Complying with the smoking ban by students before and after introducing legislative intervention

Objectives: More and more countries introduce a total ban on smoking tobacco in public places. The aim of this work was to evaluate the effectiveness of “The Act of 8 April 2010 on amendment of the act on protection of health against the consequences of consumption of tobacco and tobacco products and act on National Sanitary Inspectorate” and assess the frequency of complying with the smoking bans by the students of the Medical University of Lodz, Poland. Material and Methods: Between 2007–2011, at the Social Medicine Institute of the Medical University of Lodz, a study using random survey was carried out involving students who were starting their studies at the Health Department of the Medical University of Lodz. The analysis of the collected material showed that 1038 people reported being smokers at the time of the study. Among that group, 530 students were included in the study prior to, and 508 after the introduction of the amendment. In order to verify their compliance with the smoking ban, the respondents were asked whether they smoked only in designated areas or wherever they wanted to. Results: The ratio of people claiming they smoked anywhere they wanted to, disregarding the smoking ban, was 60% (N = 318) and after the amendment had been introduced, this ratio was 62.2% (N = 316), it increased by 2.2 percentage points. The observed difference was statistically irrelevant (Chi2 = 0.530, p > 0.05). Conclusions: The Act ”On amendment of the act on protection of health against the consequences of consumption of tobacco and tobacco products and Act on National Sanitary Inspectorate” in Poland did not result in the expected changes in the frequency of complying with the smoking ban by the 1st year students

Pediatric Asthma Caregiver’s Quality of Life Questionnaire is a useful tool for monitoring asthma in children

PURPOSE: There is little agreement among researchers whether a caregiver’s QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver’s QOL scores reflect changes in child’s QOL and their asthma control. METHODS: This was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ). RESULTS: One hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = −0.46 to r = −0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control. CONCLUSIONS: PACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma

Job satisfaction among health professionals of Home Hospice for Children of Lodz Region

Background: Job satisfaction in palliative care proffesionals seems to be one of the most important factor for effectiveness and quality of care. The aim of this study was to evaluate job satisfaction in our team. Material and methods: The anonymous questionnaire designed specifically for the study was divided into six domains: evaluation of self-abilities, evaluation of job responsibility, relationships within the team, relationships with patients and their families, work organisation and social conditions and general work evaluation. All variables have been standardized to a range of 0 to 100 points. Results: Mean level of job satisfaction was evaluated as good. Mean results in all six domains were above 50 points. Highest level of satisfaction (above 75 points) was shown in the domain regarding relationship with patients and their families. Lowest level of satisfaction was shown in domains showing relationship within the team and general work evaluation. Conclusion: Highest job satisfaction could contribute to improve the quality of home palliative care Adv. Pall. Med. 2010; 9, 3: 67–72Background: Job satisfaction in palliative care proffesionals seems to be one of the most important factor for effectiveness and quality of care. The aim of this study was to evaluate job satisfaction in our team. Material and methods: The anonymous questionnaire designed specifically for the study was divided into six domains: evaluation of self-abilities, evaluation of job responsibility, relationships within the team, relationships with patients and their families, work organisation and social conditions and general work evaluation. All variables have been standardized to a range of 0 to 100 points. Results: Mean level of job satisfaction was evaluated as good. Mean results in all six domains were above 50 points. Highest level of satisfaction (above 75 points) was shown in the domain regarding relationship with patients and their families. Lowest level of satisfaction was shown in domains showing relationship within the team and general work evaluation. Conclusion: Highest job satisfaction could contribute to improve the quality of home palliative care Adv. Pall. Med. 2010; 9, 3: 67–7

Effect of montelukast on lung function and clinical symptoms in patients with cystic fibrosis

