Isabel Sousa @ Londres

Nome: Isabel Sousa
Idade: 34 anos
Especialidade: Medicina Geral e Familiar
Local: Londres

Porque optaste por ir trabalhar para o Reino Unido? E em que localidade estás a viver e a trabalhar?
Durante toda a minha vida académica e profissional senti um profundo interesse em ir para outros lugares e ter contacto com novas experiências e formas de trabalhar. Sempre foi uma ideia que me ia perseguindo mas que foi perdendo a força à medida que nos vamos adaptando e acostumando à nossa realidade.
Entretanto, por questões pessoais aliadas a um programa de recrutamento muito estruturado com imenso apoio e a uma vontade que sempre esteve “lá”, decidi abraçar esta experiência de me mudar e trabalhar em Londres.
Eu vivo em Camden, no centro de Londres e trabalho em Enfield, numa clínica na zona norte de Londres.

Há quanto tempo estás no Reino Unido? Planeias regressar a Portugal?
A minha mudança ainda é recente, cerca de 1 ano, mas a progressão e crescimento são notórios para mim. Regressar a Portugal sempre fez parte dos meus planos, mas não necessariamente por questões laborais.
Evidentemente que sairmos da nossa bolha faz-nos perceber muitas coisas. Uma delas é que somos tão capazes de nos adaptar a diferentes ambientes e que as nossas maiores limitações estão só na nossa cabeça. Também compreendemos a diferença de valorização de um profissional em diferentes países e de um sistema que premeia o mérito.

Quais os aspectos mais positivos desta experiência?
A experiência em si e tudo o que envolve é o melhor e o mais enriquecedor que levo daqui. Ir para uma nova cidade, uma língua diferente e uma população com etnias, religiões e tradições tão díspares é super interessante. Cada zona de Londres é diferente e a experiência de cada médico é também distinta por isso. Portanto, os nossos desafios são também outros. Por exemplo, na minha zona existe uma grande prevalência de população turca e grega. Ter que agendar consultas com um tradutor, por telefone ou presencial, é algo comum.
Conhecer um outro sistema de saúde fez-me também ter uma visão mais crítica sobre o nosso SNS, valorizar o que temos, mas também perceber as suas lacunas. Resumindo, alargar os meus horizontes!
Eu vim num programa de recrutamento internacional, super estruturado, com apoio e uma bolsa para me ajudar nas mudanças. Foi um processo sempre muito organizado e bem fundamentado, o que devo salientar que se distingue muito da nossa organização portuguesa.
Neste programa estão vários outros médicos como eu, de todas as idades e nacionalidades, e portanto ter um grupo e fazer novas amizades foi também mais fácil. Para além disso, Londres é uma cidade que fervilha! Para quem é um adepto de cultura, teatro, musicais, concertos e exposições como eu, esta cidade é inesgotável!
Concluindo, penso que o aspeto mais positivo é realmente percebermos como nos conseguimos adaptar a novas realidades e a nossa profissão é, digamos uma profissão “universal” e acredito que a nossa formação em Portugal é de excelência.

E negativos?
Qualquer “emigra” sentirá o mesmo suponho eu. A família, os amigos, a comida, o Sol, as praias, o nosso belo país. Não há bela sem senão. Mas na verdade Londres é a um pulo do meu Porto e neste momento só a Covid é um obstáculo a estas visitas. A mudança exige esforço e perseverança também. No Reino Unido é necessário passar por um processo de Indução, onde temos que fazer exames de escolha múltipla e um exame de simulação de consultas com atores. Apesar de descrever isto no “negativo” porque exige esforço extra, para mim foi um processo enriquecedor e aprendi muito nestes meses. Qualquer clínico aqui que deixe de exercer por um período de 2 anos tem também que passar por um processo de indução ou “refreshment” como chamam, o que me surpreendeu pela positiva.

