Analysis of the doctor-patient communication if breast cancer is diagnosed / Análisis de la comunicación médico-paciente en el diagnóstico de cáncer de mama / Análise da comunicação médico-paciente em caso de diagnóstico de câncer de mama

The aim of the paper is the recognition and evaluation of demand for medical information among patients suffering from breast cancer. The research was conducted among 120 women with diagnosed breast cancer in the Oncological Surgery Clinic of the Independent Public Research Hospital Nº 1 in Lublin, the Oncological Clinic of the Independent Public Research Hospital Nº 1 in Lublin and the Rehabilitation Centre with the Rehabilitation Clinic at the Lublin Oncology Centre. The research included women from the Club of Women after Mastectomy “Amazons”, the Club “Amazons” at the Complex of Specialist Clinics in Ostrowiec Swietokrzyski and the Club “Amazons” in Radom. Research showed that the demand for medical information among women with diagnosed breast cancer is very high. Respondents want to know all the information concerning the diagnosis, treatment and prognosis (93 percent). They also expect that the doctor will give them medical information concerning further consequences of cancer and its influence on future health and life (78 percent). Most of the respondents expect to receive information concerning medicaments which should be taken (77 percent) and the essence of the conducted treatment (93 percent). The research analysis showed that women with diagnosed breast cancer expect that the doctor will give them reliable and real medical information. Patients want the doctor to present them the probable course of the cancer (85 percent) and all the possible side effects connected with it (89 percent).

El objetivo de este trabajo es el reconocimiento y la evaluación de la demanda de información médica en pacientes con cáncer de mama. Se realizó la investigación con 120 mujeres diagnosticadas con cáncer de mama en la Clínica de Cirugía Oncológica y la Clínica Oncológica del Hospital de Investigación Público Independiente Nº 1 en Lublin, y el Centro de Rehabilitación con la Clínica de Rehabilitación del Centro Oncológico de Lublin. La investigación incluyó mujeres del Club “Amazons” de Mujeres que han sufrido Mastectomía, el Club “Amazons” del Complejo de Clínicas Especializadas en Ostrowiec Swietokrzyski y el Club “Amazons” en Radom. La investigación mostró que la demanda de información médica de mujeres con diagnóstico de cáncer de mama es muy alta. Aquellas que respondieron quieren saber todo acerca del diagnóstico, tratamiento y pronóstico (93 por ciento). También esperan que el médico les dé información médica respecto de posteriores consecuencias del cáncer y su influencia en su salud futura y su vida (78 por ciento). La mayoría de las que respondieron esperan recibir información sobre medicamentos que deberían tomar (77 por ciento) y lo esencial sobre el tratamiento realizado (93 por ciento). El análisis de la investigación muestra que las mujeres diagnosticadas con cáncer de mama esperan que el médico les dé información médica confiable y verdadera, les presente el curso probable del cáncer (85 por ciento) y todos los posibles efectos secundarios conectados (89 por ciento).

O objetivo deste artigo é o reconhecimento e a avaliação da demanda por informação médica entre pacientes que sofrem de câncer de mama. A investigação foi conduzida entre 120 mulheres diagnosticadas com câncer de mama na Oncological Surgery Clinic of the Independent Public Research Hospital Nº 1 de Lublin, a Oncological Clinic of the Independent Public Research Hospital Nº 1 de Lublin e a Rehabilitation Centre with the Rehabilitation Clinic do Lublin Oncology Centre. A pesquisa incluiu mulheres do Club of Women after Mastectomy “Amazons”, o Club “Amazons” do Complex of Specialist Clinic sem Ostrowiec Swietokrzyskie o Club “Amazons”em Radom. Pesquisa revelou que a demanda por informação médica entre mulheres com diagnóstico de câncer mamário é muito alta. As respondentes queriam saber todas as informações concernentes ao diagnóstico, tratamento e prognóstico (93 por cento). Elas também esperavam que o médico pudesse dar-lhes informação sobre consequências tardias do câncer e a influência sobre a sua saúde e vida futuras (78 por cento). A maioria dos respondentes tinham a expectativa de receber informação sobre medicamentos que deveriam tomar(77 por cento) e a essência do tratamento realizado(93 por cento). A análise da pesquisa demonstrou que as mulheres com diagnóstico de câncer de mama esperavam que o médico pudesse fornecer-lhes informação confiável e honesta. Pacientes queriam que o médico lhes apresentasse o provável curso do câncer (85 por cento) e todos os possíveis efeitos relacionados a ele (89 por cento).

The contemporary look at the problem of recognizing and diagnosing postmenopausal osteoporosis and eliminating the risk of a fall.

