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.

The role of the clinical and psychological symptoms of mastocytosis in the patient's quality of life.

Introduction: Patients with mastocytosis have various clinical and psychological symptoms, for example, life-threatening anaphylactic reactions or anxiety, resulting in decreased quality of life (QoL). Aim: To assess the clinical and psychological symptoms (such as depression, anxiety) as well as the quality of life and satisfaction with life in patients with mastocytosis. Material and methods: The study group included 85 patients with mastocytosis (57 women and 28 men) treated at the Department of Allergology, Medical University of Gdansk, Poland. The measures employed in the study were the following: HADS-M, QLMS, and Cantril ladder. Results: Among clinical symptoms that occurred in the studied group, only allergy differentiated between the patients in terms of their QoL. Patients experiencing allergy symptoms presented lower QoL in the area of leisure time. The study findings indicate that 27.1% of participants experience anxiety, 12.9% experience depression, 15.3% present low satisfaction with the current life, and 10.6% express low satisfaction with life in the next 4 weeks. General QoL in mastocytosis, as well as the four areas of QoL in mastocytosis, remain positively correlated with anxiety, depression, and irritability, as well as negatively correlated with the satisfaction with current life and life in 4 weeks' time. Conclusions: Patients who experience allergy symptoms have a lower level of QoL in the area of leisure time. Having more obstacles in various areas of life is associated with anxiety, depression, irritability, and low satisfaction with life. Learning how to overcome them can potentially improve the patients' QoL.

Assessing quality of life in patients with mastocytosis: development of the disease-specific questionnaire.

INTRODUCTION: Appropriate and targeted psychological care, as well as psychoeducation covering the disease causes, symptoms, and their management are crucial elements of the therapeutic process in patients with mastocytosis. This care is based on the identification of problematic areas that are of the greatest importance for patients. The quality of life questionnaires available in Poland are designed for the general population; therefore, they do not encompass the specificity of difficulties experienced by people suffering from mastocytosis. AIM: To develop a questionnaire measuring the quality of life in patients with mastocytosis, and including the issues and symptoms typical for this group. MATERIAL AND METHODS: The study involved 85 patients (57 women and 28 men) suffering from mastocytosis. RESULTS: The analyses revealed that the Quality of Life in Mastocytosis Scale (QLMS) is a reliable and valid tool for measuring the quality of life, and it takes into account the specific difficulties experienced by patients with mastocytosis. Apart from the measurement of the global quality of life, QLMS offers a deeper assessment of the quality of patient's lives, including the difficulties in professional life, everyday life, leisure time, or those associated with protective behaviours. CONCLUSIONS: The presented questionnaire completes a gap in quality-of-life studies by allowing to plan psychoeducation and offering a tool for a precise diagnosis of the quality of life in patients with mastocytosis.

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.

The coping strategies during medical education predict style of success in medical career: a 10-year longitudinal study.

BACKGROUND: The stress associated with the physician's work is generally acknowledged and is related to well-being and life satisfaction. The presented study was designed to extract the role of coping strategies in identifying differentiated styles of success in a medical career during medical education. METHODS: The participants were examined when they applied to medical school and each subsequent academic year. The final study took place four years after graduation. The baseline questionnaire measured coping strategies. The follow-up questionnaire consisted of measures of: quality of life, work stress and burnout, satisfaction with medicine as a career, and professional competency. RESULTS: Based on coping strategies assessed during admission and preclinical years of medical study, some aspects of success in the participants' future medical career can be predicted. Students who take action and deal directly with a problem, neither accept resignation, nor reduce tension by expressing feelings would most probably resist future burnout. However, despite the fact that they obtain the highest quality of life or earn the highest income they would be, at the same time, the least satisfied with chosen career, as well as being more likely to be characterised by a low level of competence. CONCLUSIONS: Assessment of coping strategies at the beginning of medical education could be taken into consideration as an instrument to diagnose a specific trend in physicians' career development.

Evaluation of the Impact of Different Types of Health Education on the Adoption and Preservation of Prohealth Attitudes in Preventing Cancer in Juveniles Younger than 18 Years.

