Depression is prevalent among patients with congestive heart failure (CHF) and is associated with increased mortality and healthcare use. However, most research on this association has focused on high-income countries, leaving a gap in knowledge regarding the relationship between depression and CHF in low-to-middle-income countries.

To identify changes in depressive symptoms and potential risk factors for poor outcomes among CHF patients.

Longitudinal data from 783 patients with CHF from public hospitals in Karachi, Pakistan, were analysed. Depressive symptom severity was assessed using the Beck Depression Inventory. Baseline and 6-month follow-up Beck Depression Inventory scores were clustered using Gaussian mixture modelling to identify separate depressive symptom subgroups and extract trajectory labels. Further, a random forest algorithm was used to determine baseline demographic, clinical and behavioural predictors for each trajectory.

Four separate patterns of depressive symptom changes were identified: ‘good prognosis’, ‘remitting course’, ‘clinical worsening’ and ‘persistent course’. Key factors related to these classifications included behavioural and functional factors such as quality of life and disability, as well as the clinical severity of CHF. Specifically, poorer quality of life and New York Heart Association (NYHA) class 3 symptoms were linked to persistent depressive symptoms, whereas patients with less disability and without NYHA class 3 symptoms were more likely to exhibit a good prognosis.

By examining the progression of depressive symptoms, clinicians can better understand the factors influencing symptom development in patients with CHF and identify those who may require closer monitoring and appropriate follow-up care.

Data on associations between inflammation and depressive symptoms largely originate from high income population settings, despite the greatest disease burden in major depressive disorder being attributed to populations in lower-middle income countries (LMICs).

We assessed the prevalence of low-grade inflammation in adults with treatment-resistant depression (TRD) in Pakistan, an LMIC, and investigated associations between peripheral C-reactive protein (CRP) levels and depressive symptoms.

This is a secondary analysis of two randomised controlled trials investigating adjunctive immunomodulatory agents (minocycline and simvastatin) for Pakistani adults with TRD (n = 191). Logistic regression models were built to assess the relationship between pre-treatment CRP (≥ or <3 mg/L) and individual depressive symptoms measured using the Hamilton Depression Rating Scale. Descriptive statistics and regression were used to assess treatment response for inflammation-associated symptoms.

High plasma CRP (≥3 mg/L) was detected in 87% (n = 146) of participants. Early night insomnia (odds ratio 2.33, 95% CI 1.16–5.25), early morning waking (odds ratio 2.65, 95% CI 1.29–6.38) and psychic anxiety (odds ratio 3.79, 95% CI 1.39–21.7) were positively associated, while gastrointestinal (odds ratio 0.38, 95% CI 0.14–0.86) and general somatic symptoms (odds ratio 0.34, 95% CI 0.14–0.74) were negatively associated with inflammation. Minocycline, but not simvastatin, improved symptoms positively associated with inflammation.

The prevalence of inflammation in this LMIC sample with TRD was higher than that reported in high income countries. Insomnia and anxiety symptoms may represent possible targets for personalised treatment with immunomodulatory agents in people with elevated CRP. These findings require replication in independent clinical samples.

Globally, burns are responsible for around 11 million injuries and 180 000 burn-related deaths yearly. Unfortunately, 9 of 10 burn injuries and deaths happen in low-and-middle-income countries (LMICs) such as Pakistan. One in three people admitted to hospitals with burn injuries die within three weeks, and survivors face serious lifelong physical, emotional and psychosocial problems. This may result in anxiety, depression, post-traumatic stress disorder, increased mortality and social disintegration. This study aims to evaluate if implementation of a culturally adapted multidisciplinary rehabilitation programme for burn survivors is clinically and cost-effective, sustainable and scalable across Pakistan.

• - To understand lived experiences of burn survivors, families, and other stakeholders including the experience of care and impact of burns To work together with key stakeholders (such as burn survivors, family members) to adapt a culturally appropriate affordable burn rehabilitation programme

• - To undertake social media campaigns to promote burn prevention and risk assessment at communities, workplaces/industries/households; improve first aid; and address burn related stigma

• - To work with policy makers/parliamentarians to develop national guidelines for burns care and prevention in Pakistan

There are 6 work-packages (WPs). WP1 is to co-adapt a culturally appropriate burn care and rehabilitation programme. WP2 will develop and implement national burn registry on WHO’s initiative. WP3 is a cluster randomised controlled trial to determine clinical and cost-effectiveness in Pakistan. WP4 will evaluate social media campaigns for burn prevention and reduce stigma. WP5 involves working with key-stakeholders for burns-related care and policy and WP6 offers sustainable capacity and capability for burns treatment and rehabilitation.

