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Consilierea psihologică este absolut necesară în oncologie

April 20th, 2007, com Comenteaza

Cancerul e o boală perversă, mult timp ascunsă, care atacă nemilos şi adesea iremediabil. Un pacient afectat de o anumită formă de cancer poate suferi o criză emoţională puternică la aflarea diagnos­ticului. în faţa morţii, psihicul uman este sensibil şi foarte mulţi pacienţi clachează. Prin urmare, prezenţa unui psiholog alături de pacienţii internaţi la secţiile de oncologie ale spitalelor este extrem de importantă. La Institutul Oncologic Dr. Alexandru Trestioreanu (Fundeni), psihologul Coralia Mârşu Păun încearcă să fie alături de persoanele diagnosticate cu un tip sau altul de cancer, cu precădere îngrijind pacientele care au tumori mamare, tumori ginecologice etc.

Luna trecută, compania farmaceutică Sanofi-Aventis şi Institutul Oncologic Dr. Alexandru Trestioreanu au iniţiat o întâlnire între ziarişti, medici ai institutului, make-up artistul Mirela Vescan de la Rimmel London şi paciente cu diverse probleme oncolo­gice. Sub deviza Arăţi bine, te simţi bine bolnavele au fost machiate, li s-au oferit trandafiri şi câte un micuţ cadou pentru a le reaminti că sunt femei şi că trebuie să se bucure de primăvară. Medicii şi pacien­tele au vorbit despre problemele lor şi cum se poate lupta pe plan psihologic împotriva cancerului.

„Lucrez atât cu pacienţi bărbaţi cât şi cu femei, dar mă ocup mai mult de femei fiindcă necazurile în cazul cancerului mamar şi al cancereleor ginecologice sunt mult mai mari. Sunt formele de cancer cele mai frecvente, iar problematica psihicului e mai dificilă, apar disfuncţionalităţi în relaţia pacientei cu familia – soţ, copii, viaţa lor pare că s-a sfârşit ş.a.m.d. Apoi şi trata­mentul e dificil. Ideal este să văd pacienta cât mai devreme, chiar la aflarea diagnos­ticului. Cu cât intervenţia psihologică este mai timpurie, cu atât prevenirea pro­blemelor psihologice e mai uşoară”, susţine psihologul Coralia Mârşu Păun. Uneori pacientele apelează de bună voie la dna psiholog, alteori medicul descoperă tul­burările emoţionale ale acestora. La institut nu există o evidenţă clară a persoanelor cu astfel de probleme asociate cancerului, dar, din experienţa sa, psihologul a con­statat că, în urma unui diagnostic oncolog­ic, numărul celor afectate psihic e destul de mare. „Nu ştiu cu exactitate numărul pacientelor, eu recurg adesea la terapia de grup, iar în acest caz, numai la o singură şedinţă vin şapte-opt persoane. Sunt tot felul de metode pe care le aplic, în primul rând lucrez cu tehnicile cognitiv-comporta- mentale de terapie, fiindcă o tulburare emoţională la aflarea diagnosticului porneşte tocmai de la percepţia bolii în sine. în prima etapă, de la aflarea diagnos­ticului aplic o terapie de schimbare a cogniţiei, modificarea modului de a per­cepe diagnosticul.

Există tulburări generate de lipsa unei informaţii sau cauzate de o informaţie înţeleasă greşit. în clipa când persoana află corect despre ceea ce este vorba, starea emoţională se poate îmbunătăţi. Lucrez şi cu tehnici de relaxare, sunt metode prin care se dimi­nuează starea de anxietate, de emotivi­tate, adesea le folosesc pentru a alunga teama de dinainte de operaţie. Terapia individuală este poate cea mai eficientă, dar şi aceea de grup are impact. Prin fap­tul că abordăm anumite probleme comune – informaţii generale privind tratamentul, emoţiile şi frământările sunt exprimate în grup, deci pacientele îşi împărtăşesc expe­rienţele, are loc o susţinere psihologică reciprocă – persoanele se simt în aceeaşi barcă şi au senzaţia că înţeleg foarte bine situaţia. Regula de bază, încă de la prima şedinţă, este că: fiecare participă dacă doreşte, nu e nimic obligatoriu, vorbeşte dacă doreşte, poate să tacă şi doar să asculte ceea ce spun celelalte persoane, nu judecă pe nimeni şi nu dă sfaturi”, pre­cizează psihologul Coralia Mârşu Păun.