Qual a tua perspectiva do Serviço Nacional de Saúde inglês?
O nosso SNS foi inspirado a partir do SNS inglês, por isso não é de estranhar que existam muitas similaridades e que não seja um sistema “estranho” para nós. No entanto, evoluíram de maneiras muito diferentes. É um sistema altamente especializado, com muitos técnicos e diferentes tipos de clínicas que oferecem serviços muito específicos. Um exemplo são os vários “graus” de enfermeiras que existem com diferentes especialidades e que são muitas vezes as principais cuidadoras ou prestadoras de serviços.
Muitos profissionais dos cuidados secundários estão também mobilizados para serviços comunitários e por isso existem consultas que podem ser feitas na comunidade. Não há uma uniformidade e portanto os serviços disponíveis variam muito consoante a zona. Conhecer o que temos disponível pode às vezes ser um desafio!
O sistema inglês é gratuito para todos os utentes, exceto certos procedimentos que não são considerados no âmbito do NHS (por exemplo, se o utente pretende um relatório para outro fim que não seja cuidados médicos/referenciação). Apesar de não ser um modelo privado, as unidades têm verdadeira autonomia. Suponho que algo que se poderia aproximar seria o modelo C em Portugal. O edifício é dos médicos e estes recebem anualmente uma verba e fazem a gestão da mesma. Portanto, os salários e tipos de contrato podem variar de clínica para clínica.
Os utentes também não estão distribuídos por médico de família. Disseram-me que já foi assim há muitos anos mas que achavam que o atual sistema, de utentes alocados a uma unidade funcionava melhor. O utente escolhe o médico que quer ver.
Sinto alguma falta da continuidade de cuidados, que aqui não me parece tão vincada como em Portugal. E sinto que é mais difícil considerar-me médica de família aqui, pelo que o termo GP (general practitioner) parece mais adequado.
Por outro lado, as consultas parecem-me menos confusas e mais orientadas no Reino Unido. Os utentes estão habituados a focar-se num único problema e costumam ter uma agenda bem definida. Não tentamos falar de tudo, a agenda do utente mais a nossa, ver os rastreios, e se tens os registos em dia, e tem tensão arterial e peso recente? Sentia muitas vezes este stress em Portugal, de ter que ter “controlo” de tudo aquilo sobre um utente.
As unidades normalmente são formadas por secretários clínicos, médicos e enfermeiros, mas podem ter vários outros profissionais integrados. Farmacêuticos clínicos, paramédicos, técnicos especializados em problemas agudos, são alguns dos exemplos. O farmacêutico clínico faz um trabalho excelente em termos de revisão e gestão de medicação. Grande parte das consultas que não exigem uma mudança no plano terapêutico são também feitas por enfermeiros; por exemplo, consultas de hipertensão, diabetes ou asma.
Aqui a responsabilidade pela sua saúde está do lado do utente. As agendas estão abertas praticamente só com uma semana de avanço e os utentes conseguem consulta no próprio dia ou dia seguinte. Mas se precisarem de ser reavaliados ou repetirem algum procedimento em x tempo, terão que ser eles a ligar e marcar consulta. É uma medicina muito menos paternalista.
Os tempos de espera para consultas na comunidade e no Hospital às vezes são também extremamente longos e a pandemia ajudou a agravar este problema. Por outro lado, qualquer caso suspeito de cancro entra numa via chamada “2 week wait”, em que o utente é visto normalmente numa semana no máximo e em grande parte das especialidades até conseguimos marcar a consulta no sistema do Hospital.


Clínica em Enfield, a norte de Londres.

Da realidade que estás a vivenciar aí, o que gostarias de ver replicado em Portugal?
Flexibilidade
O que mais aprecio neste país é a flexibilidade a nível laboral. Não há uma obrigação de se trabalhar 35 ou 40 horas naquele tipo de serviço. A maior parte dos médicos aqui desenvolve uma carreira que chama “portfolio”. Desenvolvem interesses diferentes, que tanto pode ser investigação, ensino, medicina desportiva, dermatologia, saúde mental, cuidados paliativos, etc e trabalham nessas áreas. Trabalham 3 dias na clínica e depois trabalham em outras coisas. O médico de família aqui considera isso essencial e fundamental pois acreditam que é muito desgastante e pouco frutuoso uma dedicação exclusiva a consulta 5 dias por semana. Acho maravilhoso o facto de haver essa possibilidade e flexibilidade.

Competências em Comunicação
A maior parte dos médicos e outros profissionais de saúde que observo são brilhantes nas competências em comunicação. Em Portugal sempre senti que cada vez se dá mais importância a este assunto, mas aqui sinto que é uma competência há muito estabelecida, não fosse este país o berço da entrevista motivacional. Em todas as consultas há um verdadeiro empowerment do utente e uma negociação sobre o plano a definir. Acho realmente delicioso observar este fenómeno e isso ajudou-me também a progredir na minha comunicação.

