Indications for sexology consultation in women after surgical treatment due to breast cancer

Introduction and objectives. Surgical treatment due to brest cancer have an impact on women sexuality. There is a need for research about effective indications for sexology consultation in women after such treatment. The aim of this study is to determine the indications for sexology consultation in women after surgical treatment for breast cancer. Materials and method. We tested 42 women patients diagnosed with breast cancer who had undergone mastectomy 3 months before the study. 3 months after the surgery the women were surveyed using the Polish version of FSFI assessing sexual functioning in women. The result of PL-FSFI were compared with the control group. Results. It was found that the mean score of PL-FSFI in the study group 3 months after the surgery was 13.33 points (score range: 1.2–31.7; median 8.3 points) with a statistically significant difference in terms of areas: desire, arousal, lubrication and orgasm in favour of the control group. The total score of PL-FSFI was significantly lower in women after mastectomy than in women after breast-conserving surgery. It has been shown that sexually active women in whom the surgery concerned the right breast (on the side of the dominant hand) scored lower on the scale “sexual functioning” of QLQ-BR-23 than women with surgery of the left breast, with this difference being statistically significant. There was a statistically significant correlation between the baseline performance status on the Zubrod scale and the scales: desire, lubrication and satisfaction of PL-FSFI. Living in a small town proved to be statistically significant for predicting a lower risk of sexual dysfunction among the surveyed women. Conclusions. The women who underwent surgery due to breast cancer had a higher risk of sexual dysfunction compared to the general population. Higher risk of sexual dysfunction especially concerns women after mastectomy, those who underwent breast surgery on the side of the dominant hand, and those with a worse preoperative overall level of functioning of ≥ 1 point on the Zubrod scale. A lower risk of disorders was observed in women living in smaller towns. The above factors indicate the advisability for sexology consultation in women with breast cancer

Financialization may affect the therapeutic relationship in psychotherapy

Background: The therapeutic relationship is one of the most important and independent predictors in psychotherapy. Therapeutic relationships take place in a social environment, which shapes the mentality of therapists. One of the important aspects of this environment is financialization, which is considered to be the most significant socioeconomic phenomenon characteristic of capitalism. The aim of this paper is to discuss the effect of financialization on the attitudes of psychotherapists and on the quality of care they provide. Discussion: The paper presents a theoretical analysis of the relationship between the primary constituents of the therapeutic relationship (i.e. trust, realness, individuality of approach, honesty, truth, ethics, the good of the patient) and the phenomena characteristic of the process of financialization (such as replacement of relationship for transaction, distrust, advertisement, statistics, profitability, acceptance of a lie, relativism, consumptionism, perception of own benefits). Summary: Financialization can change the therapeutic relationship through indiscriminate introjection of financialization by the therapist. The primary cognitive and behavioural effect of this process is a shift in the proportions between the foundations of therapeutic relationship towards the foundations of financialization (as defined in this article). To the best of our knowledge, this is the first article presenting the correlation between financialization and psychotherapy

Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery

Introduction. Both because of the large number of women undergoing surgery and a high cure rates, psychological rehabilitation of the consequences of breast cancer and side effects of their treatment is a major challenge of modern psycho-oncology. Aim. The study analyzed the quality of life in women with breast cancer, with particular emphasis on indicators of sexual satisfaction, future perspectives and body image, depending on the method of surgery. Method. The study included 42 women aged 35–70 years, 3 months after surgery due to early breast cancer, treated with adjuvant chemotherapy. The following research tools were used in the study: two EORTC questionnaires: QLQ-C30, BR23, and sexual function questionnaire: PL-FSFI. Results. There was no significant difference in the overall quality of life, depending on the type of surgery. The greatest local complaints were reported by patients after breast conserving surgery (BCT) with axillary lymphadenectomy. A higher level of cognitive functioning but a greater severity of systemic side effects was found in women undergoing mastectomy compared to BCT-patients. Women who underwent surgery of the right breast reported increased problems in sexual functioning (p = 0.034). Multiple regression analysis showed a positive correlation of the emotional functioning variable with the assessment of future perspectives (p = 0.01) and body image (p = 0.007). Conclusions. The type of surgical technique does not affect the overall quality of life and sexual satisfaction. Problems with memory and attention do not correlate directly with the side effects, and as such require an independent diagnostics. Women undergoing treatment of the dominant-side breast should be the candidates for sexology consultation. There is a risk of disturbances in the body image and in the assessment of future perspectives in patients with emotional disorders observed within 3 months after surgery

