Przegla̧d lekarski
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HBSC (Health Behaviour in School-aged Children) study can serve as a basis for monitoring smoking prevalence in school-aged children. Previous studies 1990-1998 have shown an increase in tobacco smoking among 15-year-old students, followed by a decrease in 1998-2002. The aim of this study was to present current international comparisons of selected indicators and changes in 2002-2006. ⋯ However, in most countries the improvement was higher than in Poland, especially in girls. More attention should be paid to divergent trends in smoking among adolescent boys and girls. Despite favorable trends in Polish boys, smoking prevalence is still too high by comparison to other countries and age of smoking initiation is very low.
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Smoking cessation in the perioperative period allows a substantial reduction of a number of anesthetic and surgical complications. They primarily include pathology and adverse reactions of respiratory, cardiovascular and nervous systems and also alterations in wound and bone healing. There is no doubt that long-term (several months) tobacco abstinence reduces the complication risk; however, the significance of short-term smoking cessation is being discussed. ⋯ Interventions for preoperative smoking cessation effectively change smoking behavior and should be widely offered to surgical patients. Oral recommendations should possibly be supported by pharmacotherapy. Nicotine replacement therapy and bupropion proved to be effective and safe in the perioperative period.
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Levels of toxic substances in tobacco smoke are undeniably influenced by temperature-oxygen conditions in which the smoke is generated. These conditions depend on the way the cigarette is smoked (smoking topography). Smoking topography may be characterized by such factors as: puff volume and its velocity, intervals between puffs and a number of puffs per cigarette. ⋯ However, mean interval between puffs in our group was 20 sec.--threefold lower than in the ISO method (60 sec.). Moreover, examining the variability of subsequent puffs, the authors found out that the puff volume lowers as the cigarette is smoked. All measured smoking topography parameters were highly dispersed within the examined population of smokers.
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Congenital spine and thorax deformities are an interdisciplinary clinical problem. Apart from trunk deformity they may lead to respiratory or cardiovascular insufficiency. Surgical treatment should be implimented as soon as possible in order to improve posture, balance and further development. This treatment should not impair further growth of the young spine. This is possible with the VEPTR device. ⋯ VEPTR device is indicated in treatment of severe congenital deformities of the spine and thoracic cage. It improves patients' posture, changes the shape of thorax wall and consecutively improves respiratory function and further development.
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For several years now, with the introduction of the health care sector reform we have been observing a considerable drop in the number of postmortem examinations performed in patients who died in hospitals. The decrease amounts to as much as 50 to 70%. This is undoubtedly a consequence of financial restrictions imposed on the management of these inpatient facilities. ⋯ The result of a postmortem examination is practically the only basis for a factual evaluation of a given case. When no autopsy has been performed, the experts are virtually helpless, and in the majority of such instances, they are forced to refuse passing an expert opinion. The report presents basic principles of medico-legal opinionating in criminal cases (including proceedings pertaining to medical errors), the rules governing the medical error assessment, as well as problems encountered in evaluating the appropriate course of treatment when a post mortem examination has been waived.