Geschlechtsspezifische Aspekte der Rückkehr zur Arbeit bei Patientinnen und Patienten mit einer Krebserkrankung

Due to improved prognosis most cancer survivors are nowadays able to return to work. This review explored gender-related differences in work-related outcomes after cancer. A systematic search of studies on work-related issues in cancer survivors published between January 2001 and July 2011 was conducted. 44 original publications met the inclusion criteria (adult cancer survivors, focus on work-related outcomes, gender-specific report of results). The results of these studies indicate that impaired work ability is more common among female cancer survivors than among male cancer survivors as well as the reduction of working hours and income losses. Supportive work environments seem to be particularly helpful for the successful and long-lasting re-integration of female survivors. More systematic research and separate analyses for women and men are needed to fully comprehend gender differences in work-related outcomes. Broader knowledge can then be helpful in creating gender-specific return-to-work interventions.     

?konomische und soziale Aspekte der Jodpr?vention

Background

Iodine supplementation is a well-known measure to prevent thyroid disease in (pregnant and breastfeeding) mothers and their babies. In Germany, as iodine is only added to salt as supplementation for the general population, childbearing and breastfeeding women are at risk for iodine deficiency. Therefore, official guidelines recommend iodine supplementation during pregnancy and while breastfeeding.

Goal

The paper discusses current survey results (one of them led by the authors) on iodine intake in Germany, with a focus on the childbearing and breastfeeding population.

Results

Iodine deficiency is diminishing in the adolescent population, but more than half of the (less educated) pregnant and breastfeeding mothers do not take iodine.

Conclusion

With respect to both health economics and avoidable disease, there is a significant need of intensified antenatal consultation regarding iodine intake for pregnant and breastfeeding women in Germany.     

Schulische Tabakprävention

Aim

The aim of this paper is to give an overview of international research on the effects of structural prevention measures at schools on the smoking behaviour of pupils.

Methods

A systematic literature search was conducted using four social sciences databases. In total, 11 international publications from different countries were included.

Results

The formal adoption of written smoking bans alone does not affect the smoking behaviour of pupils. The implementation of additional activities, particularly regular controls of smoking bans and consequent sanctioning of transgressions, is related to students smoking prevalence.

Discussion

Most studies on the effect of structural prevention activities at schools are crosssectional with some methodological problems. On the basis of the results preliminary recommendations are presented.     

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients’ and family‐caregivers’ needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals’ views on a longitudinally structured, forward‐thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi‐structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team‐building measures and the necessary flexibility to respect individuality in life should be incorporated.     

Factors related to sexual functioning in male patients undergoing hemodialysis and with kidney transplants

The sexual functioning of 13 male patients undergoing renal dialysis and 13 male patients who had received kidney transplants was compared. Standardized interviews were used to assess the frequency of intercourse before illness, during dialysis, and after transplantation and to assess sexual difficulties experienced during these periods. In addition, plethysmographic recordings of erection levels were obtained for three dialysis and three transplant patients at eight separate time periods corresponding to particular points in the dialysis cycle. Assessments of depression and anxiety (IDA scale) and renal functioning (Marital Patterns Test) were also carried out. Dialysis patients were less able to gain and maintain erections than transplant patients and intercourse was less frequent for couples where the husband was on dialysis. Dialysis patients were more depressed than transplant patients, although transplant patients showed greater levels of anxiety. More marital difficulties were experienced by patients on dialysis than patients who had received transplants. The implications of these findings for the treatment of sexual problems in these patients are discussed.     

THE USE OF PHARMACEUTICALS FOR DIALYSIS PATIENTS. HOW WELL DO WE KNOW OUR PATIENTS' ALLERGIES?

Medication allergies are potentially important but usually poorly documented in patient medical records. Allergy awareness by clinical staff may be low in the haemodialysis population despite their regular attendance for treatment sessions. A cross‐sectional study of 25 patients in a satellite unit was performed. All known allergies were not documented in 36% of patients despite the patients being known to the renal service for more than five years. 81% of allergies were medication allergies. The rest were due to topical agents. 57% (affecting 8 patients) of the medication allergies related to antibiotics (especially penicillin). Four patients had multiple antibiotic allergies. The nature and severity of these allergies was not well documented. This study demonstrates that despite being under long‐term care there remains incomplete information, which is vital for optimal safe practice. Without such information, the potential for adverse events and anaphylaxis is significant in a population that is exposed to numerous pharmaceutical agents and are frequently prescribed antibiotics. Medication histories should be comprehensively re‐evaluated regularly and prescribing should not occur unless the allergy box is completed.     

Reality basis for teaching psychomotor skills in a tertiary nursing curriculum

This paper, written whilst the authors were working at Curtin University, Western Australia, describes a process of determining the psychomotor skills to be taught in an undergraduate nursing programme. It outlines how consultation with clinical agencies enhanced the planning of the skills component within the new nursing curriculum and details the outcomes in terms of faculty development and curriculum design.     

Repeated users of a psychiatric emergency service in a Canadian general hospital

The authors of this study examine the demographic and clinical characteristics of repeated users of psychiatric emergency room services in a general hospital. 37.8% of all the patients (913) seen during one year had one or more visits to the emergency room in the six months preceding the index emergency room consultation. Repeaters were more likely than non-repeaters to be unmarried, self referred and with a history of previous psychiatric treatment for a chronic psychiatric disorder. Factors affecting frequency of use of psychiatric emergency room services among different diagnostic groups were also studied. These results demonstrated the heterogeneity of the needs of the diverse diagnostic groups who over-utilize costly emergency room services. Our findings showed that in a country with universal health insurance, psychiatric emergency services also tend to reflect the gaps in the delivery of health services in the hospital and the community.     

Maternal-Infant Attachment: a Developmental Perspective

The formation of a close and satisfying maternal-infant bond is recognized as being an important contribution to the optimal psychosocial development of the child. However the relationship that develops between mother and infant is increasingly seen as an ongoing developmental process rather than a postpartum event, occurring in the first few days after birth. It is also being increasingly recognized that there are a multitude of factors during this period which affect the development of this relationship (14, 15, 16, 17). The father too plays an important role at this time, and his reactions to the birth as well as the support he is able to offer his wife are determinants in the evolving maternal-infant relationship. The view of bonding as an ongoing developmental process influenced by both ante- and postnatal factors, indicates some flexibility of response on the part of the mother when things do not go according to plan. For example, separation of mother and infant in the case of a premature delivery need not have an adverse effect on the development of the maternal-infant relationship provided that there is adequate support for the parents. Well trained I.C.U. staff and hospital practices that are sensitive to the needs of the parents at this time are important determinants here. It is felt that the success of the video programme, and the results of the long-term follow-up programme conducted at the Queen Victoria Hospital support this developmental view.