A clinical and cost-effective burn care quality and rehabilitation programme may have a huge potential to save lives and contribute health and socio-economic benefits for patients, families, and the healthcare system in Pakistan. The nation-wide implementation and involvement of burn centres across all provinces offer an excellent opportunity to overcome the problem of burn care access experienced in LMICs.

To date, burns prevention, care and rehabilitation have not received sufficient attention in policy initiatives in Pakistan and other LMICs. This study is an excellent opportunity to evaluate culturally adapted burn care and rehabilitation programmes that can be implemented across LMICs. We will disseminate our findings widely, using a variety of approaches, supported by our stakeholder and patient advisory groups.

None Declared

Low and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.

This protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.

Participants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.

National Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.

With increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.

None Declared

Suicide is a leading cause of death among young people and most deaths by suicide occur in low and middle-income countries. School is the best place where we can identify and respond to youth suicide risk. School-based interventions for suicide prevention in young people have been successful across US, Europe and Australia, but require adaptations to be acceptable and feasible in Pakistan.

To develop and test culturally adapted preventative interventions for suicidal behaviours among pupils in secondary schools in Pakistan. The qualitative component aimed at exploring the views of students, parents, teachers and general practitioners on cultural adaptation, experience of participation, areas of improvement and suggestions for scale-up of the school-based suicide prevention program (SEPAK).

A clustered randomised controlled trial. The four culturally modified interventions 1) Linking Education and Awareness of Depression and Suicide Awareness (LEADS) Training for pupils (students=260) 2) the Question, Persuade, and Refer (QPR) for teachers (students=203) 3) QPR for parents (students=445); 4) Screening by Professionals (Profscreen) (students=260) were compared against control intervention (educational posters) (students=227). Structured questionnaires were administered at baseline and 1-month post-intervention to assess suicidal behaviours, psychological well-being and quality of life. A total of 8 focus groups (FGs) were conducted at pre and post intervention stage with each stakeholders.

Patient and public involvement and Engagement (PPIE) was strongly embedded in the project to ensure meaningful benefits for participants. A total of 40 schools were recruited from 8 cities across Pakistan. A total of 243 students attended LEADS intervention, 92 teachers and 304 parents completed QPR training, and 9 general practitioners were trained in ProfScreen. The retention rate at follow-up was 99% that shows feasibility of delivering intervention package in Pakistan. All participants marked SEPAK as effective in identifying risk of and preventing self-harm and suicide in young people and in improving pathways to treatment. Interventions were perceived as helpful in improving knowledge about mental health, impact of mental health difficulties on functioning, reducing stigma, equipping stakeholders to identify and signpost at-risk people. Improvement in clinical and teaching practice as well as understanding others behaviors were also reported.

This study suggest feasibility of integrating a suicide prevention program in existing educational system and highlights positive role of creating awareness about suicide in youth, introduction of school-based mental health programs, parental counseling and strengthening of the health system by training general practitioners in early identification of suicide risk and promoting suicide prevention strategies

None Declared

Bipolar disorder (BD) is a source of marked disability, morbidity, and premature death. There is a paucity of research on personalized psychosocial interventions for BD, especially in lowresource settings. A previously published pilot randomized controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes towards BD, and improvement in mood symptom scores and health-related quality of life measures compared to treatment-as-usual (TAU).

This protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan.

A multicentre individual, parallel arm, RCT of CaPE in 300Pakistani adults with BD. Participants over the age of 18, with adiagnosis of bipolar I and II and who are currently euthymic, will berecruited from seven sites including Karachi, Lahore, Multan, Rawalpindi,Peshawar, Hyderabad and Quetta. Time to recurrence will be the primaryoutcome assessed using Longitudinal Interval Follow-up Evaluation(LIFE). Secondary measures will include mood symptomatology, qualityof life and functioning, adherence to psychotropic medications, andknowledge and attitudes towards BD.

Full ethics approval has been received from National Bioethics Committee (NBC) of Pakistan and Centre for Addiction and Mental Health (CAMH), Toronto, Canada. The study has completed sixty-five screening across the seven centres, of which forty-eight participants have been randomised.

A successful trial will lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority patients with BD.

None Declared

Depression is the leading cause of disability worldwide and low and middle-income countries (LMICs) carry over 80% of this disease burden. Attempts have been made to address depression in LMICs, with improvements in the home environment and maternal knowledge. However paternal depression is a neglected and under-researched area. Since maternal depression is associated with depression in fathers there is a need for partner inclusive parenting programs to address parental mental health and improve child outcomes.