The relationship between surgical treatment (mastectomy vs. breast conserving treatment) and body acceptance, manifesting femininity and experiencing an intimate relation with a partner in breast cancer patients

Aim. The aim of the study was to verify the following hypotheses: (1) Do women who have undergone surgical treatment for breast cancer differ from healthy women in the way they experience their body (body self)?; (2) Does the surgical technique (mastectomy vs. breast conserving treatment) differentiate the group in terms of experiencing their body after the surgery?; (3) Do demographic variables, BMI, breast size and the evaluation of the scar differentiate the group in terms of experiencing their body self after the surgery? Method. In order to gain some insight into how women experience their body after breast surgery, the Body Self Questionnaire designed in 2005 by Beata Mirucka was used. The analysis included data from 50 women who completed surveys. This data were compared to the control group. Data were analyzed using IBM SPSS Statistics package, version 24, with a one-way analysis of variance (ANOVA). Results. Statistically significant differences were obtained between the entire group of women after breast surgery (mastectomy and BCT, jointly) and the control group of healthy women in three aspects of the Body Self Questionnaire: body acceptance, manifesting femininity and experiencing an intimate relation with a partner. Conclusions. Surgical treatment of breast cancer is significantly associated with the way patients experience their body, which is expressed in three dimensions of the body self in treated women

Autotelic vs. instrumental motivation of doctors and their medical specialty choice in relation to sense of coherence

Aim. Analysis and comparison of two types of motivation (autotelic and non-autotelic) which are behind the choice of medical specialisation by doctors in relation to their sense of coherence. Method. Questionnaire method was used in the study. The study included a group of 86 graduates of the Faculty of Medicine of the Jagiellonian University, who have completed postgraduate internships at the Department of Haematology and Oncology, Department of Gynaecology of the Jagiellonian University and the L. Rydygier hospital in Krakow in 2010–2012. Statistical analyses were performed using the IBM SPSS Statistics 21. The level of significance was alpha = 0.05. Results. It has been shown that doctors are more frequently characterised by the autotelic type of motivation. It has also been proven that there is a relationship between the male sex of the surveyed doctors and their autotelic type of motivation. Moreover, it has been demonstrated that there is a correlation between the comprehensibility component of the sense of coherence and the male sex. It has been also demonstrated that there is a correlation between meaningfulness component of the sense of coherence and the choice of surgical specialisation Conclusions. Autotelic motivation prevails when choosing a medical specialty and this tendency is more noticeable in men than in women. The meaningfulness component of SoC plays a regulatory role in making career decisions related to the greater physical and mental pressure put on doctors. The observed differences in the types of motivation and the size of the components of the sense of coherence in groups of surveyed doctors – men and women – encourage further observations of these relationships on a larger population

Nowe zagrożenia dla psychoterapii w Polsce po transformacji ustrojowej lat 80. XX wieku