Reduction in the incidence of cancer can be achieved through appropriate health behaviors. We hypothesized that education would improve knowledge of cancer prevention, and this, in turn, will affect and individual's readiness to modify lifestyle. The aim of this study was to assess the impact of cancer prevention education on adopting and preserving prohealth attitudes among high school students in Poland. Research participants were 307 high school students varying by gender, place of residence, parents' education, and type of school education. Participants were divided into five groups, of which four were educated using different methods according to classification methods based on the concept of multilateral learning. The fifth (control) group was not educated. The effects of education were assessed 1 month and 1 year after education. General knowledge about cancer and healthy lifestyle level before education was low. After education, both increased compared with the control group. There was a clear relationship between level of knowledge and readiness to adopt and healthy attitudes and behavior. The most effective method of education was a discussion and a lecture by means of teaching complex. Education significantly improved generally low knowledge about cancer and healthy lifestyle in high school students. This indicates the urgent need to implement such educational programs.

The sense of coherence and styles of success in the medical career: a longitudinal study.

BACKGROUND: Sense of coherence is related to well-being, stress and life satisfaction among medical students and physicians. The purpose of the study was to investigate relation between sense of coherence during medical education and styles of success in the medical career. METHODS: The participants were first examined when they applied to medical school in 1999. Questionnaires were given to these students each academic year from 2000 to 2005. Also, 54 medical doctors who had participated in the first phase of the study completed a questionnaire in 2009, four years after graduation. The baseline questionnaire measured the sense of coherence. The follow-up questionnaire included measures of quality of life, work stress and burnout, satisfaction with medicine as a career, and professional competency. RESULTS: Medical students with the highest sense of coherence later have the highest quality of life and income, and are the least overwhelmed by work stress, but they also show the least satisfaction with medicine as a career and a low level of professional competence. CONCLUSIONS: Antonovsky's SOC-29 questionnaire can be used to identify specific tendencies in the development of the medical career. Our results may be useful to medical school admissions officers and resident selection committees, in order to identify candidates at risk for failure.

Types of reactions to malignant disease in view of V.E. Frankl philosophy.

PURPOSE: The purpose of this work was to find out whether there is interdependence between the patients- assessments of biological, psychological, psychosocial and spiritual levels. METHODS: 590 subjects, both ill and healthy, were examined by appropriate means and asked to consider their level of fear, depression (Hospital Anxiety and Depression Scale - Modification), aggression, quality of life (EORTC QLQ-C30 questionnaire), and the purpose and meaning of life (The "PURPOSE in Life Test" - PIL questionnaire). RESULTS: Three groups of patients were established with the help of statistical procedures. The first group encompassed the healthy subjects, whereas the second and third included those that were ill. Although the subjects estimated their level of physical fitness and general quality of life similarly, there were some essential differences in their disease-associated reactions (i.e. the groups adjusted differently - the second group poorly and the third well). The majority of people suffering from cancer were well adapted to the early stages of the disease. As cancer progressed the percentage of those that adjusted poorly rose. However, even in the terminal stage some of the patients, about 1/3, still belonged to the group of those that were quite well adjusted. Established meaning of life, system of values, and personal religion were factors that helped to adapt. CONCLUSIONS: There was no connection between the patients' assessments of their biological level and other (psychological, psychosocial, spiritual) levels. We can distinguish groups of patients that judge their physical condition similarly and still vary in the assessment of their emotional state or meaning of life.

Validation of the Polish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care in patients with advanced cancer.

