Suchergebnisse

Teenagers represent a large proportion of the population and have the potential for considerable morbidity because of high smoking rates and unwanted teenage pregnancy. The government intends to reduce the incidence of this important morbidity, but there is no coherent strategy for attaining these improvements. Research in this area is limited in the United Kingdom, but research from elsewhere has clarified teenagers' attitudes. There have also been some intervention studies resulting in improvements in specific aspects of teenage health. A worrying theme which emerges from this research is of a new inverse care law. Teenagers with low self-esteem and less hope for their own future are more likely to lead lifestyles which put them at risk and are less likely to ask for advice in relation to their health or lifestyle. Thus, it may be more difficult to alter behaviour in these patients; overall population based improvements may be difficult to achieve. Teenagers' own concerns appear to be at variance with the goals dictated by government and health professionals. It is suggested that the only method of meeting the needs of teenagers and at the same time aiming to reduce morbidity in this age group is to foster an atmosphere of patient centredness in dealings with adolescent patients and for further ther research in this important health gain area.

Background The importance of autoimmune encephalitis and its overlap with infectious encephalitides are not well investigated in South-East Asia. Methods We report autoantibody testing, using antigen-specific live cell-based assays, in a series of 134 patients (cerebrospinal fluid and sera) and 55 blood donor controls (sera), undergoing lumbar puncture for suspected meningoencephalitis admitted in Vientiane, Lao People's Democratic Republic (PDR). Results Eight of 134 (6%) patients showed detectable serum neuronal autoantibodies, against the N-methyl-D-aspartate and gamma-aminobutyric acid A receptors (NMDAR and GABAAR), and contactin-associated protein-like 2 (CASPR2). Three of eight patients had accompanying autoantibodies in cerebrospinal fluid (two with NMDAR and one with GABAAR antibodies), and in two of these the clinical syndromes were typical of autoimmune encephalitis. Three of the other five patients had proven central nervous system infections, highlighting a complex overlap between diverse infectious and autoimmune causes of encephalitis. No patients in this cohort were treated with immunotherapy, and the outcomes were poor, with improvement observed in a single patient. Conclusions In Lao PDR, autoimmune encephalitis is underdiagnosed and has a poor prognosis. Empiric immunotherapy should be considered after treatable infectious aetiologies are considered unlikely. Awareness and diagnostic testing resources for autoimmune encephalitis should be enhanced in South-East Asia.