Thirty-five lung pairs obtained during autopsy from randomly selected patients were investigated by particle induced X-ray emission for overall and regional elemental content determination. In each case the interbronchial lymph node was simultaneously processed. While homogenous distribution has been consistently observed for potassium, calcium, iron, copper, zinc, and rubidium, a very different distribution was recorded for titanium, chromium, nickel, and strontium. The significance of these results is discussed with regard to pollution hazards. Regional accumulation of this second group of elements seems to be related to air pollution peculiar to Liège. Advantages and limitations of the technique and the need for further research are stressed.

Adult↗

PubMedDate not supplied

Physician's involvement in the smoking cessation process of their patients. Results of a 1998 survey among 4,643 Belgian physicians.

This report relates to the 1,667 responses to a selfadministered mail-back questionnaire sent by BELTA to a sample of 4,643 physicians (17.3% current smokers) who are in professional contact with patients (response rate: 35.9%). Links between active smoking and disease are considered as well-demonstrated by 98.8% physicians and for passive smoking by 85.3%, for foetal consequences of smoking during pregnancy by 96.4%. Nicotine dependence is admitted by 83.3%. Interaction of smoking with drug metabolism is insufficiently known. Modulation of the specific approach of smoking cessation, according to the various stages of the cessation cycle, to the level of nicotine dependence and to the psychological status of the smoker is not sufficiently perceived by the physicians. Patient's smoking status is systematically determined by less than half the physicians, of whom nearly 90% claim to inform their smoking patients on smoking-related risks, and 84.2% to tackle the problem of cessation. The intervention is mostly limited to a firm advice, completed by nicotine replacement for a maximum of 50% of smokers (especially gum and patch). Referral to specialized structures is unfrequent (between 10 and 20%). Follow up after cessation is clearly deficient. In this retrospective study of their activity patterns, physicians' reports may reflect their intentions rather than their actual practices. We conclude that smoking issues and cessation techniques should be more intensively taught both at graduate and postgraduate levels, in order to obtain a more active behaviour of health professionals against smoking.

Attitude of Health Personnel↗

PubMedDate not supplied

Management of COPD according to guidelines. A national survey among Belgian physicians.

Current management of COPD by Belgian physicians was compared with the recommendations of the recently published GOLD guidelines. A random sample of 386 general practitioners and 86 pulmonologists filled in a questionnaire based on the GOLD guidelines and examining their attitudes towards COPD management. Several important deviations from the guidelines were noted. Only few GP's performed spirometry themselves and about 55% of the diagnoses were not based on spirometry. Both GP's and pulmonologists used inhaled corticosteroids considerably more often than prescribed by the guidelines, with 49% and 25% respectively, prescribing them to all COPD patients. Chronic systemic steroids were also overused in stable disease, with 55% of the GP's and 52% of the pulmonologists prescribing them in patients with repeated exacerbations. GP's did not use enough systemic corticosteroids and overused antibiotics in the treatment of exacerbations. Pulmonologists did not pay enough attention to pulmonary rehabilitation, as only 44% of them had a structured programme. Pulmonologists did not use non-invasive ventilation frequently enough in the treatment of exacerbations, as only 22% would use it in the correct indication. Both GP's and pulmonologists did not prescribe enough pharmacotherapy for smoking cessation, with 35% and 46%, respectively using it. Some interesting differences between Dutch and French speaking physicians were noted. These specific deviations from the guidelines will be addressed in a second phase implementation project.

Belgium↗

PubMedDate not supplied

[Smoking experimentation in adolescents. Is there a risk for health?].

It is clear that even low rate smoking is hazardous for health, the risk being independently increased by the daily number of cigarettes smoked and by the duration of smoking. The question raised is thus: will an adolescent experimenter be a non smoker, an experimenter for ever, a regular smoker, light or heavy? This short review shows that there are numerous factors from genetics, to familial environment not limited to tobacco issues, smoking situation at school as well as school performances of the student, and also individual psychological characteristics. The experimenter is a very good target for smoking cessation actions and should deserve particular attention from preventive medicine and, thus, from school medicine, before he becomes a regular smoker, who will be more resistant to smoking cessation programs.

Adolescent↗

PubMedDate not supplied

[The use of continuous positive pressure in patients with bronchospastic crises].

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Acute Disease↗