To evaluate the clinical and cost effectiveness of partner inclusive Learning through play plus (LTP+) intervention in reducing depression in fathers and mothers.

To evaluate the effectiveness of LTP + intervention in improving child outcomes.

To conduct process evaluation and identify challenges in transition to scale up of the intervention across Karachi, Pakistan from the perspective of fathers, mothers, and other stakeholders.

This is a cluster randomised controlled (cRCT) trial of partner inclusive group parenting program called (Learning Through Play (LTP+) across 18 towns in the city of Karachi. Over 5000 parents (fathers and partners) will participate in the study with a capacity building component of training 4000 Community Health Workers across Pakistan.

This large cRCT will confirm the clinical and cost-effectiveness of LTP+ in reducing depression in parents and improving child outcomes along with the barriers and facilitators to implement the LTP+ group parenting program and the possibilities to roll out the innovation at national level through engagement with policy makers.

Addressing depression in parents is hugely important because of its adverse effects both for child and parents. This low-cost group parenting program will help in scaling up the innovation across health services in Pakistan and other LMICs.

None Declared

Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU).

The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959.

A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder.

This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning.

A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.

Systemic venous hypertension and low cardiac output are believed to be important mediators of liver injury after the Fontan procedure. Pulmonary vasodilators have the potential to improve such haemodynamics. The aim of this study was to assess the acute effects of exercise on liver stiffness and venous pressures and to assess the impact of inhaled Treprostinil on this response.

In this prospective, double-blind, placebo-controlled, crossover trial, 14 patients with a Fontan circulation were randomised to inhalation of placebo and Treprostinil. Incremental and constant work rate exercise tests were performed to assess the effect of Treprostinil on exercise tolerance. Venous pressures were measured throughout and liver stiffness at rest and immediately after peak exercise.

Mean age was 27.8 ± 7.9 years and 66% were females. Exercise acutely increased liver stiffness by 30% (mean shear wave speed: 2.38 ± 0.71 versus 2.89 ± 0.51 ms, p = 0.02). Peripheral venous pressures increased acutely during both incremental (12.1 ± 2.4 versus 22.6 ± 8.0 mmHg, p < 0.001) and constant work rate exercise (12.5 ± 2.5 versus 23.4 ± 5.2 mmHg, p < 0.001). Overall, Treprostinil failed to attenuate exercise-induced increases in liver stiffness. Compared with placebo, Treprostinil did not significantly impact venous pressure responses, VO2peak, nor exercise endurance times.

Peripheral venous pressure increased acutely during exercise by an average of 88% above baseline and was not altered by administration of inhaled Treprostinil. Liver stiffness measured immediately post-exercise increased acutely by an average of 30%, with no attenuation following Treprostinil inhalation.

Depression is a global public health problem with highest rates in women in low income countries including Pakistan. There are no treatment trials from such countries comparing the efficacy of antidepressant treatment with a group psychological intervention.

We conducted a preliminary RCT in an urban primary care clinic in Karachi, Pakistan. Consecutive eligible women scoring > 12 on the CIS-R and > 18 on HDRS (n=66) were randomly assigned to antidepressant or group psychosocial treatment. The primary outcome measure was HDRS score; secondary outcome measures were disability and quality of life.

96% patients were assessed at 3 & 6 months after baseline. At 6 months response (50% reduction of HDRS score) occurred in 20 (60.6%) and 22(66.7%) of the psychosocial and antidepressant groups respectively. There was also significant reduction in disability and improvement in health related quality of life in both groups.

Low costs antidepressants and group psychosocial treatment on the principles of CBT merit further assessment as primary treatments for depression in low income countries.

Relapse in patients of opiod addiction is very common. Dynamics of addiction relapse are not fully understood as yet. Psychiatrists would explain it on basis neurotransmitter mediated disorders like anxiety, depression, OCD, lack of impulse control and etc. For sociologist relapse is an outcome of contradictions with in society. For a psychologist it is due to maladaptive life style. In this study integrated approach has been adopted to find out relative importance of different factors implicated in relapse.

Team of psychiatrists, psychologists, addiction counselor identified different causes of relapse in patients with opiod addiction. They designed graded scale in which 10 factors were included. Study group was comprised of hundred relapsed patients. They filled Performa’s according to their personal experiences. Regression method was used for factor analysis.

Statistical analysis revealed that peer group pressure, anhedonia, and premature ejaculation are first, second and third, factors respectively. Factors like pains and aches, insomnia, impulsivity and etc followed.

