Fatigue and the psychological characteristics of medical students.

OBJECTIVES: The present study examined the relationship between medical student fatigue with psychological variables: emotional intelligence (EI), sense of coherence (SoC) (comprehensibility, manageability, and meaningfulness), quality of life (QoL), stress, and satisfaction with studying medicine. MATERIAL AND METHODS: The sample consisted of 566 medical students from the Medical University of Gdansk, Poland. The instruments used were the Chalder Fatigue Scale, Schutte Self Report Emotional Intelligence Test, Sense of Coherence Questionnaire, and a questionnaire designed by the authors, comprised questions relating to the quality of life, stress levels, and satisfaction with studying medicine. RESULTS: The results show that fatigue was negatively related to the ability to use emotions effectively in the management of one's activities (EI), 1 aspect of SoC - a level of comprehensibility, QoL, and satisfaction with studying medicine. Fatigue is positively related to the ability to recognize, understand, and control emotions (EI) and stress connected with studying medicine. CONCLUSIONS: The outcomes of the study afford a better understanding of the relation- ship between selected variables in the field of individual differences in the context of fatigue in the medical student population. It may help medical educators and authorities to have a better understanding of the phenomenon of building resilience and increasing abilities to cope with the negative effects of chronic stress such as fatigue in the population of medical students. Early recognition of specific psychological features in medical stu- dents, such as misunderstanding emotions and their perception of environments as unstructured, would make it possible to prepare early support and development programmes. Int J Occup Med Environ Health. 2023;36(4):517-25.

Fatigue, Pro-Social Attitude and Quality of Life as Predictors of Empathy in Medical and Social-Oriented Students.

Empathy is significant in professions that require establishing proper contact as a condition for providing help. Identifying factors related to empathy is important for understanding how to teach empathic behavior. The main goal of this study was to find variables related to empathy in a group of students from two universities: medical and social oriented (N = 1701). The study group consisted of female (81%) and male (19%) participants, aged between 18-20 (37%), 21-23 (49%), or 24 years and above (14%). A self-designed questionnaire was used to collect socio-demographical information, with additional questions (social self-esteem, prosocial attitude, subjective quality of life). Empathy was measured with the EQ-40, fatigue with CHFQ-PL, and stress with PSS-10. The results showed a statistically significant regression model for empathy. A high quality of life and having feelings of pleasure when helping other people allows to predict a high level of empathy, especially among females. Higher levels of fatigue and social self-esteem, the latter of which is measured here by the belief that you are more important than others, predicts lower empathy. There were no differences between students from two different kinds of universities when taking into consideration stress levels, subjective quality of life, and prosocial attitude. However, students from the medical university were more exhausted and more convinced that their value was greater than others, as compared to the students studying social sciences. When teaching empathic behavior, it is beneficial to attempt to maintain or restore students' well-being and reduce fatigue and to teach how to achieve such effects in the future. Learning the balance between compassion, willingness to help, and self-compassion also seems to be important.

The Aftercare Survey: Assessment and intervention practices after brain tumor surgery in Europe.

Background: People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients' well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods: An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results: Thirty-eight European centers completed the survey. Thirty of them offered at least one postsurgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at long term. Twenty-eight of the participating centers offered postsurgical therapies. Patients who stand the highest chances of being included in evaluation and therapy postsurgically are those who underwent awake brain surgery, harbored a low-grade glioma, or showed poor recovery. Nearly half of the respondents offer support programs to caregivers, and all teams recommend them. Treatments differed between those offered to individuals with low-grade glioma vs those with high-grade glioma. The figure of caregiver is not yet fully recognized in the recovery phase. Conclusion: We stress the need for more complete rehabilitation plans, including the emotional and health-related aspects of recovery. In respondents' opinions, assessment and rehabilitation plans should also be individually tailored and goal-directed (eg, professional reinsertion).

Access to Health Information in the Polish Healthcare System-Survey Research.