Inflammatory process contributes to progressive lung tissue damage in cystic fibrosis(CF). Cysteinyl leukotrienes have been found in the sputum of CF patients at concentrations sufficienttocausepotentbiologicaleffect. This study was designed to assess the effect of anti-inflammatory treatment with montelukast sodium in CF patients. Twelve patients, aged 6-29 were recruited. It was 20 week, placebo-controlled, and randomized, double blind, crossover trial. At first and last week of each treatment course spirometry and whole body plethysmography parameters (FEV1, PEF, FEF25/75%, VC, TGV, Raw and RV) and clinical wheezing and cough scale were measured. In montelukast group significantimprovementinFEV1(mean&plusmn;SD,54,6 &plusmn; 22,6 before and 62 &plusmn; 19,0 after treatment, p = 0.0112) and FEF25/75% (28,9 &plusmn; 23,0 before and 37,5 &plusmn; 25,5 after treatment, p = 0.0053) were observed. Compared with placebo montelukast significantly improved FEV1(p = 0.0032),PEF(p = 0.0298)andFEF25/75%(p = 0.0091).There was no significant difference in VC, TGV, RawandRV. Montelukast compared with placebo significantlydecreasedcough(p < 0.0001)andwheezing(p = 0.0002)score. In summary, therapy with montelukast may provide clinical benefit to patients with CF

Variability in clinical profile of asthmatic child referred from allergy clinic - ten years of observation

Wstęp: Astma jest najczęściej występującą chorobą przewlekłą wieku rozwojowego. Niedodiagnozowanie jest częstym zjawiskiem związanym z niedoleczeniem, którego z kolei konsekwencją jest wzrastająca zachorowalność i śmiertelność. Opóźnienie w diagnozowaniu astmy odzwierciedla problemy z prawidłową realizacją celów diagnostycznych wytyczonych przez Global Initiative for Asthma (GINA). Celem pracy jest charakterystyka kliniczna dzieci kierowanych do Poradni Chorób Alergicznych, u których następnie rozpoznano astmę oskrzelową. Oceniono przyczyny zgłaszania się do poradni specjalistycznej, dane demograficzne i społeczne dziecka. Materiał i metody: Analizie poddano grupę 907 dzieci do 18. roku życia, u których rozpoznano astmę w poradni alergologicznej w latach 2000-2009. Było to badanie przekrojowe, w którym analizowano dane demograficzne, socjalne oraz kliniczne pacjentów. Wyniki: Na podstawie wyników ujawniono zmieniony profil kliniczny dziecka kierowanego do poradni alergologicznej na przestrzeni 10 lat, u którego następnie rozpoznana została astma oskrzelowa. Profil ten charakteryzują: młodszy wiek pacjenta, większa częstość nawracających infekcji i mniejsza częstość występowania świstów oraz atopii jako przyczyny skierowań do alergologa. Wnioski: Nowy profil kliniczny dziecka kierowanego do alergologa wskazuje na konieczność przeprowadzenia kosztownej diagnostyki różnicowej astmy w ośrodkach specjalistycznych. Dane te powinny być uwzględnione w wytyczaniu nowych strategii zdrowotnych w Polsce. Pneumonol. Alergol. Pol. 2011; 79, 3: 189-195Introduction: Asthma is the most frequent chronic respiratory disease in children. Underdiagnosis is frequent, which results in undertreatment and, consequently, in rising asthma morbidity and mortality rates. The delay in the diagnosis of asthma seems to precisely reflect problems with a proper realization of the goals of the diagnostic part of the Global Initiative for Asthma guidelines. We attempted to assess the clinical profile of children who were referred to allergy clinic followed by asthma diagnosis, we consider especially demographic and social data. Material and methods: We analyzed the group of 907 children with diagnosis of asthma between 2000 and 2009. This was cross-sectional study assessing demographic, social and clinical characteristic. All variables were tested over time. Results: We observed change in clinical profile of children checking into the clinic over time. The new profile includes: younger age of patient, higher frequency of recurrent infections, lower frequency of wheezes and atopy. Conclusions: New clinical profile of patients referred to allergist reveals the need of costly differential diagnosis of asthma in specialized centers. This should be included in new strategies in the health care system in Poland. Pneumonol. Alergol. Pol. 2011; 79, 3: 189-19

Cytokine profiling in exhaled breath condensate after exercise challenge in asthmatic children with post-exercise symptoms