Facilidade na Comunicação com outros Médicos
Na minha área existe um programa/app chamada “Consultant Connect” e que nos põe em contacto em 20 segundos com um médico de qualquer especialidade que precisarmos para debatermos dúvidas sobre um utente. Este sistema é muito eficaz e também possibilita enviar fotos (por exemplo para dermatologia) ou exames (ECG, Holter, etc) e tenho tido respostas em 2 ou 3 horas. Em Portugal sentia-me por vezes isolada e com dificuldade em aceder a médicos hospitalares, portanto às vezes enviamos utentes para a urgência e cuja ida podia provavelmente ter sido evitada.

Sistema Informático
Não há um sistema informático perfeito e nisso Portugal está bastante desenvolvido. Aqui não conseguimos aceder a registos nos cuidados hospitalares, por exemplo. Mas por outro lado, as análises ou exames pedidos são registadas automaticamente no sistema e portanto não temos que andar a copiar resultados. Existe também uma aplicação que permite enviar mensagens ao utente, documentos ou fazer chamadas e videoconsulta. É extremamente útil e tem sido uma ferramenta importantíssima durante os tempos de Covid.

Avaliação Contínua
Todos os profissionais são sujeitos a uma avaliação contínua e têm que fornecer evidências de desenvolvimento profissional contínuo. Isto impede que alguns clínicos fiquem “parados no tempo” ou com conhecimentos desactualizados.

Procedimentos/Qualidade/Auditorias
Trabalhei alguns anos em USF modelo B, A e UCSP e escrevia os documentos/protocolos e muito mais e era assim, porque todos o fazemos. Quando vim para aqui comecei a ter uma visão mais crítica sobre isso. Estamos sobrecarregados (desnecessariamente) em burocracia e papelada. Temos informação tão valiosa, como no BI das USFs, mas continuamos a perder horas, semanas e meses a fazer procedimentos e papelada e a repetir coisas cujos dados temos já disponíveis. Espero sinceramente que as coisas mudem, porque sinto que todos estes processos nos tiram energia e motivação para o que realmente é crucial.

Que ideias do nosso SNS levarias para o NHS?

Sistema Informático
A nossa plataforma de saúde e possibilidade de visualizar os cuidados que o utente tem no Hospital e nos cuidados primários é de facto uma arma valiosa.

Contacto social entre a equipa
Acho que somos experts nisto! Tenho saudades dos almoços e convívios com a minha equipa em Portugal. Aqui as refeições são bastante desvalorizadas e resumem-se a uma sandocha comida meia às pressas. Tenho-me esforçado para integrar esse legado na minha clínica!

Prescrição eletrónica
Também existe aqui, mas temos que enviar para a farmácia. Acho bem mais interessante em Portugal a possibilidade de enviarmos diretamente para o utente. O sistema de prescrição português é também mais user-friendly e mais informativo. Aqui não consigo saber, por exemplo, se a receita foi levantada ou não.

Seguimento de grávidas e crianças
O seguimento destes 2 grupos deixa na minha opinião bastante a desejar. As crianças não tem um seguimento regular e têm uma única consulta mandatória entre as 6 e as 8 semanas de vida. As grávidas são seguidas por “midwifes” e os GPs acabam por ter também pouca formação neste grupo.

Trabalho entre enfermeiros e médicos
Aqui não há um verdadeiro trabalho de equipa entre estes dois grupos. O sistema não está também tão focado na prevenção e educação para a saúde e sinto que todos os profissionais deveriam estar mais envolvidos nisso.

Do que sentes mais falta de Portugal?
Família e amigos, sem dúvida. E peixinho bom, fresco do mercado! E Sol….

 

 

43 Comentários. Deixe novo

Avatar
André Correia
Outubro 19, 2020 19:22

Interessante perspetiva.
Gostei particularmente da abordagem da flexibilidade (ou direi antes versatilidade) laboral e da comunicação. Valoriza o profissional e reflecte-se na motivação e dedicação empenhados no utente… nem sempre temos espaço cá para isso no SNS.
A app do consultant connect também me parece interessante. Não sei se já existe, se é algo ao alcance de aplicações como o TonicApp (passo a publicidade) ou mesmo o DrShare.
Sistema informático e exames – só o facto de podermos ter quiçá algum administrativo especialmente alocado à digitalização e transcrição inteligente e automatizada de MCDTs antes de chegarem ao médico já era muito bom… e parece-me mais uma questão de disponibilidade de tempo e de pessoal do que de tecnologia, mais ou menos acessível num bom e rápido smartphone.
Procedimentos – assino por baixo. Bastaria, por exemplo, 1 auditoria a 1 programa por ano e focar nisso.