Osteoporosis constitutes a relevant health, social and economic problem of the contemporary world. As a chronic disease, often nicknamed the "silent thief", it is an object of the clinical research and a reason for many ambiguities. The most noticeable and basic symptom of osteoporosis is a low-energy fracture, which brings pain, physical disability, and a noticeable decrease in one's quality of life. Osteoporosis affects the entire population; however, women in the postmenopausal period and the elderly are mostly exposed to its progress. The risk of falling ill concerning women simply grows with the age and doubles with every decade after the age of 65. It is estimated that osteoporosis affects 200 million women worldwide, and about 20-25% of them will sustain an injury in the form of a bone fracture. In Poland, the problem of osteoporosis concerns 2.4 million women. The article attempts to show current views on examining and diagnosing postmenopausal osteoporosis and prevention of the fall risk. The BMD (bone mineral density) is considered the basis of osteoporosis diagnosis in postmenopausal women as well as an absolute 10-year risk of fractures and experienced osteoporotic fractures. All people at an increased fall risk should be provided with the multifactorial programme of fall prevention.

Psychosocial aspect of quality of life of Polish women with breast cancer.

INTRODUCTION AND OBJECTIVE: Breast cancer is one of the most frequently occurring malignant tumours among women in Poland. The highest incidence of the disease is registered among women aged 50 and more. Cancer imposes a considerable psychological strain on a woman. It causes a sense of uncertainty about one's health and further life, as well as frequent problems with accepting the image of one's own body. It often results in low self-esteem and a feeling of embarrassment, accompanied by symptoms of apathy and detachment. The aim of the study was to determine mental and social life quality of Polish women treated for breast cancer. MATERIALS AND METHODS: The research encompassed 107 women aged between 45 and 65 (SD=6.11) undergoing treatment for breast cancer. The WHOQOL-Bref scale was applied in the research. RESULTS: The social field was better evaluated in comparison with the mental sphere. There was a statistical correlation between place of residence and social sphere of quality of life (p=,036), with higher ratings assigned by respondents residing in rural areas (M=15.36) compared with residents of towns (M=14.15). CONCLUSIONS: Given the fact that respondents were coping with cancer or its consequences, paradoxically, perception of the overall quality of life and examined areas was generally good, especially among women with higher education, those who were single and those living in rural areas. Along with age, there decreases at the respondents the experienced quality of life, however a rise of evaluations of the mental sphere is accompanying the rise in the education level.

Quality of life in peri- and post-menopausal Polish women living in Lublin Province--differences between urban and rural dwellers.

INTRODUCTION AND OBJECTIVE: The quality of life in peri- and post-menopausal women constitutes a serious public health problem. The aim of this observational cross-sectional study was to reveal the influence of the permanent domicile on the quality of life of women in peri- and post-menopausal period, and to establish the influence of employment as a full-time agricultural worker on the quality of life in these women. MATERIALS AND METHODS: The research was carried out by means of a survey using the postal questionnaire technique. Three standardized questionnaires: WHOQOL-BREF, Women's Health Questionnaire (WHQ) and SF-36 were used as research tools. An original questionnaire was also used. The study comprised a representative sample of the female population aged 45-65 living in Lublin Province. The sample size was 2,143 women. RESULTS: The quality of the women's life was significantly affected by the place of permanent residence. The worst quality of life was found in permanent country dwellers. City and town inhabitants revealed a considerably higher level of quality of life. Permanent place of residence in the country was an independent predictor of a poorer quality of life. Employment as a full-time agricultural worker was an independent predictor of a worse quality of life in the SOM domain of WHQ, as well as RP, RF and RE domains of SF-36. On the other hand, employment as a full-time agricultural worker was an independent predictor of a better quality of life in the SLE domain of WHQ, and psychological domain of WHOQFL-BREF. CONCLUSIONS: Awareness of the dependence is necessary in order to effectively plan health education and physical and social health promotion campaigns. Country dwellers need special attention in the process of undertaking any preventive or curative steps.

[Pain in children in historical perspective]. / Ból u dzieci--spojrzenie historyczne.

Pain in children, especially in infancy, is frequently underestimated. Surprisingly, in ancient times, writers were more aware of the existence of pain in infancy and the need for its relief than in 20th century. They rated pain perception as being higher in infancy than in childhood. The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years. Later studies on pain perception in foetuses, and careful analysis of infants' reactions to blood sampling, helped doctors to understand the necessity of adequate analgesia in young children. In this review, we present the approach to pain in children over centuries, from ancient times to the latest developments in this field.

The type of relationship in marriages of patients with neurosis disorders.

Conjugal relationships are an integral part of spouses' bonds. The only pattern of relationships in the marriages of patients with neurosis disorders was a type based on a dependence mechanism, i.e. subordinating one partner to another, whereas in the control group the pattern is based on a sense of mutual confidence, self-control, and the need to understand oneself and other people as well.

Psychosocial functioning of the people with delusional disorders under forensic psychiatric observation in the ward of forensic psychiatry in 1998-2002.

In the literature on the subject frequency and kind of deeds committed by people with mental illness in relation to individual clinical diagnoses are analyzed mainly, whereas little attention is paid to the issue of their psychosocial functioning. Intellectual functioning of the people manifesting delusional disorders in the course of committing attributed deeds, was on an average level. The patients' social functioning was on a low level.

Functioning of care-and-treatment health centers and nursing-and-care health centers illustrated by the Province of Lublin.