Introduction: Markers of exhaled breath condensate (EBC) correlate with lung function impairment, airway remodeling and different aspects of the disease such as exercise-induced bronchoconstriction (EIB). Aim of the study was to determine the cytokine profile in EBC of children with asthma after an exercise treadmill challenge in order to obtain clinically useful information about mechanisms of EIB; also, to assess correlations between cytokine concentrations in EBC and clinical characteristics of the patients. Material and methods: The study population consisted of 25 randomly selected children, aged 8 to 19 years, with asthma and EIB symptoms despite the use of control medications. Patients on the day of the study visit underwent fractional exhaled nitric oxide measurement (FeNO) and baseline spirometry, performed an exercise treadmill challenge (ETC), and EBC samples were obtained at the end of the ETC. Results: In asthmatic children with positive ETC, monocyte hemotactic protein-1 (MCP-1) and IL-16 adjusted to pre-EBC forced expiratory volume in 1 s (FEV1) were significantly higher compared to children with negative ETC (p = 0.022 and p = 0.017 respectively). After adjustment to pre-EBC FEV1 other cytokines (IL-4, IL-5, IL-6, IL-8, MIG, TNF-) were not related to post-exercise changes in FEV1. Conclusions: We observed a specific inflammatory profile in the airways of asthmatic children with bronchoconstriction induced by exercise. The concentration of cytokines in EBC depended on the post-exercise decrease in FEV1, which was measured by the area under the curve (AUC). MCP-1 and IL-16, adjusted to pre-EBC FEV1, were significantly higher in children with a positive exercise challenge compared to those with a negative one.This study was funded by grant 503-2056-1 from the Medical University of Lodz, Poland. ClinicalTrials.gov Identifier: NCT01798823. The study was approved by the Medical University of Lodz Ethics committee, Poland. Written consent from the patients and their parents was obtained

Recommendations for diagnostics and therapy of gastrointestinal stromal tumors (GIST) in 2008

