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Ageing is gradually receiving more attention in Poland. There is a need for an integrated policy on ageing, improvements in care and service provision, development of institutional care and promotion of active ageing. During the 1990s the support given to the elderly was quite generous. The policy of reducing the labour supply through the possibility of early retirement resulted in a rapid increase of pensioners. Due to the steep decrease in contributions to the social security system coupled with its increasing expenditures and the expected acceleration in the ageing of the population, it was decided to implement a reform in the pension system in 1999. The new two-pillar system that is entirely based on individual accounts concerns as such those born after 1968. The legal retirement age is 65 years for men and 60 years for women. For people in certain working conditions early retirement is possible for men at age 60 and for women at age 55. Limiting the possibility of early retirement and eliminating pre-retirement benefits have recently been discussed. It is assumed that the regulations will come into force in 2007. As a consequence there is a need to increase the chances for older workers in the labour market. There are three main areas of care and services provided to elderly people: support for elderly people still living at home, support for families taking care for the elderly and institutional care. Most of the financial responsibility for public care and services has been delegated to the local level. However, the scarcity of resources considerably affects their provision. The family members of elderly people are a very important source of care. A remarkable proportion of elderly people are living with their children's family. This is partly due to the tradition of strong family ties and partly to undeveloped institutional care. There are no explicit policies supporting the families in care, but families can make use of services provided by social assistants from local assistance centres, different organisations and municipal day care centres.
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5b. How long did you wait before seeking medical advice? Hours Days Got medical advice straight away mins.
Manju said that since she was very young at the time of hysterectomy, everyone, especially her husband, had advised her to opt for HRT. In retrospect, in spite of some recent studies which reported increased morbidity associated with long term use of HRT, Manju feels that opting for HRT treatment was the right thing to do in her case. Interpretation of findings and discussion Although the four women who were interviewed for the case study were different in many respects, certain factors emerge common to all the cases. All of them suffered from various physical and psychological problems both before and after the hysterectomy. In the first three cases, severe, prolonged and irregular bleeding had interfered with the daily functioning of those women forcing them to opt for hysterectomy. The common complaints during the post-hysterectomy period were hot flushes, irritability, mood swing and weight gain. Other problems varied from person to person. In terms of sexual life, responses varied from loss of libido to increase in sexual pleasure after the operation. It was seen that even in those cases where heavy and painful bleeding led to the hysterectomy, the women undergoing the surgery had mixed feelings about it. While they accepted the hysterectomy as necessary and expressed relief from painful symptoms after the hysterectomy, they had approached surgery with various apprehensions. Such apprehensions had its origin in a ; inadequate information given to the women by the doctor, and b ; accounts of other people regarding what to expect after the hysterectomy. It was seen that the accounts of post-hysterectomy life passed on to women who are to undergo hysterectomy by friends, relatives and acquaintances are mostly of a negative character. Such accounts make the patients apprehensive and anxious. In addition, the information given by the health care providers to the women undergoing hysterectomy was found to be inadequate. In most cases, doctors did not discuss the posthysterectomy problems or its treatment with these women and zestril. CASE STUDY 7.1 Mr RJ and his 9-year-old son Jimmy want to buy something for Jimmy's verruca. Mr RJ thinks that Jimmy has had the verruca for about 4 to 6 weeks. He describes it as a circular discoloured piece of skin that looks like the verrucas he used to get. a. What course of action are you going to take? Try and question Jimmy directly. See if Jimmy knows how long the suspected verruca has been there. Ask if the lesion is causing any pain when walking. Instead of asking for further descriptions of what the lesion looks like and where it is positioned ask if you can actually look at the lesion. Remember to wash your hands before and after inspecting the foot. On further questioning and examination you concur with the self-diagnosis of a verruca. The lesion is small less than 0.5 cm in diameter ; and causes no pain when direct pressure is applied. b. What are you going to recommend? A salicylic-acid-based product is the most suitable product and you recommend Bazuka, after first making sure Jimmy is not diabetic. Six weeks later Mrs J returns with Jimmy and demands to see the pharmacist. She says the stuff you recommended is rubbish and that Jimmy's verruca is bigger than it was before! c. How are you going to respond? First, you must stay calm and not be defensive. Ask open questions to find out why Mrs J is unhappy; this approach will generally reveal what the problem is. Second, if the reason is not obvious then you must find out about compliance. Who has been responsible for applying the product? If the parents have told Jimmy to use it, has he been using the product correctly and at the correct dosage frequency? In addition, many patients have unrealistic expectations on how quickly the verruca will resolve with therapy. Did you tell them how long it would take before an effect will be seen? This is a vital piece of information to ensure patients realise that treatment is not a quick cure. You find out that Mrs J has been applying the Bazuka and doing everything the instruction leaflet says. You inspect Jimmy's feet again and from what you can remember the lesion does look slightly larger. d. Why might this be the case? Salicylic acid is destructive in nature and if the product comes in to contact with non-affected skin then it can damage skin and appear to the patient that the lesion has indeed got bigger. Mrs J wants to try Bazuka Extra Strength because the normal Bazuka isn't helping. e. What are you going to do? You must try to stress to Mrs J that she continues with the normal Bazuka because 6 weeks of therapy is not long enough to make a decision to alter therapy. Reluctantly, Mrs J accepts your advice and leaves the pharmacy promising she will try for a bit longer. One week later she presents a prescription for Cuplex gel for Jimmy. f. What are you going to do? It appears that Mrs J was not satisfied or convinced with your advice and has decided to see the GP. You do not know whether she told the GP about using an OTC product. You could ring the GP to tell him or her that Mrs J has been using a salicylic-acid-based product already, however, this is likely to have little bearing on the outcome of product selection as Jimmy will still need to continue treatment with something for a few more weeks. The prescription should be dispensed and Mrs J counselled appropriately. It would be unprofessional to point out to that Cuplex is unlikely to be any better than Bazuka. When you hand Mrs J the Cuplex she mentions that the doctor said this was stronger than Bazuka and should do the trick. 1. Staff members want to be informed of everything being published currently which is in any way related to the work they are doing. They are particularly interested in journals which are outside their main field of interest. A bacteriologist would be apt to read the Journal of Bacteriology, but might not see an article on the use of a new vaccine preparation in the New England Journal of Medicine. 2. They want to be informed about this material the moment it is published. Every day of delay in hearing about work done in another laboratory may mean lost time in their own laboratories. 3. They want to be given enough information about the published material to know whether it is worth their time to check the original. 4. They want the facts to be accurate and to give a proper picture of the author's point of view.