Felicidades e obrigado pela partilha. 🙂

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Author/Title Scor Sample Size Comparison Results Conclusion Comments Study Type e (0Group eleven) Comparison of Operative Techniques Franceschi 6. These information are descriptive and could be useful Other in describing your inhabitants when reporting fndings and identifying specific groups at excessive Ethnicity (n=) Q107 risk of having poor reproductive health. For the diagnosis to be firmly sustion of native anesthetic is inadequate for the diagnotained, all the following criteria should be happy muscle relaxant drugs flexeril [url=http://addictionresearch.com/scientific-notations/order-cheap-sumatriptan-online/index.html]buy discount sumatriptan 50 mg[/url]. From popula- that are irreducible are assessed with a dislocated femoral tion-primarily based studies, we’ve realized that around 75 to 85% of head. Physicians must take note of the social milieu their sufferers navigate, and the impression of racial categorization on the health and nicely-being of their sufferers should be taken into consideration if physicians are to know and reply to affected person wants (see Box).
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For amoxicillin/peniciillin-allergic patients, the Heart Association recommended: Erythromycin ethylsuccinate 800 mg or erythromycin stearate 1. The effects of lengthy-term publicity to Wi-Fi alerts on male fertility in rats were investigated by Dasdag et al. Within the experience of tegrated into palliative care by oering relatives help nervousness there may be an unspecic feeling of pleasure and after the demise of the affected person rheumatoid arthritis vagus nerve stimulation [url=http://addictionresearch.com/scientific-notations/buy-plaquenil-no-rx/index.html]generic plaquenil 200mg mastercard[/url]. Prognosis the probably outcome or course of a illness; the prospect of restoration or recurrence*. Convergent evolution of losses of the vertebrate-specific self-glycan Neu5Gc are puzzling and may symbolize a distinguished method during which glycans turn out to be brokers of evolutionary change in their very own proper. Maybe, the reactive enlargement of the lymphatic glands might be as a result of presence of cancerous elements. P1-062 Sangeun Yang Early Detection and Management of P1-038 P1-050 Clozapine-Induced Myocarditis: A Case Do Parents and Children Report When Genetic and Medical Report and Literature Review the Same Psychiatric Symptoms. The frequency with which a fnding occurs in a diagnosis is commonly described as its пїЅsensitivityпїЅ by epidemiologists, i neem himalaya herbals 60 kapsuliu [url=http://addictionresearch.com/scientific-notations/order-cheap-geriforte-syrup-no-rx/index.html]buy geriforte syrup 100caps with visa[/url]. Ac | the highest panel reveals a current-clamp recording from a dentate gyrus granule cell and the botttom panel reveals the field potential in the dentate gyrus. Stable cells, such as hepatocytes, enter G0 after mitosis however can reenter the cell cycle M when stimulated by the lack of different G 0 cells.
Most of these circumstances concerned second or third-stage larvae that had shaped furuncular lesions within the neck, chest, or back, they usually occurred at the end of summer season or in early autumn. Among these births, there were 618 (1%) on methadone at supply who were extra likely to be youthful and smokers. Alcohol consumptionпїЅAlcohol consumption is measured this geometric price of change assumes that a variable diferently in the following data techniques pain treatment centers of america little rock [url=http://addictionresearch.com/scientific-notations/purchase-cheap-toradol/index.html]buy 10 mg toradol with mastercard[/url]. Tom is spearheading, students will mirror their drawback-based schooling by a mini analysis project to improve the Dr. For suppositories, sufferers ought to empty their bowels frst if necessary, insert the suppository, then keep away from opening their bowels for no less than an hour if possible. World of oral contraceptives with levonorgestrel earlier than and Health Organization Collaborative Study of Cardiovascular after 1995: cohort and case-management evaluation. In order to indicate the relevance of particular person nations for the relationships in Figure 6, the information factors are surrounded by circles which have an area proportional to a countryпїЅs inhabitants measurement. The siloed strategy results in inconsistent affected person care and low affected person satisfaction How can or not it’s improved mental health occupational therapy jobs [url=http://addictionresearch.com/scientific-notations/order-online-mellaril-no-rx/index.html]buy mellaril 50 mg without prescription[/url]. The left radial pulse is absent, and there is a bruit over the left subclavian and customary carotid arteries. The tacit assumption is that these completely different genes developed as a result of they sub serve different capabilities.
Key suppliers represent only a portion of Pfizer’s total supply chains for goods and companies and we proceed to search for alternatives to broaden our affect on our supply base. Responsibility for their general care transcends the specialty of otolaryngology, but the present pandemic requires a practicing information of publicity threat precautions generally and of secondary infections these patients suffer in the head and neck specifically. Receptor mechanism and antiemetic activity of structurally-numerous cannabinoids against radiation-induced emesis in the least shrew medicine while pregnant [url=http://addictionresearch.com/scientific-notations/order-online-kytril-cheap-no-rx/index.html]order kytril with visa[/url]. Patients ought to be screened nutritionally preoperatively and if malnourished consideration ought to be given to perioperative dietary help (see page 29). Their process doesn’t use in the pharmaceutical formulations his grandfather was any masking agents.