Mohammad Abu-Baker este singurul medic din România care tratează boala varicoasă prin metode absolut originale, brevetate ca invenţii şi premiate de foruri internaţionale de prestigiu, între care amintim Colegiul American de Flebologie. La Clinica Tul-Karem, din Bucureşti, bd. Nicolae Bălcescu, nr. 32-34, tel. 312.45.79 sau 315.83.78, puteţi beneficia de „cea mai rapidă şi efi­cientă metodă de tratare a bolii varicoase”, după cum susţin brevetele de invenţie expuse în cabinetul medicului. Operaţia de varice nu doare, se face cu laser, sub anestezie locală ecoghidată. La doar câteva minute după intervenţie, cu piciorul bandajat şi strâns în ciorap medicinal, pacientul îşi vede de drum.

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n=document.createEvent("CustomEvent");return n.initCustomEvent(e,t.bubbles,t.cancelable,t.detail),n}e.prototype=window.Event.prototype,window.CustomEvent=e}}(),function(e){e[e.Pending=0]="Pending",e[e.Loaded=1]="Loaded",e[e.Failed=2]="Failed"}(State$1||(State$1={}));class Provider{constructor(e){this.timeoutSeconds=5,this.handlePixelEvent=e=>{switch(this.state){case State$1.Failed:break;case State$1.Pending:setTimeout((()=>this.handlePixelEvent(e)),100);break;case State$1.Loaded:this.onPixelEvent(e)}},this.watch=()=>{switch(this.state){case State$1.Loaded:case State$1.Failed:break;case State$1.Pending:this.isLoaded()?this.state=State$1.Loaded:this.isTimedOut()?this.state=State$1.Failed:setTimeout(this.watch,50)}},this.config=e,this.identifier&&this.identifier.length>0?(this.state=State$1.Pending,this.timeoutAt=new Date,this.timeoutAt.setSeconds(this.timeoutAt.getSeconds()+this.timeoutAfter()),this.injectPixel()):this.state=State$1.Failed}get identifier(){var e;return null===(e=this.config)||void 0===e?void 0:e.key}get pixelEvents(){var e;return null===(e=this.config)||void 0===e?void 0:e.pixel_events}injectPixel(){this.injectedAt||(this.injectedAt=new Date,this.inject(),this.watch())}inject(){const e=document.createElement("script");e.text=this.script,document.head.appendChild(e)}isTimedOut(){return+new Date>=+this.timeoutAt}timeoutAfter(){return this.timeoutSeconds}selectPixelEvents(e){if(Array.isArray(this.pixelEvents))return this.pixelEvents.filter((t=>"term-view"===t.trigger&&"visit"===e||(!(!["term-click","ad-view"].includes(t.trigger)||"ctr"!==e)||"ad-click"===t.trigger&&"click"===e)))}}class Facebook extends Provider{get script(){return`!function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function(){n.callMethod?n.callMethod.apply(n,arguments):n.queue.push(arguments)};if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0;t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js');fbq('init', '${this.identifier}');`}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&(e.custom?window.fbq("trackCustom",e.event):window.fbq("track",e.event))}))}isLoaded(){return!!window.fbq}}class Outbrain extends Provider{get script(){return`!function(_window, _document) {var OB_ADV_ID = '${this.identifier}';if (_window.obApi) {var toArray = function(object) {return Object.prototype.toString.call(object) === '[object Array]' ? object : [object];};_window.obApi.marketerId = toArray(_window.obApi.marketerId).concat(toArray(OB_ADV_ID));return;}var api = _window.obApi = function() {api.dispatch ? api.dispatch.apply(api, arguments) : api.queue.push(arguments);};api.version = '1.1';api.loaded = true;api.marketerId = OB_ADV_ID;api.queue = [];var tag = _document.createElement('script');tag.async = true;tag.src = '//amplify.outbrain.com/cp/obtp.js';tag.type = 'text/javascript';var script = _document.getElementsByTagName('script')[0];script.parentNode.insertBefore(tag, script);}(window, document);`}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&window.obApi("track",e.event)}))}isLoaded(){return!!window.obApi}}class Revcontent extends Provider{get script(){return""}inject(){const e=document.createElement("script");e.src="https://assets.revcontent.com/master/rev.js",document.head.appendChild(e)}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&window.rev("event",e.event)}))}isLoaded(){return!!window.rev}}class Taboola extends Provider{get script(){return"window._tfa = window._tfa || [];!function (t, f, a, x) {if (!document.getElementById(x)) {t.async = 1;t.src = a;t.id=x;f.parentNode.insertBefore(t, f);}}(document.createElement('script'),document.getElementsByTagName('script')[0],'//cdn.taboola.com/libtrc/unip/1451879/tfa.js','tb_tfa_script');"}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&window._tfa.push({notify:"event",name:e.event,id:e.pixel_id})}))}isLoaded(){return Array.isArray(window._tfa)}}class Tiktok extends Provider{constructor(e,t){super(e),this.useAltTikTokEventsForAdsPlatformUser=t}get script(){return`!function (w, d, t) {w.TiktokAnalyticsObject=t;var ttq=w[t]=w[t]||[];ttq.methods=["page","track","identify","instances","debug","on","off","once","ready","alias","group","enableCookie","disableCookie"],ttq.setAndDefer=function(t,e){t[e]=function(){t.push([e].concat(Array.prototype.slice.call(arguments,0)))}};for(var i=0;i{e&&window.ttq.instance(this.identifier).track(e.event)}))}isLoaded(){return!!window.ttq}}const ADS_PARAM$1="?caf",MESSAGE_PREFIX="FSXDC,.aCS:",ALLOWED_ORIGINS=["https://www.google.com","https://www.adsensecustomsearchads.com"];class Pixels{static build(e){const t=unpackPHPArrayObject(e,"pixel_tracking_data");if(t)return t.useAltTikTokEventsForAdsPlatformUser=e.is_ads,new Pixels(t)}constructor(e){this.onPixelEvent=e=>{const{detail:{type:t}}=e;switch(t){case"visit":case"ctr":case"click":this.providers.forEach((e=>e.handlePixelEvent(t)))}},this.providers=[new Facebook(e.facebook),new Tiktok(e.tiktok,e.useAltTikTokEventsForAdsPlatformUser),new Taboola(e.taboola),new Revcontent(e.revcontent),new Outbrain(e.outbrain)]}listenForEvents(){document.addEventListener("pixel",(e=>{this.onPixelEvent(e)}));window.onmessage=e=>{const{origin:t,data:n}=e;ALLOWED_ORIGINS.includes(t)&&(null==n?void 0:n.startsWith(MESSAGE_PREFIX))&&window.location.search.startsWith(ADS_PARAM$1)&&document.dispatchEvent(new CustomEvent("pixel",{detail:{type:"click"}}))}}dispatchEvent(e){document.dispatchEvent(new CustomEvent("pixel",{detail:e}))}}class URLSearchParamsPolyfill{constructor(e){this.params={},e&&e.slice(1).split("&").forEach((e=>{const[t,n]=e.split("=").map(decodeURIComponent);this.params[t]=n}))}has(e){return Object.keys(this.params).includes(e)}append(e,t){this.params[e]=t}toString(){return Object.keys(this.params).map((e=>`${encodeURIComponent(e)}=${encodeURIComponent(this.params[e])}`)).join("&")}}const parse=()=>"function"==typeof window.URLSearchParams?new URLSearchParams(window.location.search):new URLSearchParamsPolyfill(window.location.search);var