Gender medicine attitudes among medical students: An Italian cross-sectional study.

We aimed to explore attitudes and training experiences of medical students toward gender medicine (GM). A cross-sectional study with convenience sampling was conducted (sample size = 430). To assess predictors of high GM consideration in patient management, a multivariable logistic regression was performed. A total of 82% considered sex and gender important; 61% stated that they would use GM skills in their careers. A total of 76% had never discussed GM with their tutors, with differences between male and female students (p = .002). Predictors of high GM consideration were: age (adjOR = 1.4, 95%CI = 1.1-1.8) and the impression that tutors considered patients' sex and gender during practice (adjOR = 3.9, 95%CI = 2.0-7.6). Thus, participants considered GM important, but some students were unsure whether it could be useful in practice. The strongest predictor of high GM consideration was the tutors' good example during training. It would be advisable to implement the teaching of this topic during both courses and traineeships.

How the reduction of working hours could influence health outcomes: a systematic review of published studies.

OBJECTIVES: The health effects of work-time arrangements have been largely studied for long working hours, whereas a lack of knowledge remains regarding the potential health impact of reduced work-time interventions. Therefore, we conducted this review in order to assess the relationships between work-time reduction and health outcomes. DESIGN: Systematic review of published studies. Medline, PsycINFO, Embase and Web of Science databases were searched from January 2000 up to November 2019. OUTCOMES: The primary outcome was the impact of reduced working time with retained salary on health effects, interventional and observational studies providing a quantitative analysis of any health-related outcome were included. Studies with qualitative research methods were excluded. RESULTS: A total of 3876 published articles were identified and 7 studies were selected for the final analysis, all with a longitudinal interventional design. The sample size ranged from 63 participants to 580 workers, mostly from healthcare settings. Two studies assessed a work-time reduction to 6 hours per day; two studies evaluated a weekly work-time reduction of 25%; two studies evaluated simultaneously a reduced weekly work-time reduction proportionally to the amount of time worked and a 2.5 hours of physical activity programme per week instead of work time; one study assessed a reduced weekly work-time reduction from 39 to 30 hours per week. A positive relationship between reduced working hours and working life quality, sleep and stress was observed. It is unclear whether work time reduction determined an improvement in general health outcomes, such as self-perceived health and well-being. CONCLUSIONS: These findings suggest that the reduction of working hours with retained salary could be an effective workplace intervention for the improvement of employees' well-being, especially regarding stress and sleep. Further studies in different contexts are needed to better evaluate the impact of work-time reduction on other health outcomes.

The emotional side of post-traumatic stress reaction during COVID-19 pandemic: an Italian survey.

BACKGROUND: Social restrictions due to COVID-19 might have had a significant impact on mental health. The aim of this study was to assess the prevalence of four emotional domains (nervousness, anger, numbness, physiological arousal) in a sample of citizens during the first pandemic wave in 2020, and their association with sociodemographic characteristics, housing conditions and lifestyle modifications. METHODS: A cross-sectional study based on a self-administered online questionnaire was set up to investigate emotions. Respondents were recruited through a non-probabilistic snowball sampling approach. The SPAN questionnaire was used to measure emotions in the interviewed population. The association between emotions and independent variables (gender, age, marital status, educational level, working condition, housing condition, COVID-19 positivity, sleep disturbance, increase in alcohol consumption and decrease in physical activity) was assessed through the multivariate Poisson regression. RESULTS: A total of 6,675 subjects were included in the analysis. Almost half of respondents (48.9%) experienced nervousness, 41.3% anger, 15.6% numbness and 18.8% physiological arousal. Females were more likely to face nervousness, anger and physiological arousal. For all the outcomes a decreasing trend was observed from younger to older. Singles were more likely to experience numbness compared to married people. Increase in alcohol consumption was associated with nervousness, anger and numbness. Decrease in physical activity was associated with nervousness, anger and physiological arousal. Restless sleep was the variable most associated with all emotional domains. CONCLUSIONS: The first COVID-19 pandemic wave had a significant emotional impact on this sample, especially among younger people, singles and females. Even without reaching clinical relevance, these emotions could represent a form of psychological distress, which requires the implementation of preventive strategies, in particular regarding lifestyle care.

Gender sensitivity and stereotypes in medical university students: An Italian cross-sectional study.