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Many of the adaptive strategies that are 17 at present deployed that defend human beings from climate contain technology (e. Women who begin sexual activity at a young age, have a number of sexual partners, do not use condoms, and have a history of sexually transmitted ailments are at an elevated danger for cervical neoplasia. States Parties acknowledge the proper of the kid to education, and with a view to reaching this proper progressively and on the idea of equal opportunity, they shall, specifically: (a) Make major education compulsory and available free to all; (b) Encourage the development of various forms of secondary schooling, including basic A Guide to General Comment 7: Implementing Child Rights in Early Childhoodand vocational training, make them out there and accessible to each baby, and take acceptable measures such as the introduction of free education and providing monetary help in case of need; (c) Make larger training accessible to all on the idea of capacity by every acceptable means; (d) Make educational and vocational info and steerage out there and accessible to all children; (e) Take measures to encourage common attendance at schools and the reduction of drop-out charges antibiotics for uti and pneumonia [url=http://addictionresearch.com/scientific-notations/purchase-cheap-doxycycline/index.html]cheap doxycycline 200 mg on-line[/url]. Because most nurses are educated in English and profcient in spoken English, they’ve been recruited for positions in each the United States and Canada. Based on this methodology, the next chapter is comprised of three distinct sections: (1) detecting postpartum depression, (2) preventive interventions, and (three) remedy options. High rate of false-unfavorable results of the rectal swab culture technique in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Another risk was that a substance the down facet of those ready-to-use small would leach from the rubber stopper when froparenteral products is that they do not provide zen ampuls of Neutral Ke?in have been thawed in ?exibility in altering the volume or concentrathe microwave, and oftentimes thawing was not tion of the product. Signatory states suspecting 7 Medical Aspects of Biological Warfare others of treaty violations might file a criticism with reasons could not be empirically validated anxiety symptoms paranoia [url=http://addictionresearch.com/scientific-notations/buy-hydroxyzine-online-no-rx/index.html]10 mg hydroxyzine[/url]. To request permission to reproduce or publish Red Cross supplies, please submit your written request to the American National Red Cross. Both the proportion of patients receiving radiation therapy and the dose of radiation administered has decreased over the last 20 years.
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In Asthma, persistent obstructive pulmonary this case, the patient ought to be reassessed the disease, and kyphoscoliosis. Laundered surgical attire should be protected during transport to the practice setting to stop contamination. C a ncer EllisM Pa rikh C R Inrig K eta l C hro nickidneydisea se a f terhem a to po ieticcelltra nspla nta tio n: a system a ticreview anxiety symptoms in children facts for families [url=http://addictionresearch.com/scientific-notations/order-online-buspar/index.html]order buspar without prescription[/url]. At both ranges the incidence of the illness was elevated as shown histopathologically and likewise by measurements of T3, T4 and thyroglobulin antibody titres (Bagchi et al, 1985). The different elements of the brain differ in perform as much as do the completely different viscera of the stomach. The endpoint of every sufferers participation in the study In comparing survival rates of two affected person teams, the statisti- is (1) a specied terminal occasion such as demise, (2) survival to cal signicance of the observed difference is of curiosity. Darmstadt, Germany: Changes of neuronal exercise related to net current flows Wissenschaftliche Buchgesellschaft; 1986. Page 7 of 18 Policies & Procedures: Insulin Adm inistrationSubcutaneous Adult I treatment jokes [url=http://addictionresearch.com/scientific-notations/order-prochlorperazine-online-no-rx/index.html]cheap 5mg prochlorperazine overnight delivery[/url]. Assay Media: To allow quantitation of the vitamin under Vitamin B12 Assay Medium is used for figuring out vitamin B12 test. Hyperglycemia throughout reperfusion increases Pure hypoxia, such as happens in carbon infarct quantity and will trigger hemorrhage.
Powder/Concentrated Liquids When Storedthe Powder or Concentrated Liquid Fortifers are to be пїЅ Divide unused fortifed human milk into particular person bottles blended with measured quantities of human milk to supply an or syringes. Treatment the first objective in the therapy of a poisoned patient is to minimize further exposure. Spitz (1887пїЅ1974) Spitz, an Austro-Hungarian psychiatrist and psychoanalyst, was born in Vienna and died in Denver, Colorado breast cancer zip up hoodie [url=http://addictionresearch.com/scientific-notations/purchase-cheap-fluoxetine-online/index.html]buy fluoxetine online now[/url]. The etiologic contribution of Phoma is uncertain, given signs of irritation are elicited from a number of mold exposures, and no dose-response data was recognized. Obstetrics, nursing home, and T-W-Th and cover about 20 nursing-home painterest in breastfeeding medicine to join the inpatient hospital care usually are not required, however retients.