Progress in medicine, transformations in healthcare organisation systems and access to new technologies have contributed to many changes in relations and communication between patients and healthcare personnel. The time to discuss and clarify doubts has shortened, while the period of waiting for an appointment and a consultation with a specialist has often been prolonged. Due to the lack or misunderstanding of information obtained from medical professionals, many people seek health information on their own account. The purpose of this document is to analyse the access Polish patients have to health information, the sources of and reasons for seeking that information, as well as the degree to which patients are satisfied with the information they find. We will also examine cases where patients choose self-healing. This is a survey based on an original questionnaire. The survey was conducted online and offline. The results of the survey were analysed by use of descriptive statistics. The analysis has indicated that access to health information is a universal need, which is independent of gender, age or education. Health information obtained from a doctor is most desired. The second-best source of information chosen by respondents is the Internet. Family members and friends are indicated as the third information source. Polish patients greatly appreciate doctors as a source of health information; however, given the difficulties connected with gaining direct access to information from healthcare personnel, they often search non-professional sources for information. The Internet and other media may be tools supporting the establishment of a safety culture, provided that the content published therein is consulted with medical professionals.

The Impact of Reflection on Death on the Self-Esteem of Health Care Workers.

BACKGROUND: The study was based on the Terror Management Theory. This theory assumes that self-preservation and awareness of imminent death create the potential to trigger fear. The "culture buffer" can protect people from fear, and it is composed of two factors: personal views on world issues and self-esteem. The aim of the study was to show that exposure to content that increases the availability of thoughts about death causes changes in medical personnel (doctors, nurses, and paramedics) in areas such as self-esteem, mood, sense of agency, and communion. METHODS: The research was experimental. Standardized psychometric tests were used, including the Rosenberg self-esteem scale (RSE), the University of Wales Institution of Science and Technology) Mood Adjective Check List (UMACL), scales measuring agency and communion, and an additional questionnaire containing two types of text. Respondents were divided into two text groups: A (exposed to increased availability of thoughts of death) and B (neutral). RESULTS: Reflection on death, triggered by the experimental manipulation of the independent variable (text version), did not modify mood (in groups of medical staff and students) or self-esteem of health care professionals but did modify scores on a single RSE item in the student's group. Moreover, age, income level, religious attitude, and belonging to a professional group had an impact on self-esteem, mood components, and other parameters but did not interact with the text group. Reflection on death modified the sense of agency and communion. CONCLUSIONS: Exposure to content increasing the availability of thoughts of death led to observable effects possible to observe in all groups only after taking into account an additional factor, which turned out to be the religious attitude of the respondents in the experiment. Specific tools should be selected or developed for the needs of research on respondents working in health care.

Comparing Students of Medical and Social Sciences in Terms of Self-Assessment of Perceived Stress, Quality of Life, and Personal Characteristics.

The aim of this study was to compare medical and social sciences students' outcomes in terms of self-perceived stress, quality of life, and personality traits. We put particular emphasis on external and internal differences in students of specific fields-medicine, nursing, psychology, and pedagogy. In a survey, 1,783 students from Medical University of Gdansk and University of Gdansk participated in our study, of whom 1,223 were included in the final statistical analysis. All of them were evaluated using valid and reliable questionnaires-TIPI-PL, PSS-10, and a one-item scale of quality of life. Stress turned out to have a negative effect on quality of life, regardless of the type of field of study. Moreover, students from different fields varied in terms of personality factors: conscientiousness, agreeableness, openness to experience, and emotional stability. In conclusion, many students regardless of their field suffer from high stress and report low quality of life, which potentially further affects their academic performance and social life.

Walsh Family Resilience Questionnaire-Polish Adaptation (WFRQ-PL).

Family resilience is a construct based on interactive processes occurring in the family, enabling the family to effectively overcome everyday stressors, as well as developmental and unpredictable crises. By observing how the family deals with difficulties using family resilience processes, we are able to support both parents and protect children against the harmful effects of unfavourable conditions. The aim of our research was to carry out the procedure of adaptation to the Polish language and culture of the Walsh Family Resilience Questionnaire. In this study, 930 Poles participated (72.5% women), aged from 18 to 63 (M = 26.94, SD = 9.8). They filled in the questionnaire online. Confirmatory factor analysis confirmed the model with three factors: belief system, organisational processes, and communication processes. The model indicators were found to be well suited to the data: χ2/df = 1.12, RMSEA = 0.01, CFI = 0.99, TLI = 0.99, SRMR = 0.04. The reliability (Cronbach's alpha) of the scales was also satisfactory (0.94 for the belief systems, 0.86 for the organisational processes, and 0.94 for the communication processes). Tool validation with FRAS-PL scales showed convergence. We named the Polish version of the WFRQ Questionnaire Kwestionariusz Preznosci Rodzinnej Walsh (WFRQ-PL) and found it to be a good tool for assessing the processes of family resilience in our country.