Every relapse prevention program should adopt policy keeping in view relative importance of causes of relapse. For peer pressure narcotic anonymous meeting is the best solution. Anhedonia is due to reduction dopaminergic input at nucleus accumben. Dopamine agonist drugs like bupropion can be used for that. Inordinate sexual behavior and substance abuse are strongly associated. Premature ejaculation plays vital role in relapse of patients of opiod addiction. Sex therapy and drugs like SSRI,s and gabapentine can improve intra vaginal latency time.

Factor analysis can be helpful in relapse prevention program.

Erectile dysfunction is twice common in patient with depression. Testosterone plays vital role in erectile function. Low testosterone level is found in patients of depression. High level of prolactin has depressive effect on libido function. Hypogonadism and hyperprolactinemia can be the causative factor for depression. Hormonal changes can be both cause and effect of depression with ED.

In sample of 76 patients having depression with co morbid ED blood levels of prolactin, and free testosterone were determined.

Half of patients were treated with sex friendly antidepressants while in other half mesterolone and piribedil were used as adjunct medicines.

In 9.2% free testosterone level was below than reference value. In 28.9% prolactin level was high .51 .31% were found having border line free testosterone level.

In younger age group free testosterone level was lower than older age group. There exist inverse relation between prolactin level and free testosterone level. Patients who were given adjunct medication showed rapid improvement both for depression and erectile dysfunction.

Reduced level of free testosterone and high level of prolactin has bilateral relation with depression with co morbid ED. Although prevalence of hypogonadism and hyperprolactinemia is low in the study yet high numbers of borderline cases are of great significance. It is postulated that fall in sexual function is directly proportional to change in levels of these hormones from the base line that are reversed by adjunct medicines.

In patients with concomitant major depression and erectile dysfunction hormonal changes plays important role.

Depression is a global public health problem with highest rates in women in low income countries including Pakistan. Paediatricians may be a resource to help with maternal depression. Little is known in low income countries about the prevalence of depression and its social correlates in mothers of children attending paediatric clinics.

Using cross-sectional design consecutive women attending the paediatric clinic were screened using the Edinburgh Postnatal Depression Scale (n=185). Women scoring 12 or more (n=70) and a random sample of low scorers (n=16) were interviewed using the Clinical Interview Schedule Revised (CIS-R) to confirm the diagnosis of depression, the Oslo scale was used to measure social stress and EQ-5D for health related quality of life.

The prevalence of maternal depression was 51%. The mean age of the sample was 26 years. Depressed mothers were more likely to be living in a joint family household, they were less educated and they and their husbands were less likely to be employed. The depressed mothers had more financial difficulties and they were more likely to sleep hungry during the last month due to financial problems. The depressed mothers had less social support and poorer quality of life compared to non depressed mothers.

Maternal depression in this health care setting is high and it is associated with social stress and poor social support. Paediatric appointments may be an opportunity for care and care delivery for maternal depression.

Earthquake disaster of Pakistan in 2005 caused massive destruction. Death toll was more than 70000. Many survivors were diagnosed as having variable anxiety disorders including panic disorder and PTSD. Frequency of female patients was much higher than male. The major factors responsible are loss of life and property and uncertainty regarding future, harsh weather and repeated tremors.

Data was collected from various agencies including WHO, Turkish Red Crescent, Canadian team of relief and some other NGOs working with earth quake hit area. Diagnosis was made using semi-structured interviews.

Data analyses of women (1056), men (281) and children (204) indicate high prevalence of anxiety disorders including PTSD (853 women, 153 men) and depression (73 women, 31 men). Results vary from the observations made from other disasters. Sex ratio shows huge difference in prevalence between males and females.

Patients with PTSD have dysregulation of HPA axis response. This alteration is more pronounced in case of women. Studies show that estrogen plays important role in the genesis of disease. Dexamethasone suppression test also indicates greater dysregulation of glucocorticoid receptor. Studies reveal predisposition in women for PTSD and depression.

Women and children were affected most because most of them were at home and in schools. Hence, they sustained more physical injuries and psychiatric consequences.

In our study depression came out to be more prevalent in females. This can be explained as comorbidity of PTSD and because of its own dynamics.

After exposure to trauma male and female respond differently.

Early psychosis is not a discrete disorder; rather it is mixed-up state .Different states like depression, anxiety, psychosis, obsession manifest during this period. 20% to 40% of BLIPS positive subjects eventually make transition to psychosis. Large proportion of remaining patients develops anxiety or mood disorders. During early psychosis unitary psychosis, manifest itself in forms of different psychiatric disorders.

An electronic search was made at data based websites including pub med and Blackwell synergy using key words, unitary psychosis, prodrom, early psychosis .This was followed by manual and internet study of relevant articles .