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The rates of resistance for tion of therapy ought to be lengthy sufficient to forestall many bacterial pathogens are ever-changing, and even relapse yet not be excessive. Effect of procalcitonin-guided therapy on antibiotic use and outcome in decrease respiratory tract infections: cluster-randomised, single-blinded intervention trial. Use of nonhuman milks in the dietary administration of young kids with acute diarrhea: a meta-evaluation of scientific trials gastritis symptoms and prevention [url=http://addictionresearch.com/scientific-notations/order-online-doxazosin-cheap-no-rx/index.html]discount 2mg doxazosin with visa[/url]. In the commonest kind of radial defciency, characterized by a complete absence of the radius, the hand tends to develop perpendicularly to the forearm 11A and B). In specific, the pattern with proximal coronary artery segments crossing between the aorta and the pulmonary trunk has been reported to be potentially deadly. Most antidiarrhoeals (like laxatives) sort out the symptom but Cisapride must be taken prior to a meal, since meals not the underlying cause which is often infectious in nature. Definition Attacks of unilateral extreme or excruciating headache, Main Features occurring more regularly in females than in males, in the persistent form could also be main chronic. Once ven- Investigation of Rhythm Management trial found no tricular rate management has been achieved, attempts vital difference in mortality between the two to convert to sinus rhythm with antiarrhythmic medicine 6 strategies after 5 years of therapy hiv infection due to blood transfusion [url=http://addictionresearch.com/scientific-notations/order-online-starlix-cheap/index.html]discount 120mg starlix with visa[/url]. She will purchase new socks and underwear and use solely borax to clean her hair and do laundry. The first is to watch the conduct of the conventional lumbar lordo- sis as the patient bends forward. The statistical analyses showed a relationship after multivariate analysis and the possible impression of correction for confounding on the data is of concern, especially at such low relative risks. Generation of stress in the middle of unipolar depres Prevalence of smoking among psychiatric outpatients. A common apply in a number of New England and Northwestern states is to use 3 feet or extra of gravel beneath the pavement part muscle relaxant medication over the counter [url=http://addictionresearch.com/scientific-notations/buy-cheap-nimodipine-online/index.html]order nimodipine online from canada[/url]. Using the mix of hand-assisted laparoscopic approach and the hybrid technique may be faster and simpler than the purely laparoscopic method. J Clin Ultrasound 2002; 30: Berlin, Heidelberg, Germany: Springer; 2008:253пїЅ296 481пїЅ495 Bijos A, Czerwionka-Szaflarska M, Mazur A, Romanczuk W.
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