The impact of conventional and nonconventional inhalants on children and adolescents.

AIM: Inhalant abuse in the adolescent population is a growing concern for care givers, communities, physicians, and medical providers. The aim of this article is to provide a review of the literature about this new challenge. In addition, it raises awareness about recent health policy rulings. METHODS: Review of the literature was done. RESULTS: In this review article, the prevalence of different modes of inhalant use and abuse in children and young adults and their potential health implications will be examined: Cigarettes, ENDS (E Cigarettes), Hookah, Marijuana, and Huffing. Additionally, marketing and advertising tactics will be reviewed to understand how they target this population. A review of current health policy recommendations from the FDA, American Thoracic Society, and the American Academy of Pediatrics will also be discussed. CONCLUSION: The rapid rise in e-cigarette and hookah use in school aged children should trigger a call to action in the medical and public health communities. Health policy recommendations need to be made to reduce the level of adolescent substance abuse.

Complications in body contouring stratified according to weight loss method.

BACKGROUND: Body contouring procedures following massive weight loss have become increasingly common and, unfortunately, continue to be associated with a high complication rate. OBJECTIVE: To evaluate how weight loss method affects complications following abdominally based body contouring procedures. METHODS: Patients undergoing abdominally based contouring procedures were retrospectively evaluated over an 11-year period and stratified into two groups based on method of weight loss: diet and exercise; or bariatric surgery. Complications, including seroma, wound dehiscence, skin necrosis, infection, hematoma and venous thromboembolism, were included if they required intervention. An adjusted logistic model was used to examine the effect of weight loss method on aggregate complication rates. RESULTS: A total of 307 patients were included: 77 (25%) lost weight through diet and exercise; and 230 (75%) through bariatric surgery. Results from the logistic model showed no difference in complication rates between weight loss methods (OR 1.01 [95% CI 0.51 to 2.02]). However, there was a strong correlation between body mass index at the time of surgery and complication rates (OR 1.05 [95% CI 1.02 to 1.08]; P<0.01). CONCLUSIONS: The findings reveal no difference in complication rates following abdominal body contouring procedures attributable to method of weight loss. Rather, there was a proportional rise in complication rates in patients with a higher body mass index at the time of surgery. Surgeons and patients should be aware of this trend, and it should be part of any discussion of abdominal body contouring procedures and informing patients of their risk profile.

HISTORIQUE: Les interventions de remodelage du corps après une perte de poids massive sont de plus en plus courantes. Malheureusement, elles continuent d'être associées à un taux de complication élevé. OBJECTIF: Évaluer l'influence de la méthode de perte de poids sur les complications après des interventions de remodelage de l'abdomen. MÉTHODOLOGIE: Les chercheurs ont fait l'évaluation rétrospective de patients qui avaient subi des interventions de remodelage sur une période de 11 ans et les ont stratifiés en deux groupes, selon la méthode de perte de poids: régime et exercice ou chirurgie bariatrique. Ils ont inclus les complications qui avaient nécessité une intervention, y compris le sérome, la déhiscence de la plaie, la nécrose cutanée, l'infection, l'hématome et la thromboembolie veineuse. Ils ont utilisé un modèle logistique rajusté pour examiner l'effet de la méthode de perte de poids sur les taux de complication globaux. RÉSULTATS: Au total, 307 patients ont été inclus dans l'étude, dont 77 (25 %) ont perdu du poids par suite d'un régime et d'exercice et 230 (75 %) après une chirurgie bariatrique. Les résultats du modèle logistique n'ont révélé aucune différence dans les taux de complications selon la méthode de perte de poids (RC 1,01 [95 % IC 0,51 à 2,02]). Cependant, ils ont constaté une forte corrélation entre l'indice de masse corporelle au moment de l'opération et les taux de complications (RC 1,05 [95 % IC 1,02 à 1,08]; P<0,01). CONCLUSIONS: Les résultats n'ont révélé aucune différence dans les taux de complication attribuables à la méthode de perte de poids après des interventions de remodelage abdominal. Ils ont plutôt démontré une augmentation proportionnelle des taux de complication chez les patients dont l'indice de masse corporelle était plus élevé lors de l'opération. Les chirurgiens et les patients devraient connaître cette tendance, qu'il faudrait intégrer aux discussions sur les interventions de remodelage abdominal et à l'information aux patients sur leur profil de risque.

An Analysis of the Decisions Made for Contralateral Prophylactic Mastectomy and Breast Reconstruction.

BACKGROUND: Little is known about the role breast reconstruction plays in decisions made for contralateral prophylactic mastectomy. This study explores factors critical to patient medical decision-making for contralateral prophylactic mastectomy and reconstruction among women with early stage, unilateral breast cancer. METHODS: A mixed methods approach was used to gain an understanding of patients' choices and experiences. Patients with stage 0 to III unilateral breast cancer who underwent reconstruction were recruited, and semistructured interviews were conducted. Patient-reported outcomes were evaluated using the Concerns About Recurrence Scale and the BREAST-Q. RESULTS: Thirty patients were enrolled; 13 (43 percent) underwent unilateral mastectomy and 17 (57 percent) underwent contralateral prophylactic mastectomy. Three broad categories emerged from patient interviews: medical decision-making, quality of life after mastectomy, and breast reconstruction expectations. Patients who chose contralateral prophylactic mastectomy made the decision for mastectomy based primarily on worry about recurrence. Quality of life after mastectomy was characterized by relief of worry, especially in patients who chose contralateral prophylactic mastectomy [n = 14 (82.4 percent)]. Patients' desires for symmetry, although not the primary reason for contralateral prophylactic mastectomy, played a role in supporting decisions made. Levels of worry after treatment were similar in both groups (72.7 percent). Patients with contralateral prophylactic mastectomy had higher mean scores for satisfaction with breast (82.4 versus 70.6) and satisfaction with outcome (89.9 versus 75.2). CONCLUSIONS: The choice for contralateral prophylactic mastectomy is greatly influenced by fear of recurrence, with desires for symmetry playing a secondary role in decisions made.