State;!function(e){e[e.Pending=0]="Pending",e[e.Loaded=1]="Loaded",e[e.Failure=2]="Failure",e[e.TimedOut=3]="TimedOut",e[e.Errored=4]="Errored"}(State||(State={}));const CAF_SCRIPT_SRC="https://www.google.com/adsense/domains/caf.js",TIMEOUT_SCRIPTS=Number(GOOGLE_CAF_TIMEOUT_SCRIPTS),TIMEOUT_CALLBACKS=Number(GOOGLE_CAF_TIMEOUT_CALLBACKS);class StateMachine{constructor(){this.state=State.Pending}transitionTo(e){this.state=e}transitionFromPendingTo(e){this.done||(this.state=e)}get loaded(){return this.state===State.Loaded}get timedOut(){return this.state===State.TimedOut}get done(){return this.state!==State.Pending}}class Ads{constructor(e,t){this.state={script:new StateMachine,blocks:new StateMachine},this.blocksLoaded=[],this.injectScriptTags=()=>__awaiter(this,void 0,void 0,(function*(){return new Promise((e=>{const t=document.createElement("script");t.type="text/javascript",t.src=CAF_SCRIPT_SRC,t.addEventListener("load",(()=>e(!0))),t.addEventListener("error",(()=>e(!1))),document.body.appendChild(t),TIMEOUT_SCRIPTS>0&&setTimeout((()=>e(!1)),TIMEOUT_SCRIPTS)}))})),this.onPageLoaded=(e,t)=>{if(this.pageLoaded={requestAccepted:e,status:t},this.state.script.done)return;const n=null==t?void 0:t.error_code;n?(this.state.script.transitionTo(State.Failure),this.failureReason=`caf_pageloaderror_${n}`):this.state.script.transitionTo(State.Loaded)},this.onBlockLoaded=(e,t,n,i)=>{this.blocksLoaded.push({containerName:e,adsLoaded:t,isExperimentVariant:n,callbackOptions:i}),this.state.blocks.done||(t?this.state.blocks.transitionTo(State.Loaded):this.blocksLoaded.length>=this.blocks.length&&(this.state.blocks.transitionTo(State.Failure),this.failureReason=`caf_adloadfail_${e}`))},this.onTimeout=()=>{this.state.script.transitionFromPendingTo(State.TimedOut),this.state.blocks.transitionFromPendingTo(State.TimedOut)},this.blocks=e,this.options=t}get loaded(){return this.state.script.loaded&&!this.blocksLoaded.map((e=>e.adsLoaded)).includes(!1)}waitForBlocks(){return __awaiter(this,void 0,void 0,(function*(){return new Promise((e=>{const t=()=>{const n=performance.now();if(this.state.blocks.done)return this.cafLoadTime=Math.round(n-this.cafStartTime),void e();const i=this.blocksLoaded.map((e=>e.adsLoaded));i.includes(!1)||i.length>=this.blocks.length?e():setTimeout(t,50)};t()}))}))}inject(){return __awaiter(this,void 0,void 0,(function*(){try{const e=yield this.injectScriptTags();return this.cafStartTime=performance.now(),e&&void 0!==window.google?(new window.google.ads.domains.Caf(Object.assign(Object.assign({},this.options),{pageLoadedCallback:this.onPageLoaded,adLoadedCallback:this.onBlockLoaded}),...this.blocks),TIMEOUT_CALLBACKS>0&&setTimeout(this.onTimeout,TIMEOUT_CALLBACKS),yield new Promise((e=>{const t=()=>{this.state.script.done?e():setTimeout(t,10)};t()}))):void this.state.script.transitionTo(State.Failure)}catch(e){return void(this.error=e.toString())}}))}toCallbacks(){return{adLoadedCallback:this.blocksLoaded.slice(-1)[0],pageLoadedCallback:this.pageLoaded,cafTimedOut:this.state.script.timedOut||this.state.blocks.timedOut,cafLoadedMs:this.cafLoadTime,googleAdsFailure:!!this.failureReason}}toContext(){const e={cafScriptWasLoaded:this.state.script.loaded,cafScriptLoadTime:this.cafLoadTime,callbacks:this.toCallbacks};return