Loneliness, Complaining and Professional Burnout of Medical Personnel of Psychiatric Wards during COVID-19 Pandemic-Cross-Sectional Study.

BACKGROUND: Professional burnout in the medical community has been present for a long time, also among mental health professionals. The aim of the study was to examine the links between loneliness, complaining and professional burnout among medical personnel in psychiatric care during a pandemic. Loneliness and complaining of the medical staff are not documented in the literature well enough. METHODS: Oldenburg Burnout Questionnaire, the Loneliness Scale, the Complaint Questionnaire and author's questionnaire. The respondents: 265 medical employees-doctors (19.2%), nurses (69.8%), paramedics (4.9%), medical caregivers (5.7%). RESULTS: Loneliness and complaining are significant predictors of exhaustion. The model explains 18% of exhaustion variance. Loneliness, complaining and job seniority are also predictors of disengagement; the model allows to predict 10% of the variance of disengagement. Women are more prone to complain. Complaining significantly correlates with direct support from management. A high rate of loneliness correlates, in a statistically significant way, with worse work organization, less management support, worse atmosphere in the team and with more irresponsible attitudes of colleagues. CONCLUSIONS: Loneliness and complaining can be used to predict occupational burnout. Women and people without management support complain more often. Loneliness is connected with bad work organization and bad cooperation in a team.

Psychosocial predictors of persistent low back pain in patients presenting to the emergency department.

OBJECTIVES: Chronic low back pain is an important public health problem, generating high financial and social costs. While most clinical guidelines stress the importance of managing low back pain in primary care, in practice a disproportionate amount of patients with low back pain present to emergency departments. Patients presenting to emergency departments may form a specific group with different factors leading to chronicity. This prospective cohort study aimed to determine the sociodemographic and psychological predictors of persistent low back pain and the length of sick leave due to pain in patients with acute symptoms visiting an emergency department. METHODS: Patients with a first episode of non-specific acute low back pain in at least three months were qualified for this study. The participants filled a battery of questionnaires, including measures of pain, pain-related disability, depression, anxiety and pain coping strategies. A structured telephone interview was performed after three months with questions regarding pain and the length of sick leave. RESULTS: 110 patients participated in the study. 97 patients completed the follow-up, with 70.1% suffering from pain after three months. Lower self-rated health predicted pain after three months. Longer length of sick leave was predicted by lower self-rated health, distraction as a coping strategy and decreased behavioral activity. CONCLUSION: Because of its simplicity, a measurement of self-rated health may be included in future clinical practice for assessing the risk of persistent pain.

Parent's Stress Predictors during a Child's Hospitalization.

A child's illness and hospitalization are particularly difficult and most often an unpredictable situation in a family's life cycle. The level of stress of a parent of a hospitalized child depends on many factors, such as the psychological characteristics of the child and the parent, the child's health condition, and support from the family and medical staff. Our research aimed to search for interactions between the stress experienced by the parent and the temperamental variables of both the child and the parent, and the support received from the family and hospital staff. Using three pencil-paper questionnaires-PSS, EAS-D, EAS-C-and interview questionnaire, we tested 203 parent-child dyads at the time of children hospitalization. It was revealed that the most notable moderator of the relationship between temperamental traits and the characteristics of the hospital-related situation is the child's age. When analyzing the situation of a family with a hospitalized child, particular attention should be paid to parental emotional distress, which, regardless of the child's age, predicts a high level of parental stress.

Intensity, dynamics and deficiencies of empathy in medical and non-medical students.