Nowotwory podścieliskowe przewodu pokarmowego (gastrointestinal stromal tumors – GIST) są najczęstszymi nowotworami pochodzenia mezenchymalnego w obrębie przewodu pokarmowego. Nowotwory te, dzięki postępom w diagnostyce patologiczno-molekularnej, powszechnie rozpoznawane są dopiero od kilku lat. W pracy przedstawiono zalecenia dotyczące diagnostyki i terapii tych nowotworów, opracowane na podstawie danych naukowych oraz doświadczenia ekspertów, które są powszechnie akceptowane i warte rekomendacji. Nadekspresja błonowego receptora KIT, będąca następstwem mutacji protoonkogenu KIT, jest wysoce specyficzna dla GIST, i możliwa do wykrycia metodami immunohistochemicznymi (CD117) w preparatach histopatologicznych z guza, stanowiąc najważniejsze kryterium w jego diagnostyce mikroskopowej i wskazaniach do leczenia drobnocząsteczkowymi inhibitorami kinaz tyrozynowych. W każdym przypadku zalecane jest przesłanie materiału do badań molekularnych (w celu analizy mutacji KIT i PDGFRA). Radykalne leczenie operacyjne jest nadal najskuteczniejszą metodą leczenia pierwotnych GIST, jednakże nowotwór ten cechuje duży potencjał nawrotowości. W przypadkach zmian nieoperacyjnych/rozsianych leczeniem z wyboru jest zastosowanie inhibitora kinaz tyrozynowych – imatinibu, leku, który stanowi pierwsze efektywne leczenie systemowe w zaawansowanym GIST CD117(+). Zalecana dawka początkowa powinna wynosić 400 mg raz dziennie (800 mg dziennie w przypadku mutacji w eksonie 9 KIT). Monitorowanie leczenia musi opierać się na powtarzanym badaniu tomografii komputerowej jamy brzusznej, z uwzględnieniem zmian wielkości i gęstości. W przypadku progresji zaleca się zwiększenie dawki imatinibu do 800 mg na dobę, a w przypadku braku skuteczności zastosowanie sunitynibu w dawce początkowej 50 mg dziennie. Obecnie trwają badania kliniczne nad ustaleniem roli leczenia chirurgicznego w skojarzeniu z imatinibem oraz skuteczności innych leków celowanych molekularnie w przypadku występowania oporności w czasie leczenia imatinibem. Dostępne dane odnośnie leczenia uzupełniającego wskazują na poprawę przeżyć wolnych od nawrotu, ale wpływ tej strategii na przeżycia całkowite i optymalna długość czasu leczenia są nadal przedmiotem badań. Przedstawione zasady postępowania diagnostyczno-terapeutycznego powinny być praktycznie wprowadzane przez lekarzy zajmujących się chorymi na GIST w Polsce. Zaleca się rejestrowanie przypadków chorych na GIST w ramach narodowego Rejestru Klinicznego ([email protected]) oraz standardowe leczenie chorych w wielodyscyplinarnych zespołach, mających doświadczenie w terapii GIST i włączanie nowych przypadków GIST do prospektywnych badań klinicznych.Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of gastrointestinal tract. Advances in the understanding of the molecular mechanisms of GIST pathogenesis have resulted for last years in the emerging of GIST as a distinct sarcoma entity. The paper describes guidelines for diagnostics and therapy of these tumors based on scientific basis and experts’ experience, which are commonly accepted and worth to recommend. Overexpression of KIT receptor, as a consequence of mutation of protooncogene KIT, is highly specific for GIST and enable for detection by immunohistochemistry staining (CD117) in tumor specimens. It is the most important criterion in microscopic diagnostics and indications for treatment with small-molecule tyrosine kinas inhibitors. Sending material for molecular analysis is strongly recommended (for KIT and PDGFRA genotyping). Radical surgery is still the mainstay treatment for primary, localized, resectable GISTs, although high percentages of the patients after potentially curative operations develop recurrent or metastatic disease. In inoperable/metastatic lesions the treatment of choice is tyrosine kinase inhibitor – imatinib mesylate – the first effective systemic therapy in advanced CD117(+) GIST. Recommended initial dose should be 400 mg daily (800 mg for exon 9 KIT mutants). Monitoring of the therapy should be based on serial computed tomography imaging of abdominal cavity with the assessment of changes of tumor size and density. In case of disease progression the increase of imatinib dose to 800 mg daily is recommended and if further progression exists – sunitinib in the initial dose 50 mg daily should be introduced. Clinical trials evaluating the role of surgery in combination of imatinib and the efficacy of other molecular targeted drugs in resistant cases are ongoing. Existing data indicate beneficial role of adjuvant imatinib therapy in terms of relapse-free survival, but the impact of this policy on overall survival, optimal duration of adjuvant therapy and criteria for its implementation are currently investigated. Presented recommendations for diagnostics and therapy of GIST should be practically implemented by physicians involved in management of GIST patients in Poland. The including GIST cases in national Clinical Registry ([email protected]) and standard treatment of patients in multidisciplinary team with expertise in GIST therapy, as well as enrollment of new cases to prospective clinical trials, are recommended

Risk factors for asthma in children in Łódź region

The incidence of asthma and other allergic diseases continues to increase. In addition to genetic factors, environmental influences are thought to play an important role. The aim of this study was to identify factors that influence and drive the atopic march from atopic sensitization to asthma in children from Łódź. Methods: 800 atopic children, aged 5-18 years, were included to our study. Parents filled in questionnaires and gave interviews about their children's diseases. 405 (43 %) children have diagnosis of asthma. Results: A significant association was observed between asthma and male sex, parents' history of atopy, parentalhighest school grade, maternal smoking during pregnancy, maternal chronic disease (especially chronic renal diseases), maternal allergen-sensitizating diet during breast-feeding, increased exposure to indoor humidity and moulds. Similar effect was seen for episodes of wheeze occurring in the first 3 years of life as followed: wheezing during an airway infection, wheezing not connected with respiratory tract infection, wheezing not related with physical exercise. Child's daycare attendance (nursery school) was associated with decreased risk of asthma