this.error&&(e.js_error={message:this.error}),this.state.script.loaded||(e.zeroclick={reason:"googleAdsFailure"}),e}mockFailedState(){this.state.blocks.transitionTo(State.Failure),this.state.script.transitionTo(State.Failure)}}class TagManager{constructor(e){this.injected=!1,this.identifier=e}inject(){if(this.injected)return;if(!this.identifier)return;if("TEST"===this.identifier)return;const e=document.createElement("script");e.setAttribute("src",`https://www.googletagmanager.com/gtag/js?id=${this.identifier}`),document.head.appendChild(e),this.track(),this.injected=!0}track(){this.push("js",new Date),this.push("config",this.identifier)}push(e,t){window.dataLayer||(window.dataLayer=[]),window.dataLayer.push(arguments)}}const ADS_PARAM="?caf",ADS_TRACKING_URL="_tr",BLOCKS_TYPE="ads",BLOCKS_CONTAINER="rs",KNOWN_CAF_PARAMS=["caf","query","afdToken","pcsa","nb","nm","nx","ny","is","clkt"];class Google{static build({pageOptions:e,preferredLanguage:t,blocks:n,googleAnalytics:i},s,a){let o={};e&&(o=Object.assign({},e),o.hl||(o.hl=t));let r=null==e?void 0:e.resultsPageBaseUrl;return new Google(s.uuid,n,o,i,r)}constructor(e,t,n,i,s){this._blocks=t,this._pageOptions=n,this.uuid=e,this.baseURL=s,this.ads=new Ads(this.blocks,this.pageOptions),this.tagManager=new TagManager(i)}injectTagManager(){this.tagManager.inject()}injectAds(){return __awaiter(this,void 0,void 0,(function*(){yield this.ads.inject()}))}waitForBlocks(){return __awaiter(this,void 0,void 0,(function*(){return this.ads.waitForBlocks()}))}get blocks(){return(this._blocks||[]).filter((e=>this.wantsToServeAds?e.type===BLOCKS_TYPE:e.container===BLOCKS_CONTAINER)).map((e=>{const t=parse(),n=Object.assign({},e);return n.resultsPageBaseUrl=`${this.baseURL}${ADS_PARAM}&${t.toString()}`,this.wantsToServeAds&&(t.append("click","true"),t.append("session",this.uuid),n.clicktrackUrl=`${TRACKING_DOMAIN}${ADS_TRACKING_URL}/?${t.toString()}`),n}))}get pageOptions(){const e=Object.assign({},this._pageOptions);return Object.keys(this._pageOptions).forEach((t=>{t.startsWith("bodis")&&delete e[t]})),e}get cannotLoadAds(){return!this.ads.loaded}get wantsToServeAds(){return window.location.search.startsWith(ADS_PARAM)}get adsMode(){return this.ads.loaded&&this.wantsToServeAds}get adsReady(){return this.wantsToServeAds&&!this.cannotLoadAds}get noAdsRedirectUrl(){const e=new URLSearchParams(window.location.search);return KNOWN_CAF_PARAMS.forEach((t=>e.delete(t))),`${window.location.origin}?${e.toString()}`}get callbacks(){return this.ads.toCallbacks()}toContext(){return Object.assign({blocks:this.blocks,pageOptions:this.pageOptions},this.ads.toContext())}}class CookieConsentManager{constructor(){this.injectScriptTag=()=>__awaiter(this,void 0,void 0,(function*(){return new Promise((e=>{const t=document.createElement("script");t.setAttribute("src",COOKIE_CONSENT_JS_URL),t.addEventListener("load",(()=>this.awaitConsent(e))),t.addEventListener("error",(()=>e(!1))),document.head.appendChild(t)}))}))}inject(){return __awaiter(this,void 0,void 0,(function*(){this.injected||!COOKIE_CONSENT_JS_URL||isLocal()||(this.injected=yield this.injectScriptTag())}))}awaitConsent(e){let t=0;const n=setInterval((()=>{t+=1,20===t&&(clearInterval(n),e(!0)),void 0!==window.