Male and Female Physicians in Hospital Gynaecology Departments - Analysis of the Impact of "Feminisation" from the Viewpoint of Medical Directors.

Introduction: At present the topic "feminisation" in medicine, in other words the increasing number of female staff members is under heavy discussion; however, there are only few data upon the basis of which a scientific discussion can be held. The question arises as to the possibility of problems arising therefrom for the specialty gynaecology and obstetrics. Methods: With the help of a questionnaire the directors of departments of gynaecology and obstetrics were questioned about the various aspects of the topic feminisation in gynaecology and obstetrics. Results: Among current applications the proportion of female applicants is estimated to be 84.2 %. Reasons given most frequently for the feminisation in the specialty include low income, loss of face of the medical profession and the poor career chances. Among the spontaneously mentioned reasons were the increasingly female dominated image of gynaecology and the working conditions in hospitals. Whereas the taking on of surgical duties and of directing functions was less markedly desired by women than by men, the questioned directors found that male and female staff members were equally motivated to take on duties outside of their working hours or to engage in research work. Discussion: Feminisation in medicine represents a challenge. It seems to be important to evaluate and investigate the motivation of staff members with regard to their wishes in professional life and thus to be able to offer an appropriate working environment based on the survey results.

[Oncologic mistletoe therapy: physicians' use and estimation of efficiency]. / Onkologische Misteltherapie--zur Anwendung und Bewertung der Wirksamkeit durch Arzte.

BACKGROUND AND OBJECTIVES: In the field of unorthodox therapies in oncology, mistletoe extracts represent the most important method in Germany. In spite of its use for decades, there is no sufficient evidence for its efficiency. Since physicians have been identified to be the main providers of unconventional cancer therapies, the question of what experiences they have made using mistletoe extracts and other methods. PERSONS AND METHODS: In a cross-sectional study, 202 physicians in their private practices answered a structured, pretested questionnaire on unconventional cancer therapies, including their attitudes towards them and their judgement on efficiency. Response rate 80.2%. RESULTS: 79.2% of the physicians reported to provide unconventional cancer therapies, especially older and more experienced doctors. Among these, the rate of physician with a special preference of mistletoe extracts was 44.4%. The average probability to achieve complete or partial remissions with mistletoe extracts, eventually in combination with other unconventional methods was estimated to be 6% and 15%, thus receiving slightly lower estimates than other methods. With respect to changes in quality of life, use of mistletoe extracts was judged to be inferior to other methods (pT-Test = 0.063; pT-Test = 0.059). Furthermore, mistletoe extracts were significantly less frequently used because the physician was convinced of its efficiency (p = 0.025). CONCLUSION: Clinical studies to prove possible benefits of mistletoe extracts are mandatory. It remains unclear why this method has become so popular in spite of providers moderate judgments on efficiency.

The attitudes of physicians and oncologists towards unconventional cancer therapies (UCT).

Physicians represent the main providers of unconventional cancer therapies (UCT) in Germany. However, little is known about providers' characteristics, as well as their attitudes towards UCT. 833 questionnaires on this topic answered by general practitioners and hospital physicians were analysed. Providers differed significantly from non-providers with respect to gender (male>female, i.e. more male providers), age (older>younger), amount of subjective knowledge about UCT, place of work (office>hospital>university clinic), greater wish for coverage of UCT costs, the belief in future positive trends concerning UCT, the recognition of patients' demand for UCT, the number of patients seen per month and medical specialty (GPs>oncologists and radiation oncologists). UCT were not considered to be highly effective, but estimations varied considerably. Further investigations in this area, better education about UCT, training in coping strategies with the fate of cancer patients, and reasonable complementary treatments appear to be of the utmost importance.

Wishes and expectations of pregnant women and their partners concerning delivery.

AIMS: The study investigated factors related to the expectations and wishes concerning delivery of expectant parents. METHODS: A self-administered questionnaire on the relevant aspects of delivery was developed, pre-tested, and administered to 545 expectant mothers (n = 336) and fathers (n = 209) attending open house informational events at 3 hospitals around Giessen, Germany. RESULTS: Response rate was 96.3%. Three major areas of interest were identified and converted into scales: "management and obstetrical equipment" (ME; alpha = 0.81), "medical standards" (MS; alpha = 0.82), and "hospital conveniences" (HC; alpha = 0.78). Preferences of participants were influenced by age, gender and parity, as well as by different levels of state- and trait-anxiety. Expectant fathers focused more on HC of the hospital whereas ME, as well as MS, were more important to pregnant women, especially older women from rural areas with high state and/or trait anxiety (p < or = 0.05). However, MS were also found to be important for younger, nulliparous women with at risk pregnancy. Parents of high-risk pregnancies did not emphasize their wishes for ME (p < or = 0.05). CONCLUSION: Fashionable obstetrical equipment of delivery rooms, high medical standards, the reputation of the hospital, and certain conveniences are important issues for expectant parents. However, their importance varies with the above mentioned factors.

Self-concept, body image, and use of unconventional therapies in patients with gynaecological malignancies in the state of complete remission and recurrence.

OBJECTIVE: Are there differences in self-concept and body image in patients with cancer recurrence in comparison to patients with complete remission? What impact has cancer recurrence on use, users and non-users of unconventional cancer therapies? PATIENTS AND METHODS: One hundred and nine patients with no evidence of disease after gynaecological cancer and sixty-one patients with recurrent disease were analysed for self-concept with the Frankfurter Selbstkonzeptskalen and body image with the Frankfurter Körperkonzeptskalen. Use and motivation for unconventional therapies was assessed with a questionnaire. RESULTS: With respect to frequency of use and expected benefits of unconventional therapies no differences were observed between the groups. However, cancer recurrence was found to induce considerable changes of self-concept and body image, some indicating even positive changes due to cancer recurrence. CONCLUSION: It may be beneficial to consider body therapy and psychotherapy as a mean to improve body image and self-esteem in cases with cancer recurrence.

Epicutaneous breast forms. A new system promises to improve body image after mastectomy.

Mastectomies will remain a treatment alternative for breast cancer in spite of efforts to perform more breast-conserving treatment. Restoration of body symmetry may then be an important issue, which can be achieved by surgical breast reconstruction or with an epicutaneous breast prosthesis. A new improved system has recently been developed, which is self-adhesive to the thorax wall. In this study we investigated the advantages and disadvantages of the new system. The body image of 55 patients after unilateral mastectomy was assessed before they entered the study and after approximately 6 months of experience with the system. The "Frankfurter Körperkonzeptskalen" plus additional questions concerning problems after mastectomy and the handling of the new breast form were used for the assessment. About 50% of the patients had problems with the adhesiveness of the breast form, which remains a problem to be solved. Patients who suffered badly from mastectomy, have a smooth and plane mastectomy scar, and who were not suffering from hot flushes, which can impair the adhesiveness of the prosthesis, were more likely to profit from the new self-supporting breast forms. Significant differences were observed in the scales "self-acceptance of the body", acceptance of the body by others" for the subsets of patients mentioned above. The differences were less pronounced in patients who were already familiar with another type of epicutaneous breast form, which is attached to an adhesive plate on the thorax wall by nylon touch and close fasteners. Most (90.7%) of the patients would recommend this new type of breast prosthesis for other patients with mastectomy. The concept of self-supporting breast forms is an improvement with respect to social and psychological rehabilitation. According to the manufacturer, the problem with adhesion has meanwhile been solved.