BACKGROUND: Empathy is an important competence in the professional development of medical students. The purpose of our study was to compare the levels and scales of empathy in people studying in different educational strategies. METHODS: The study was conducted between April 2019 and March 2020. Medicine, nursing, midwifery, physiotherapy, psychology, pedagogy and sociology students were the participants of this study. University students preparing for medical professions (n = 1001) and students of programs unrelated to medicine (n = 700) underwent the Empathy Quotient test (EQ-40). We have compared results in both study groups with the use of the distribution of density, analysis of variance and student's t-test. RESULTS: The average results received by students of the university preparing for medical professions were lower (M = 42.6) than those of the non-medical university students (M = 45.3) and the differences between the universities turned out to be statistically important (t = - 5.15, df = 1699, p < 0.001). As many as 14.6% of the students in the 1st EQ class were preparing for various medical professions while 9% studied social sciences. 18.2% of all medical programme students (n = 412) manifested the lowest empathy class. Our research has revealed that the students with Asperger profile (AP) and high-functioning autism (HFA) studied at universities preparing for medical professions (n = 18) more frequently than at non-medical universities (n = 5). CONCLUSIONS: We have noticed a serious indicator of erosion in the levels of empathy in medical students and an increase in the number of people with AP and HFA. Empathy decreases in students after the third year of their studies, regardless of the kind of university. We recommend an introduction of career counselling when specialization is being chosen.

Polish Adaptation of the Pregnancy-Related Anxiety Questionnaire-Revised 2 for All Pregnant Women.

Pregnancy-related anxiety (PrA) is a specific type of anxiety characteristic of the perinatal period. PrA can affect pregnancy and birth. However, no validated tool exists to measure PrA in Polish obstetric practice. The aim of this study was to translate the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) into Polish and to evaluate its reliability and factorial and construct validity. This study was conducted in Poland as an online questionnaire in April 2020 and included 175 healthy women. To validate the PRAQ-R2, we used standardized tools for the measurement of general anxiety: the modified Visual Analog Scale (VAS), the Ten-Item Personality Inventory (TIPI), and the Hospital Anxiety and Depression Scale (HADS). Scale reliability was assessed using Cronbach's alpha. Concurrent validity was evaluated by calculating Spearman's rho correlation coefficients. Statistical analyses were performed using R ver. 4.0.2. Values for comparative fit index >0.90, Tucker-Lewis index >0.90, and root mean square error of approximation <0.08 indicated acceptable model fit, confirming the reliability of the three-factor structure of the translation. The subscales and total scores had good consistency (α > 0.7), and convergent validity was demonstrated. The PRAQ-R2 as translated into Polish represents the first validated tool in Poland to measure PrA for all pregnant women.

Preferred musical attribute dimensions underlie individual differences in music-induced analgesia.

Music-induced analgesia (MIA) is a phenomenon that describes a situation in which listening to music influences pain perception. The heterogeneity of music used in MIA studies leads to a problem of a specific effect for an unspecified stimulus. To address this, we use a previously established model of musical preferences that categorizes the multidimensional sonic space of music into three basic dimensions: arousal, valence and depth. Participants entered an experimental pain stimulation while listening to compilations of short musical excerpts characteristic of each of the three attribute dimensions. The results showed an effect on the part of music attribute preferences on average pain, maximal pain, and pain tolerance after controlling for musical attributes and order effects. This suggests that individual preferences for music attributes play a significant role in MIA and that, in clinical contexts, music should not be chosen arbitrarily but according to individual preferences.

Preferences of women with low obstetric risk for cesarean or vaginal birth in Poland: Areas for intervention.

BACKGROUND: In Poland, the rate of cesarean birth (CB) is 43%, which is much higher than the European average of 27%. Optimizing the CB birth rate is of critical importance, especially among women with low-risk pregnancies. However, the determinants of cesarean preference among low-risk women in Poland have not been well explored. METHODS: This cross-sectional study included 1011 pregnant women and aimed to identify associations between selected determinants of women's preferences for CB vs. vaginal birth (VB) in Poland. A descriptive questionnaire was distributed online, and a theoretical model was validated against empirically gathered data. Group comparisons were performed using the Welch t test for continuous data or chi-square test for categorical data. All statistical analyses were performed using R (R Core Team, 2018). RESULTS: The mean age of women preferring CB (30.46 years) was 1.25 years higher than that of women preferring VB (29.21 years). Pregnant women who expressed a preference for CB tended to be multigravid, inhabited cities, and were characterized by higher levels of anxiety and depression. Moreover, the majority of women who underwent a previous CB asserted their intention to repeat the procedure for the current pregnancy. CONCLUSIONS: The primary factors that were correlated with high CB preference among the low-risk group included age, previous childbirth experiences, and anxiety. The underlying reasons that drive birth preferences remain poorly understood. However, women who have previously undergone difficult childbirth experiences and are afraid of pain require specialized care.

