[A CHILD IS LOST: THE PHENOMENON OF REFUSING TO BE HOSPITALIZED IN FAMILIES OF CHILDREN REFERRED TO THE DEPARTMENT OF EMERGENCY MEDICINE].

BACKGROUND: Discharge against medical advice (DAMA) in pediatrics may endanger the child, increase the rate of complications, morbidity or mortality. Despite the prevalence of this phenomenon in the world, we found only one study that examined the DAMA phenomenon in Israel. The study examined the phenomenon in one ER in general and did not distinguish between adults and children. OBJECTIVES: To describe the characteristics of children and parents who left the ER against medical advice for hospitalization and to examine the reasons given by the parents, and factors associated with this phenomenon. METHODS: A prospective study involving parents who refused to hospitalize their children despite a medical recommendation. Data was collected from medical records and telephone interviews after discharge. RESULTS: During the study, there were 16,376 visits to the pediatric ER, 3288 recommendations for hospitalization (20.07%) and 200 DAMA (6%). Reasons for parents refusing hospitalization can be categorized according to: child's health reasons, parents personal reasons and reasons related to the health system`s function. A total of 22 of the children returned to the ER for the same complaint and 12 of them were hospitalized (7.9% of the children who completed their participation in the study). DISCUSSION: Refusal of medical care for children is a disturbing phenomenon due to the negative consequences that may result from this. In order to minimize the extent of DAMA and its damage, it is very important to recognize the extent and understand the factors associated with this phenomenon.

[Sexual functioning and information needs in women with premature menopause following breast cancer treatment].

BACKGROUND: Breast cancer is the most common malignant disease among women in Israel and the western world. Approximately 4,000 women a year are diagnosed with breast cancer in Israel and about 900 die as a result of the disease. Large numbers of women who had breast cancer are struggling to cope with sexually oriented difficulties. They feel ashamed and embarrassed in front of their doctor or nurse regarding what they might think about them, for instance if they dare to ask a question regarding a non life-threatening subject. PURPOSE: The aims of this research are: 1. To describe the changes in physiological and sexual function among young Israeli women who survived breast cancer and as a consequence experience premature menopause. 2. To understand their information needs regarding sexual functioning. 3. To examine if and to what extent these needs were met by the professional staff. This research was based on the fact that the professional staff provides the patients with information regarding the surgery, the effects of chemotherapy and nutrition but avoids providing substantial information about predicted altered sexual functions and premature menopause. Research shows that medical staff members ignore this crucial information due to personal, professional and social reasons. METHODS: In a cross-sectional convenience sample, data was collected from 82 women who had been diagnosed with grade 1-2 breast cancer and were treated by one or more of four interventions: surgery, chemotherapy, radiation and hormonal therapy. They were asked to fill out a four-part self-questionnaire. FINDINGS: 1. Premature menopause differs from physiological menopause by the symptom acuteness and intensity. 2. Women treated with chemotherapy reported more sexual function difficulties in comparison to other treatments. 3. Women treated with chemotherapy reported increased sexual pleasure and decreased dyspareunia over time following the completion of treatment. 4. Most women reported no significant influence on their ability to experience orgasm during treatments. 5. Almost all the women received a considerable amount of information about treatments and their side effects, but limited information about sexual function, and were very interested in receiving more information on this subject. CONCLUSION: Breast cancer is becoming more widespread amongst young women. Therefore, it is very important for the medical staff, despite the difficulties, to prepare women treated for breast cancer for the effects of this treatment on sexual function and premature menopause.