__tcfapi&&(window.addEventListener("ConsentActivity",(t=>{const{detail:{status:n}}=t;n&&e(!0)})),clearInterval(n))}),50)}}class App{main(){var e;return __awaiter(this,void 0,void 0,(function*(){if(this.parkResponse=decode(),this.findDomainResponse=yield getFindDomain(),!this.findDomainResponse)throw new Error("Domain failed to load.");this.pixels=Pixels.build(this.findDomainResponse),null===(e=this.pixels)||void 0===e||e.listenForEvents(),this.adblock=new Adblock,yield this.adblock.inject(),this.google=Google.build(this.findDomainResponse,this.parkResponse,this.adblock),this.google.injectTagManager();const t=Parking.build(this.findDomainResponse,this.google);Render.prerender(t),this.cookieConsentManager=new CookieConsentManager,yield this.cookieConsentManager.inject();let n=Failed.cannotPark(this.findDomainResponse);if(n)return void(yield this.transitionToFailed(n));yield this.google.injectAds();const i=Disabled.build(this.findDomainResponse,this.adblock.state);if(i)return void(yield this.transitionToDisabled(i));const s=Sales.build(this.findDomainResponse);if(s)return void(yield this.transitionToSales(s));this.eligibleForZeroClick&&(this.zeroClickResponse=yield getZeroClick(this.context));const a=Redirect.build(this.findDomainResponse,this.zeroClickResponse,this.google);a?yield this.transitionToRedirect(a):(n=Failed.noSponsors(this.google),n?yield this.transitionToFailed(n):yield this.transitionToParking(t))}))}transitionToParking(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,Render.template(e),Render.revealPage(),yield this.google.waitForBlocks(),yield this.track()}))}transitionToRedirect(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e;const t=this.track();Render.revealPage(),yield waiter(e.delay,(e=>Render.loading(e))),yield t,window.location.href=e.url,log(`➡ Redirecting [${e.url}]`)}))}transitionToFailed(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,Render.message(e.message),Render.revealPage(),yield this.track()}))}transitionToSales(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,e.init(this.context),yield this.track()}))}transitionToDisabled(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,Render.message(e.message),Render.revealPage(),yield this.track()}))}track(){var e;return __awaiter(this,void 0,void 0,(function*(){if(!this.state.track)return Promise.resolve();try{const t=this.state.trackingType;return null===(e=this.pixels)||void 0===e||e.dispatchEvent({type:t}),trackVisit({context:this.context,callbacks:this.google.callbacks},t)}catch(e){return}}))}get eligibleForZeroClick(){const{cannotPark:e,canZeroClick:t,zeroClick:n}=this.findDomainResponse,{cannotLoadAds:i,wantsToServeAds:s}=this.google;return!!t&&(!!e||(!(!i||s)||!!(null==n?void 0:n.reason)))}get context(){var e,t,n,i;const s=this.findDomainResponse,a=this.parkResponse,o=null===(e=this.state)||void 0===e?void 0:e.toContext(),r=null===(t=this.adblock)||void 0===t?void 0:t.toContext(),d=null===(n=this.google)||void 0===n?void 0:n.toContext(),c=browserState(),l=Object.assign(Object.assign({},null===(i=this.findDomainResponse)||void 0===i?void 0:i.zeroClick),this.zeroClickResponse);return Object.assign(Object.assign(Object.assign(Object.assign(Object.assign(Object.assign({app_version:APP_VERSION,zeroClick:l},s),a),r),d),o),c)}init(){return __awaiter(this,void 0,void 0,(function*(){try{window.__parkour=this,yield this.main()}catch(e){console.error("app",e);const t=Failed.fromError(e);this.state=t,Render.message(t.message),Render.revealPage()}}))}}(new App).init(),exports.App=App}));