A confirmatory factor analysis for an adapted and validated Polish version of the Chalder Fatigue Questionnaire.

OBJECTIVES: The Chalder Fatigue Questionnaire (CFQ) was developed to measure fatigue in 2 dimensions: physical and mental. The aim of the study was to translate, adapt and evaluate the psychometric properties of the Polish version of the CFQ (CFQ-PL). MATERIAL AND METHODS: The process of translation was conducted using a forward and backward translation procedure. After cultural adaptation, the psychometric properties of the CFQ-PL were evaluated. Participants of the study were healthy individuals: medical students (N = 304) and pregnant women (pregnancy without complications, N = 925). The reliability and validity were estimated using fatigue numerical rating scales, the Beck Depression Inventory and the State-Trait Anxiety Inventory. To examine the factor structure of the CFQ-PL, a confirmatory factor analysis was conducted. RESULTS: The internal consistency of the CFQ-PL was similar to the original version (Cronbach's α 0.85-0.91). Statistically significant correlations between the CFQ-PL and the current fatigue level, average fatigue and the sleepiness level (measured using numerical rating scales), as well as the intensity of depression and anxiety symptoms, all confirming the validity of the adapted scale. Using a confirmatory factor analysis, it was determined that a 1-factor model did not fit the data well. A 2-factor model with a correlation between mental and physical factors fitted better than the 1-factor model, yet fit indices revealed a poor fit. Using a 2-factor model with added covariance between items - 1 (problems with fatigue), 2 (resting more), 9 (slips of the tongue), 10 (finding the correct word) - resulted in acceptable fit indices in both groups of participants. CONCLUSIONS: After the process of translation, adaptation and validation of the CFQ-PL, it is now available for use under Polish conditions. This study provided evidence for structural validity of the 2-factor model of the 11-item version. Int J Occup Med Environ Health. 2020;33(1):67-76.

Evaluation of outcomes of Urethral Stricture Surgery: psychometric validation of a Polish language version of the Patient-Reported Outcome Measure for urethral stricture surgery.

INTRODUCTION: The aim of this study is to validate the Polish version of the Urethral Stricture Surgery - Patient-Reported Outcome Measure (USS-PROM) by evaluating its psychometric properties. MATERIAL AND METHODS: Patients with urethral stricture scheduled for urethroplasty between 2014 and 2018 were prospectively enrolled. The results of the USS-PROM were obtained before the operation, and during follow-up visits. The original USS-PROM was translated into Polish and re-translated into English in accordance with the guidelines by Dawson et al. regarding the adaptation process. Psychometric assessment included internal consistency, test-retest reliability, criterion validity and responsiveness. RESULTS: One hundred twelve patients were included. 54 patients completed the USS-PROM both before and 3 months after the surgery and 39 of them completed the questionnaire 6 months after the surgery to evaluate the test-retest reliability. Cronbach's α for internal consistency of the lower urinary tract symptoms (LUTS) domain score was 0.87. The test-retest intraclass correlation coefficient was 0.82. Spearman's coefficients showed no correlation between USS-PROM's result and maximal urinary flow (Qmax) result before the surgery (rs = 0.13; p >0.05) and a positive correlation between USS-PROM's result and Qmax result at follow up: 3 months after (rs =- 0.56; p <0.05), 6 months after (rs -0.64; p <0.05), and 12 months after (rs = -0.85; p <0.05). There were statistically significant strong and positive correlations between LUTS score and International Prostate Symptom Score (IPSS). Responsiveness of the test was confirmed with non-parametric Friedman's analysis of variance (ANOVA) with Kendall's coefficient of concordance (χ2 ANOVA = 8.95, p = 0.03). CONCLUSIONS: The Polish version of the USS-PROM questionnaire has appropriate psychometric properties and can be used in the assessment of patients with urethral stricture undergoing urethroplasty.

Relative Cerebral Blood Transit Time Decline and Neurological Improvement in Patients After Internal Carotid Artery Stenting.