BACKGROUND: Limited data exist on the validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care in advanced cancer patients. AIM: To adapt the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care to the Polish clinical setting and to evaluate its psychometric properties in advanced cancer patients. DESIGN: Two quality-of-life measurements were performed at baseline and after 7 days. The concurrent validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care was established by the Pearson correlation coefficients with the modified Edmonton Symptom Assessment System, the Karnofsky Performance Status and the Brief Pain Inventory - Short Form. Reliability was assessed using Cronbach's alpha coefficients and the Spearman correlation coefficients of the baseline and of the second measurement of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care items. SETTING/PARTICIPANTS: A total of 160 consecutive patients in one academic palliative medicine centre were included. RESULTS: A total of 129 patients completed the study. The concurrent validity revealed significant correlations of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care pain scale with the Brief Pain Inventory - Short Form, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care symptom items with the modified Edmonton Symptom Assessment System and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care functional scales with the Karnofsky Performance Status scores. High Cronbach's alpha and standardised Cronbach's alpha values were found in the case of both functional (range: 0.830-0.925; 0.830-0.932) and symptom scales (range: 0.784-0.940; 0.794-0.941) of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care, respectively. The Spearman correlation coefficients between the first and the second measurements were significant (p < 0.0001) for all European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care items. CONCLUSIONS: Polish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care is a valid and reliable tool recommended for quality-of-life assessment and monitoring in advanced cancer patients.

Attitudes of Polish physicians and medical students toward breaking bad news, euthanasia and morphine administration in cancer patients.

Medical students and physicians should possess basic knowledge concerning medical ethics and palliative care. The aim of the study was to explore the knowledge on the end-of-life ethics and palliative care in third-year medical students and physicians during internal medicine specialty training and their attitude towards breaking bad news and euthanasia. A voluntary and anonymous questionnaire survey with the participation of 401 students and 217 physicians filled after lectures concerning ethics for medical students and after palliative medicine course for physicians during internal medicine specialty training. A total of 28 % students and 24 % physicians (p = 0.282) were ready to reveal full information to advanced cancer patients. A total of 82 % of students and 90 % of physicians (p = 0.008) would not practice euthanasia; 67 % of students and 75 % of physicians (p = 0.039) were opponents of euthanasia legalisation. A total of 70 % doctors and 23 % students indicated oral as the most preferable route of morphine administration. A total of 74 % physicians and 43 % students stated that there is no maximal dose of morphine; 64 % of doctors and 6 % of students indicated constipation as a constant adverse effect of morphine. Breaking bad news is a significant difficulty for both students and physicians. There is a small percentage of those tending to practice euthanasia and bigger accepting its legalisation with fewer physicians than students. In contrast to medical students, the majority of physicians have knowledge concerning chronic morphine use in the treatment of cancer patients.

A comparison of attitudes toward euthanasia among medical students at two Polish universities.

The aim of the study conducted upon completion of obligatory palliative medicine courses among 588 medical students at two universities was to compare their attitudes toward euthanasia. Four hundred ninety-two (84.97 %) students were Catholics; 69 (11.73 %) declared they would practice euthanasia, 303 (51.53 %) would not, and 216 students (36.73 %) were not sure. The idea of euthanasia legalisation was supported by 174 (29.59 %) respondents, opposed by 277 (47.11 %), and 137 (23.30 %) were undecided. Five hundred fifty-six (94.56 %) students did not change their attitudes toward euthanasia after palliative medicine courses. Students from the two universities were found to have different opinions on practicing euthanasia, euthanasia law and possible abuse which might follow euthanasia legalisation, but they shared similar views on the choice of euthanasia if they themselves were incurably ill and the legalisation of euthanasia. Gender and religion influenced students' answers. Differences observed between medical students at the two universities might be related to gender and cultural differences.

[Real self and ideal self of pregnant and postpartum women with symptoms of perinatal depression]. / Ja realne i ja idealne u kobiet ciezarnych i poloznic z objawami depresji okoloporodowej.

AIMS: To assess real self and ideal self in pregnant and postpartum women with symptoms of perinatal depression in the area of psychological needs and topical scales. METHODS: The study involved 239 pregnant women whose gestational age ranged between 32 and 40 weeks, and 105 postpartum women (2 to 5 days after childbirth). The Edinburgh Postnatal Depression Scale questionnaire was used as a screening test for antenatal and postnatal depressive symptoms. Personality profiles were assessed using the Adjective Check List test. RESULTS: Pregnant and postpartum women with symptoms of perinatal depression varied in their self-assessment of a number of their real psychological needs, while they presented similar scores with respect to their ideal (expected) self. The differences between pregnant and postpartum women correspond to changes in roles and activities related to pregnancy and the postpartum period; women presenting more passive attitudes in pregnancy become more active in the postpartum period. Apositive change in the real self-image related to motherhood in the postpartum period occurs despite depressive disorders. CONCLUSION: Numerous significant differences between the ideal and real self in both pregnant and postpartum women with perinatal depressive symptoms demonstrate their lack of self-acceptance, which requires individualised psychological intervention.