Cognitive deficits and defects of facial recognition were present in both schizophrenic and bipolar prodrom .In 24.2% schizo-obsessive patients reduced size of the left hippocampus was found. 84% subjects reported depressive symptoms before transition to psychosis, 73% of patient of schizophrenia starts with non-specific affective and negative symptoms. In presence of depression, probability of transition to psychosis increased from 4% to 21.7%. In 47.3% of patients, OCD occur before onset of frank psychosis.

High prevalence of comorbidities during prodromal phase indicates that shared common factor is involved. Anxiety, depression and attenuated psychosis are integral components of early psychosis. Overlapping of bipolar and schizophrenic prodrms depicts commonality of origin of two disorders.OCD is associated with schizo-obsessive subgroup. Strong interactive relationship among different disorders could be explained on basis of unitary psychosis.

Presence of unitary psychosis is realized in the studies of early psychosis.

Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.

342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.

This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.

Premature ejaculation (PME) is the most prevalent sexual disorder. It affects more than 30% of male population. Thus far SSRI,s clomipramine, local anesthetic along with psychological therapies are the mainstay in the treatment of PME. However, not all the cases are amenable to these treatments. Attempts are underway to find out better remedies for this problem. Gabapentine an anticonvulsant drug is being tested for treatment of PME.

Electronic search was made at database websites, using key words gabapentine, premature ejaculation. It was followed by manual research to find out possible mechanism by which gabapentine could delay orgasm.

Search could not provide concert mode of action which explain inhibitory action on premature ejaculation by gabapentine; except for its anti anxiety effect mediated by gabanergic properties.

Gabanergic action explains its anti anxiety, muscle relaxant and CNS depressant properties which could be beneficial, for premature ejaculation. Gabapentine has anti glutamate properties as well. This action further imparts anti excitatory effect which is helpful for PME. Excellent efficacy on neuralgic pains and neuropathies indicates that gabapentine desensitize the receptors which are oversensitive as are found in erogenous zones of premature ejaculators. Orgasm and partial seizure share many common features. Hence anti antiepileptic properties increase threshold of physiological seizure that is orgasm.

Gabapentine can be considered as medicine which works on PME with a mode of action different from SSRI,s.

Tobacco smoking is one of the major preventable causes of premature death and disease in the world. Adolescents are amongst the most vulnerable group of individuals in society and are highly susceptible to cigarette smoking. Sixth Formers being the most senior members of the school act as role models to younger pupils and could influence smoking behaviour.

In a cross sectional and comparative study we aimed to determine the differences in smoking prevalence and patterns between Sixth Form students in Pakistan (a developing country) and the United Kingdom (a developed country).

A self-administered questionnaire, adapted from the WHO questionnaire, about tobacco smoking for health professionals was distributed amongst the students. The responses were anonymised to encourage truthful answers; there was no pressure to respond.

Of the 235 participants in the UK, 38 (16%) were regular smokers. Of the 297 participants in Pakistan, 20 (7%) of participants were regular smokers. In both countries there was a significant difference between the genders, with males being more likely to smoke. In Pakistan it was identified that the main reason for smoking was due to peer pressure, where as in the UK it was for recreational and social purposes.

The prevalence of smoking was higher in UK compared to Pakistan. There was a significant difference in the smoking behaviour patterns in the two countries.

Childhood obesity has reached epidemic proportions: Some 4.7 million youths between 6 and 17 years of age are overweight or obese. The number of over-weight youths (11%) has more than doubled over the past 30 years. Obesity has links with disease such as diabetes, heart disease, sleep disorders and some forms of cancers. Developing and maintaining a healthy lifestyle are essential for the prevention of obesity.

In a cross sectional study we aimed to investigate and compare the attitudes towards healthy eating and obesity in adolescent students in Pakistan and the UK. The sample size for this study consisted of 618 students in total. A self administered anonymised questionnaire was given to the students and they were to answer questions regarding eating and exercise.

A Total of 151 students were recruited from the UK, while 467 students were recruited from schools in Pakistan. 5.4% of the students in the UK and 2.6% students in Pakistan were obese. The reasons for students' different eating habits varied between both countries; in the UK an increase in eating was linked to stress while in Pakistan it was linked to cravings. In both the UK and in Pakistan, a high percentage of students took part in physical activity, 80% and 81.8% respectively. There were some similarities in eating habits, with similar numbers of students refraining from eating unhealthy foods in both the countries.

We found significant differences in BMI and reasons for overeating when comparing students in Pakistan and the UK. These findings have implications for designing interventions