In this study we hypothesized that the alleviation of neurological symptoms long after internal carotid artery (ICA) stenting may be related to sustained improvement of cerebral perfusion. Thirty-four subjects (F/M; 15/19) with >70% stenosis of a single internal carotid artery and neurological symptoms, who underwent a carotid artery stenting procedure, were studied. Brain computed tomography perfusion (CTP) imaging was performed before and 3 years after ICA stenting. The following relative variables were compared: cerebral blood flow (rCBF), cerebral blood volume (rCBV), mean transit time (rMTT), time to peak (rTTP), and permeability surface area product (rPS). A survey also was conducted to compare the patients' clinical symptoms. Overall, we found that a trend toward rMTT decline was the only persisting change after ICA stenting. We then stratified the patients into the subgroups of <2%, 2-5%, and > 5% rMTT decline and found that those with a rMTT decline >2% reported a prominent reduction in subjective clinical symptoms such as headache, dizziness, tinnitus, blurred vision, transient blindness, a sense of gravity of the head, and pain in the eyeballs. We conclude that a shortened mean rMTT, likely reflecting improved cerebral microcirculation, underlies the improvement of neurological symptoms in patients with ICA stenosis.

Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery.

BACKGROUND: Anxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery. AIMS: The purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery. DESIGN: This was a cross-sectional study. SETTINGS: A neurosurgical ward in Gdansk, Poland. PARTICIPANTS/SUBJECTS: All patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited. METHODS: A battery of questionnaires, including Illness Perceptions Questionnaire-Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates. RESULTS: Higher anxiety was predicted by stronger beliefs about negative consequences of illness (ß = .205, p < .05), worse illness coherence (ß = .204, p < .05), negative emotional representations of illness (ß = .216, p < .05), and depression (ß = .686, p < .001). Higher depression was predicted by anxiety (ß = .601, p < .001), pain interference (ß = .323, p < .01), lower personal control over pain (ß = -.160, p < .05), and lower external control of health (ß = -.161, p < .05) but, surprisingly, higher internal control of health (ß = .208, p < .01). CONCLUSIONS: Anxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.

Cognitive and emotional representations of pain in cancer patients at an inpatient unit and home palliative care.

PURPOSE: To compare symptomatic treatment at inpatient palliative care unit and at home in terms of: pain intensity; negative impact of pain on functioning in different areas of life; and beliefs about pain (cognitive and emotional aspects according to Leventhal's theory). PATIENTS: The sample consisted of 74 cancer patients qualified for palliative care at an inpatient unit (N = 53) and at home (N = 21). METHODS: Brief Pain Inventory--Short Form (measurement of pain intensity and pain interference with daily activities), Karnofsky Scale (performance status), Illness Perception Questionnaire for cognitive and emotional representations and beliefs about pain, and Hospital Anxiety and Depression Scale. RESULTS: Patients treated at inpatient unit and patients treated at home did not differ in terms of pain intensity, depression, and anxiety. The only significant differences between groups were the beliefs about pain. Patients with cancer in home care were more convinced of pain treatment effectiveness but expressed higher level of distress related to pain. Patients convinced that pain can be treated more effectively were younger, the pain they experienced was less severe, and they were treated at home. CONCLUSIONS: Effectiveness of symptomatic treatment is comparable in patients with cancer at inpatient unit and at home. Treatment at home is associated with stronger patient convictions that pain can be effectively treated and higher level of distress. In future studies, the source of higher distress intensity in patients treated at home may be further explored.

Multicenter study on midwifery students' attitudes towards abortion and it's place in their future practice - Comparison of respondents at early and late stages of the university education.

Evidence based midwifery education and practice are fundamental to assure high quality care of childbearing women, also with complications. In Poland, midwifery education includes aspects of participation in the abortion. A cross-sectional study was designed to describe the attitudes towards abortion at the beginning and at the end of students' university education. The study was aimed to verify change of attitudes throughout the course of the university education. Most of the students approved abortion if the pregnancy constitutes a threat to woman's health or life, results from a rape, or whenever the fetus presents with a lethal defect. More than a half did not approve participation in the abortion if the fetus presents with a non-lethal defect. Generally, the acceptance rates were significantly higher among the final year students, but more than a half of them stated, that the abortion-related topics were inadequately addressed in their study curriculum. That bring to the conclusion that higher rates of abortion acceptance among the final year students, were not necessarily a manifestation of informed approval for this procedure, but rather a form of a "systemic" adjustment. Midwifery program need to be revised to support students in developing informed and evidence-based attitudes toward abortion.