteristics be considered.

Cognitive behavioural therapy and psycho‐education for chronic fatigue syndrome in young people: Reflections from the families' perspective

Recent trials have produced optimistic results for family-focussed cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) in young people. This study sought to examine the under-researched question of the views and experiences of patients and families who take part. Semi-structured interviews and qualitative analysis were chosen in order to address clients' perspectives in depth. Sixteen young people and sixteen parents who participated in a trial of CBT versus psycho-education (PE) for CFS were interviewed. Key themes were discerned using inductive thematic analysis. Most families had low expectations of a cure but hope for improvement. Generally speaking, participants found both CBT and PE acceptable and helpful. Behavioural aspects of CBT (e.g. goal-setting, graded activity) were found helpful. The opportunity to gain support, recognition and validation was important. Cognitive elements of therapy were sometimes deemed inappropriate and some felt emotional aspects of CFS were not adequately addressed. Participants were ambivalent towards the extent of family involvement. Negative experiences related to the therapy setting and feeling inappropriately labeled. Most participants felt therapy was a stepping-stone towards normal life, although many felt recovery was incomplete. Very few differences were found between themes from CBT and PE participants. A notable exception was that every young person who experienced CBT described therapy as helpful, whereas the participants who strongly opposed the therapy approach had all experienced PE. The detailed insights regarding families' therapy experiences suggest areas of improvement for service delivery and topics for further investigation.

Impact of the body mass index on occurrence and outcome of acute ST-elevation myocardial infarction

Obesity is a traditional risk factor for the development of cardiovascular disease. However, recent studies have described a better outcome of obese patients in the clinical course of acute coronary syndromes.We investigated the impact of the body mass index (BMI) on occurrence and outcome of acute ST-elevation myocardial infarction (STEMI). Data of 10 534 consecutive patients with STEMI of the German MITRA PLUS registry were analyzed, comparing international classes of the BMI (obesity: BMI >or= 30 kg/m(2), overweight: 25-29.9 kg/m(2), normal weight: 18.5-24.9 kg/m(2)).STEMI occurred at a younger age in obese patients. The obese patients with first STEMI were 3 years younger than the normal weight patients with first STEMI (62.5 vs 65.7 years, p <0.0001).After STEMI has occurred, the obese patients had the lowest hospital (6.0%) and long-term mortality (4.8%) of all compared BMI-groups. In a multivariate analysis, obesity compared to normal weight was associated with a trend of a reduced mortality without significance during the hospital course (OR 0.81, 95% CI 0.60-1.08) and with significance during follow-up (OR 0.56, 95% CI 0.40-0.79).In conclusion, our data show that obesity is a risk factor of a manifestation of STEMI at a younger age compared to normal weight patients. After STEMI has occurred, obesity is associated with a trend of a lower mortality during the following clinical course. Therefore, the focus of prevention should be the reduction of obesity and metabolic syndrome in young people, to avoid the early occurrence of STEMI by primary prevention.

Cannabis and cocaine: a lethal cocktail triggering coronary sudden death

The case of a 31-year-old man who died suddenly, with a history of drug abuse and no risk factors for coronary artery disease, is herein reported. Postmortem examination disclosed critical stenosis due to a fibrocellular atherosclerotic plaque complicated by occlusive thrombosis at the level of the left anterior descending coronary artery. Chemico-toxicological analysis revealed high levels of cocaine, tetrahydrocannabinol, and metabolites. When dealing with an acute coronary syndrome in young people, with or without a history of drug abuse, toxicological examination should always be performed to rule out unnatural causes of myocardial ischemia.

Chronic fatigue syndrome in young people: the spectrum and the myths

Large telephone surveys in both the UK and USA suggest that chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) in children is both surprisingly common (0.19–2%), and indiscriminate in who it affects (Jordan et al, 2000; Chalder et al, 2003; Jones et al, 2004). There is no gender preference, no social class gradient, and all ethnic groups are affected. The CFS/ME described in studies where patients are recruited from specialist care is much rarer and predominantly affects white females of higher socioeconomic status (Patel et al, 2003).