[Quality of Life in Depression Scale (QLDS)--development of the scale and Polish adaptation]. / Kwestionariusz Jakosci Zycia w Depresji (QLDS)--powstanie narzedzia oraz adaptacja do warunków polskich.

AIM: The aim of this study was to adapt the Quality of Life in Depression Scale to Polish conditions. The scale determines the quality of life, defined in terms of the concept of needs, and focuses on patients with depressive disorders. Since its basic version has been developed, the tool was adapted in many countries, also outside Europe. METHOD: The adaptation procedure included the translation of the original version into Polish, followed by the English retranslation, and was performed by four independent, qualified translators. The final Polish version was verified during a pilot study. RESULTS: This pilot study confirmed high reliability of the Polish version of Quality of Life in Depression Scale. CONCLUSION: The Quality of Life in Depression Scale (QLDS) can be considered an interesting tool in view of its broad theoretical background, and a simple procedure to complete during a clinical evaluation. The use of a specialist translation procedure, and the results of our pilot study suggest that the QLDS can be used in further research, both when evaluating a clinical population and when dealing with individual patients.

[The perception of social support by students of the 2nd year nursing faculty of the Medical University of Gdansk]. / Spostrzeganie wsparcia spolecznego przez studentów Il roku Pielegniarstwa Gdanskiego Uniwersytetu Medycznego.

In the year 2012, a study of the assessment of social support after traumatic and/or stressful life events among 85 students of nursing faculty of Medical University of Gdansk was done. The Berlin Social Support Scale was used. Nursing students after traumatic and/or stressful life events often look for the help of other people than students who had not suffered those experiences. Respondents who had partners often feel the need to use support from them after traumatic and/or stressful life events. For respondents who were in close relationship important was not only to receive support from partners, but also to give support to others.

Illness Perception and the Severity of Depression and Anxiety Symptoms in Patients with Multimorbidity: Observational Cohort Studies.

INTRODUCTION: Many studies have shown a correlation between the patient's engagement in treatment and their perception of the illness. AIM: The aim of this study has been to explore the link between the patient's perception of their illness with anxiety and depression, and to leverage this link to promote health education. MATERIALS AND METHODS: The study was carried out using the following tools: the Hospital Anxiety and Depression Scale and the Illness Perception Questionnaire-Revised. The study participants included N = 143 patients. RESULTS: The participants' age was statistically significantly associated with the expected duration of the illness (p < 0.01), the conviction that the treatment was effective (p < 0.01), and the perception of the severity of the disease symptoms (p < 0.05). The employment status was statistically significantly associated with the illness perception (p < 0.01). Anxiety and depression levels were statistically significantly associated with the perceived impact of the illness on life (p < 0.001) and emotional status (p < 0.001), the perceived control over the illness (p < 0.01), the potential for recovery (p < 0.001), the concern about the illness (p < 0.001), and the impact of the illness on emotional well-being (p < 0.001). CONCLUSIONS: Individuals who perceived a high severity of illness symptoms also assessed that the illness significantly impacted their life and emotional state. The authors demonstrate a strong link of a "negative" perception of the illness with depression and anxiety. A better understanding of the illness predicted a less severe depression and lower anxiety. IMPLICATIONS FOR PRACTICE: The results suggest that the study of illness perception holds significant potential to contribute effectively to educational and psychotherapeutic practices.

Academic achievement, depression and anxiety during medical education predict the styles of success in a medical career: a 10-year longitudinal study.

