Ihavealwaystaken mayhavebrokenabone.Inaturallyassumedshe InterviewbySaraFaithfull
publication of studies on the efficacy of
would see a doctor, but she told me that she could not
Viagra after surgery and radiotherapy for
afford health insurance and farms could not afford
prostate cancer, and even after colorectal
workers’ insurance, so her injuries were self-treated. I
An active member of the Interna-
learned from her that most of her friends and family
tional Society for Sexual Medicine
were not covered by health care and that only
(ISSM), Luca Incrocci has worked closely
physician for their sexual problems.
children, the over 65s or those who had been in the
with psychologists, sexual therapists and SF: What are the barriers in clinical
military were covered outside of personal or work
nurses to develop interventions for men
insurance. She was largely unaware of the debate on
suffering sexual problems following radio-
health reforms. Until then, I had not realised the scale
therapy. In this interview he talked to
of the problems faced by low-income workers, and this
EONS Past-President Sara Faithfull about LI: The main problem is the training of
shocked me. Back at the conference I asked nurses
his involvement in sexual health medicine
about their experiences, and they told me about their
and the experience and research he
talking to patients about sexual problems.
inability to give some people cancer medications or
brought to the field of oncology.
Furthermore, the limited time available in
pain relief for palliation, and described the inequalities
SF: Do you think that sexual
clinical practice is a real problem. Sexual
between social groups, especially in the current
dysfunction in men with prostate cancer is
not well represented in clinical practice?
10 minutes before the next patient enters
The cowgirl’s plight was clearly not an isolated case. LI: Urologists often do not have enough
In the USA, despite being one of the world’s wealthiest
time to properly address the problem, and
with “cutting edge” treatments for some patients, and
countries, 15% of the population do not have health
LI: Not yet. Fortunately today’s training
prescribing a pill, and this is not the best
on the other, large inequalities, rising costs and
care cover – ranking 37th in the world. As health costs
inadequate quality. From 1999 to 2008, average health
increase, the American system costs more per head
taught to communicate more with patients.
insurance premiums and individual contributions for
than anywhere in the world and is increasing faster
ejaculation, libido, intimacy and partner
family coverage have increased by approximately 120%.
than inflation. This may be due to over treatment, high
operating theatres as more important. SF: What is the commonest problem
Health care spending, both public and private, is
cost of therapies and a litigation culture. In Europe we
SF: How did you first develop an interest SF: Most prominent sexologists and
expected to exceed the US defence budget, and is one of
are also facing rising costs in health care, including
researchers working in this area are based
LI: Questions about erectile
the highest per capita in the world. The debate over the
the cost of providing expensive cancer drugs. This
LI: I am not a urologist but an oncologist
in the Netherlands. Is this a reflection of a
Health Reform Bil has been particularly vigorous and,
has forced some countries to review the cost-
on December 24th, it was passed on a 60-39 party line
effectiveness of new medications. However, we
LI: It is true that Dutch people are SF: How do you see the oncology
vote by the US Senate. The $871 bil ion bil is expected
provide health care in a variety of ways through
listening as well as talking to my patients
to be merged with similar legislation passed by the
social systems as well as through insurance.
about their issues; I am therefore used to
LI: Nurses are very important in such a
House of Representative to reach the President’s desk by
Discussion of health care reform is in many political
oncology world, for example radiotherapists
team. In the Netherlands, there has been a
mid-February. Its sweeping provisions are likely to be the
about sexual dysfunction related to cancer
switch from specialist to advanced practice
largest extension to health care since Medicare
inequalities? Most probably not. However, perhaps
diagnosis and treatment. I started in 1992
SF: What do you think has been the
nurses in the fol ow-up of cancer patients
legislation in 1965 which provided coverage for the over
we assume too much about the benefits of our own
doing research on sexual dysfunction after
and also for the preparation of treatments.
65s. This bil wil provide health insurance for about 36
systems and need to reflect on those who face
of the 46 mil ion currently uninsured Americans.
inequalities. Oncology nurses in the US face difficult
LI: The introduction of oral medications
patient (and their partner) and patients often
I saw first-hand the reality of not having health care
times ahead and it made me realise that nurses in
to treat erectile dysfunction has certainly
find it easier to talk about their sexual
when, on a day off from the conference, I visited a
Europe will also be facing reform in the future.
cowboy ranch to ride American style. I noticed my
As economic pressures, increased ageing and
sexual functioning. In those years this was
guide having difficulty getting on her horse and in
workforce shortages grow, this will increasingly
patient in a few minutes. But for nurses, the
obvious pain. Being a nurse never stops and, as I
influence health service provisions and we
SF: Do you think most clinicians have an
quizzed her, she told me that she fell from a horse and
should be prepared for changes ahead.
COG-ACNS0334: A Phase III Randomized Trial for the Treatment of Newly Diagnosed Supratentorial PNET and High Risk Medulloblastoma in Children < 36 Months Old with Intensive Induction Chemotherapy with Methotrexate Followed by Consolidation with Stem Cell Rescue vs. the Same Therapy Without Methotrexate FAST FACTS Eligibility Reviewed and Verified By ______________________
Aripiprazole-Induced Enuresis in a Child with Autistic Disorder Otizm Tan›l› Bir Çocukta Aripiprazole Ba¤l› Enürezis Hasan BOZKURT, Osman ABALI ‹stanbul Üniversitesi ‹stanbul T›p Fakültesi, Çocuk Ruh Sa¤l›¤› ve Hastal›klar› Anabilim Dal›, ‹stanbul, Türkiye ABSTRACT ÖZET Aripiprazole is being increasingly reported to be effective in treating behavior