The purpose of the article is the presentation of reflections of authors: practitioners, psychotherapists and doctors belonging to the generation of the political transformation which started in Poland over the end of ‚ 80s and lasts until today. This article is a result of the sequence of discussions between authors about threats occurring in social environment for the organization of the Polish system of the health care at all, and especially for psychotherapy as one of the areas of the medical market. Authors are paying attention to the threats which are: the risk of reducing the quality of psychotherapy, the risk of objectifying the patient and change of the psychotherapist into the service provider. The other issue is a subject of the organization of the system of training psychotherapists and the need of re-definition of the psychotherapy in the light of the observed latest trend turning up in the West. Authors hope, that issues presented by them referring to their experience in the therapeutic and academic work will be an incentive to further discussion and putting next questions for interested readers.Celem artykułu jest przedstawienie przemyśleń autorów: praktyków, psychoterapeutów i lekarzy pokolenia transformacji ustrojowej która rozpoczęła się w Polsce w końcu lat 80. ubiegłego wieku i trwa do dziś. Artykuł ten jest wynikiem wielu dyskusji, jakie autorzy toczyli ze sobą na temat zagrożeń, jakie procesy zachodzące za ich życia zawodowego w obszarze społecznym i kulturowym niosą dla organizacji polskiego systemu opieki zdrowotnej w ogóle, a dla samej psychoterapii jako jednej z gałęzi rynku usług medycznych w szczególności. Zagrożenia, na jakie autorzy zwracają uwagę, to: ryzyko obniżenie jakości usług psychoterapeutycznych na korzyść ich rentowności ekonomicznej, ryzyko uprzedmiotowienia pacjenta i podporządkowania jego interesów interesom systemu finansowego, korporacji lub instytucji, zamiany roli terapeuty w świadczeniodawcę, a co za tym idzie, stopniowe pozbawienie go prawa do dyskusji na temat zasadności pewnych zachowań, postaw i wartości. Osobnym zagadnieniem poruszanym przez autorów jest temat organizacji etycznego i zgodnego z podmiotowym charakterem relacji terapeutycznej systemu organizacji pracy i jej wynagradzania oraz zasad szkolenia psychoterapeutów i spojrzenia na samą definicję psychoterapii w świetle obserwowanych nowych trendów pojawiających się w krajach zachodnich. Autorzy wyrażają nadzieje, że prezentowane przez nich rozważania odwołujące się do ich doświadczeń w pracy terapeutycznej i dydaktycznej będą dla ciekawych czytelników zachętą do dalszej dyskusji i stawiania kolejnych pytań

Wpływ hipercholesterolemii na morfologię blaszek miażdżycowych w tętnicach wieńcowych

Wstęp: Hipercholesterolemia jest ważnym czynnikiem wpływającym na powstawanie blaszek miażdżycowych. Ultrasonografia wewnątrznaczyniowa pozwala przyżyciowo oceniać morfologię blaszek miażdżycowych w tętnicach wieńcowych u ludzi. Celem pracy była ocena zależności morfologii blaszek miażdżycowych od występowania hipercholesterolemii u pacjentów z udokumentowaną angiograficznie chorobą wieńcową. Materiał i metody: Badaniem objęto 38 chorych (w tym 30 mężczyzn), u których wykonano podczas interwencji wieńcowej ultrasonografię wewnątrznaczyniową. Zebrano dane demograficzne oraz informacje dotyczące obecności wybranych czynników ryzyka choroby wieńcowej. Oceniono retrospektywnie morfologię blaszek miażdżycowych we wszystkich badanych segmentach tętnic na podstawie zapisów badań ultrasonograficznych. Analizę przeprowadzono w 3 grupach segmentów w zależności od stopnia zwężenia naczynia (grupa I - zwężenie < 50%, grupa II - zwężenie 50-75%, grupa III - zwężenie ł 75%). Wyniki: Hipercholesterolemia występowała u 25 pacjentów (66%). W grupie chorych z hipercholesterolemią liczba osób palących tytoń była istotnie wyższa niż w grupie bez hipercholesterolemii. W zakresie innych czynników ryzyka miażdżycy i danych demograficznych nie stwierdzono istotnych różnic. Obserwowano znamiennie częstsze występowanie zwapnień w blaszkach miażdżycowych u chorych z hipercholesterolemią - 58% (56/97), w porównaniu z 26% (16/62) u chorych bez tego czynnika ryzyka; także w poszczególnych grupach segmentów: grupa I - odpowiednio 36% i 10%, grupa II - 67% i 29%; grupa III - 67% i 41%. Typ blaszki miażdżycowej (miękka, mieszana, twarda) i jej rozkład przestrzenny (koncentryczna, ekscentryczna) nie były czynnikami różnicującymi chorych z hipercholesterolemią. Wnioski: Hipercholesterolemia jest prawdopodobnie niezależnym czynnikiem, zwiększającym częstość występowania zwapnień w blaszkach miażdżycowych. Współistnienie podwyższonego stężenia cholesterolu oraz nałogu palenia tytoniu wiąże się z przedwczesnym rozwojem miażdżycy. (Folia Cardiol. 2003; 10: 83-90