AIM: Our study investigated the styles of success in the medical career in young physicians, in comparison with the same subjects examined 4-10 years earlier. METHODS: The participants were first studied when they applied to the medical university (1999). Questionnaires were sent to all students each year (2000-2005). Fifty-four medical doctors participated in the first phase of the study completed a questionnaire four years after graduation. The current questionnaire included measures of burnout, satisfaction with medicine as a career, quality of life (QOL) and postgraduate examination results. Previous questionnaires had included measures of academic achievement, depression and anxiety. RESULTS: We can describe three different styles of success, which can be predicted during medical education. Physicians with the best professional competence have the lowest income. However, physicians with the lowest professional competence gain the highest income. Those with the highest QOL (general well-being and life satisfaction) have the lowest professional stress and vulnerability to burnout. Anxiety and academic achievement (during the second and fourth year of study) are the significant predictors of specific style belonging. CONCLUSIONS: Our results may be useful to medical school admissions and resident selection committees to identify candidates at risk for less satisfaction or less competence.

[Nicotine experiences among students of the Medical University of Gdansk]. / Doswiadczenia nikotynowe studentów Gdanskiego Uniwersytetu Medycznego.

In the years 2009 and 2010, a study of the assessment of nicotine experience and exposure to cigarette smoking among the students of Medical University of Gdansk were done. 410 students were included to the study. The authors used anonymous on-line survey. Relatively low percentage of smokers was found in the population of students of Medical University of Gdansk. Smoking persons usually smoke few cigarettes per week. Only 33% of students want to give up smoking.

Health-Related Quality of Life of Patients with Marfan Syndrome-Polish Study.

Background: Despite extensive knowledge about the quality of life of people suffering from rare diseases, data on patients with Marfan syndrome (MFS) are scarce and inconsistent. Hence, the problem of assessing the quality of life (QOL) and its relationship with the assessment of which ailments are the most burdensome for these patients is still open. Aim: Comparison of the quality of life of patients with MFS and determination as to which of the reported complaints in patients with MFS are related to the QOL of patients. Methods: The study included 35 patients with MFS and 35 healthy controls, matched for gender and age. In the study, the questionnaire of quality of life assessment SF-36 was used to assess the level of health-related quality of life, as well as an interview of the most severe symptoms reported by patients with MFS. Results: The level of the physical dimension of the QOL (p < 0.001) and limiting of roles due to physical health (p = 0.002), as well as the level of general index of the QOL (p < 0.001), were statistically significantly lower in MFS patients when compared to controls. People from both studied groups do not vary in the scope of pain, vitality, social functioning, limiting the roles due to emotional problems, and state of mind but also in the mental dimension of the health-related quality of life (HRQL). Additionally, there has been a correlation between HRQL and the subjective assessment of the effects of orthopedic, ophthalmic, and cardiological problems in life, as well as lower exercise tolerance in the evaluation of people with MFS and QOL in most areas. Conclusions: Patients with MFS present a reduced QOL in the areas of physical functioning, limiting roles due to physical health, general feeling of general health, the physical dimension of the HRQL, and the general index of the QOL; in these areas, they require careful evaluation, as well as medical and psychosocial assistance.

Psychological factors determining success in a medical career: a 10-year longitudinal study.

BACKGROUND: Systemic review of predictors of success in medical career is an important tool to recognize the indicators of proper training. AIM: To determine psychological factors that predict success in a medical career. The success is defined as professional competence, satisfaction with medicine as a career, occupational stress and burnout and quality of life (QOF). METHODS: Part I (1999-2005), medical students were examined each subsequent year, beginning with admission. Assessment included academic achievement (high school final examination results, entrance exam results, academic results during medical school) and psychological characteristics (sense of coherence (SOC), depression, anxiety, coping styles, value system and need for social approval). Part II (2008-2009), the same participants completed an Internet survey 4 years after graduation. Results of the postgraduate medical exam were taken under consideration. RESULTS: Academic achievement predicts only professional competence. Coping styles are significant indicators of satisfaction with medicine as a career. SOC, while assessed with anxiety and depression during studies, enabled us to recognize future QOF of medical graduates. Professional stress is not predictable to such an extent as other success indicators. CONCLUSIONS: There are significant psychological qualities useful to draw the outline of the future job and life performance of medical graduates.

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.