A commonly felt problem in the Polish system of health protection is the lack of long-term care in the properly functioning family. With the introduction of a new system of health insurance, chronically ill patients with an established diagnosis and therapy and not requiring hospitalization are considered not eligible for hospital care. It concerns a big group of patients with a considerable limitation of self-caring activities. The demographic data imply that this problem is growing systematically. A bigger and bigger part of the society is at their post-production age in which many diseases limiting independent functioning develop. Problems arising from the disease influence not only the family but also the whole society. In many cases a chronic disease leads to disability, which results in the requirement for nursing care. Year by year there is an increasing number of people requiring everyday at least 2-hour nursing care. A considerable number of these patients qualify for stationary long-term care. There is a great deficit of services in the long-term care at present. New principles of financing health services force the health care settings to use the beds in the optimum way, to make a quick diagnosis and treatment without extending the patient's stay in hospital by a period that would not influence the change of health condition. Therefore, long-term care should comprise about 60% of the whole potential of stationary care. In our country the deficit of stationary forms of long-term care is felt. It creates the opportunity for many hospitals providing the short-term care to transform to treatment-care settings or nursing-and-care settings which will be performing longterm care.

The needs of aphasic patients for verbal communication as the element of life quality.

The fact of using the language by man confirms the specific properties of his brain. Man is not able to learn this skill without a contact with speaking and human environment. This skill of linguistic communication with others allows man to get knowledge about the surrounding world and on the other hand it enables him to express his thoughts, feelings and needs. Therefore, people with serious speech disorders, i.e. aphasic patients, suffer not only from the problems connected with communication but mainly because of the deterioration of their social status that consequently will change their life quality. Generally, they cannot cope with the tasks they are lacking both in their personal and professional life. Speech is defined as the process of communication; the act in which the transmitter sends verbal structured message (statement), and the receiver perceives this message or understands its contents. The present paper presents the realised programme of 8-week speech re-education of 10 patients with motor aphasia and 10 patients with sensory aphasia. The examination of speech was performed on the basis of clinical-experimental tests developed by A. Luria. Diagnostic treatment in this test is focused on the qualitative analysis of the disorders structure.

Prophylaxis of breast cancer among nurses in health care settings in the city of Lublin.

The goal of this project was to assess the kind, extent and knowledge about the actions undertaken by nurses in the field of primary and derivative prophylaxis of breast cancer. The research was conducted with the use of an anonymous poll. We surveyed 180 nurses from medical centres in Lublin. The data included in 150 questionnaires which were qualified for the research were statistically analyzed. Despite medical education and theoretically easier access to medical services the research showed inadequate knowledge about the disease and lack of individual preventive actions of women employed in this sector. Insufficient knowledge about the ways of primary prophylaxis of the methods of early detection of breast cancer may be the reason why health-oriented habits are not given proper attention. Only 24 per cent of the polled women perform regular monthly breast self-control. The surveyed group of nurses display a rather passive attitude towards screening tests. Out of 51 per cent of the respondents who were given a chance to have screening tests just a little more than one third took advantage of this opportunity. The reason, according to the surveyed, was too low awareness, lack of time and fear of the disease.

The influence of unemployment on functioning of the family.

The aim of the study was to determine the impact of unemployment on family welfare. It was conducted between April and June 2002 among 200 unemployed registered at the Regional Employment Bureau in Lublin. The method of choice was a questionnaire. The study results demonstrated that the most direct consequence of unemployment is financial impoverishment. Most participants claimed their income did not allow them to cover the basic needs. Managing a very limited budget, they had to give up buying new clothes, more expensive food and toilet items as well as spending money on cultural and leisure pursuits. They were unable to use paid medical services and to meet household payments deadlines. These consequences were borne not only by the unemployed themselves but also by their families. Those with school children had to cut their expenditures on education and in extreme cases the children were unable to attend junior or senior high school. The results indicate that unemployment had a negative impact on many different spheres of family life and in the long run it has a negative impact on the life of the whole society.

Primary health care physicians' knowledge of prophylactics of drug abuse.

The purpose of the study was the evaluation of the assumptions of drug addiction prophylactics and its realization in the practice of primary health care physicians as well as determination of the possibilities of introducing changes in the training of physicians which would favour the increase and extension of knowledge in this field. The method applied in the study was a survey based on the questionnaire distributed among 410 primary health care physicians who attended up-dating courses on family medicine organized by the Institute of Rural Medicine in Lublin. The results were statistically analyzed with application of Excel Statistica Stargraf 6.0 software and the authors' own programmes. The results indicate that primary health care physician's basic and limited knowledge on drug abuse originates from university studies and it is limited to information concerning the reasons, mechanisms, medical effects and some methods of treatment. In the procedures created for the practice of primary health care physicians direct activities related to the drug abuse prophylactics are not considered but only a general health care in the region. However, indirectly the primary health care physicians and family physicians realize so called educational care in the region by cooperating with the nurses and midwives employed in the region or in so called practice of a family physician where educational packages are created, ie. prophylactics of addiction.