Gender medicine is crucial to reduce health inequalities. Knowledge about students' attitudes and beliefs regarding men, women and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender stereotypes and its predictors in Italian medical students. We performed an online cross-sectional study among students from the University of Turin. We used the validated Nijmegen Gender Awareness Scale in Medicine scale to explore gender sensitivity and stereotypes. Multivariable logistic regression model was performed to explore potential predictors of gender awareness. We enrolled 430 students. Female sex, a better knowledge on gender medicine and having had a tutor aware of gender issues are associated with higher gender sensitivity. Older age, a better knowledge on gender medicine and having had a tutor sensitive to gender issues were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine, male sex and older age were associated with more stereotypes towards doctors. Italian students have high gender sensitivity and low gender stereotypes. Age, higher knowledge of gender medicine and having had a tutor that considered gender were associated with higher gender stereotypes. Focusing on gender awareness in medical schools can contribute to a better care.

Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy.

BACKGROUND: To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy. METHODS: Interrupted time-series analysis (ITSA) comparing hospitalization rate and timing of hip-fracture surgeries between pre- and post-quarantine period. The same data observed in Piedmont the year before were included as a control time series with no "intervention" (quarantine) in the middle of the observation period. RESULTS: We found that 70.3% and 69.4% of hip-fracture patients received surgery within 2 days of hospital admission in the 16 weeks before and after the national quarantine, respectively. One-day surgery went from 46.0% to 46.5%, and same-day surgery from 13.3% to 12.4%. Unchanged trends were confirmed by ITSA after controlling for the 32-week time-series observed the year before. In the second week of March 2020, there was a borderline significant decrease in weekly hospital admissions for hip fractures as compared with that of the same week of March 2019 (-1.95 per 100 000, 95% CI = -4.10 to 0.21, P value = .075), followed by a weekly significant increase in the hospitalization rate (+0.14 per 100 000, 95% CI = 0.01 to 0.27, P value = .039), although the difference-in-differences of slopes failed to achieve statistical significance (0.19 per 100 000, 95% CI = -0.03 to 0.41, P value = .090). CONCLUSION: Our study shows that the timing of hip-fracture surgery was unchanged during the lockdown period. This suggests that the healthcare systems can be resilient and able to guarantee a high-quality and safe healthcare to hip-fracture patients, even in the most challenging working conditions.

Predictive values of symptoms for SARS-CoV-2 infection among primary care patients in Piedmont.

OBJECTIVES: to investigate the combinations of clinical features and symptoms that best predict the positive outcome of the SARS-CoV-2 swab in a primary care setting. DESIGN: prospective cohort study. SETTING AND PARTICIPANTS: patients listed in the rosters of general practitioners volunteering for the study who reported flu-like symptoms and/or anosmia/ageusia between 01.03.2020 and 30.06.2020. MAIN OUTCOME MEASURES: positive molecular swab result. The predictive value of the reported symptoms and their association with this outcome were estimated using multivariable logistic regression models, adopting an inverse probability weighting approach. RESULTS: a swab was requested for 1,045 (77.2%) out of 1,354 patients included in the study: 79.6% of them were tested, with a positive result in 50.4% of cases. Patients aged 40 to 64 years (OR 1.59; 95%CI 1.09-2.33) and those older than 64 years (OR 2.64; 95%CI 1.66-4.19) showed a higher likelihood of a positive swab results, compared with younger subjects (<40 years). A positive association with a positive swab result was observed among patients reporting fever >37.5°C (OR 1.67; 95%CI: 1.18-2.36) and anosmia/ageusia (OR 1.44; 95%CI: 1.01-2.04). The predictive value of fever tended to increase with increasing age, while an opposite trend was observed for anosmia/ageusia. No difference by gender was observed. CONCLUSIONS: among patients reporting flu-like symptoms in a general practice setting, fever >37.5 and anosmia/ageusia were predictive of a positive SARS-CoV-2 swab test result and this association was modified by age. Although the generalizability of these findings might be limited, this study highlights the importance of the contribution of the research conducted in primary care settings to the definition of effective and sustainable strategies to contrast the pandemic emergency.

Evaluation of the Strategies to Control COVID-19 Pandemic in Four European Countries.

On March 11, 2020, the World Health Organization (WHO) has officially declared the novel coronavirus outbreak a pandemic. The national governments deployed a series of severe control measures and a set of public health policies in order to stop the spread of COVID-19 pandemic. The aim of this study is to investigate the correlation between specific interventions and incident cases during the second wave in multiple and specific countries. The observational study was based on data from the Oxford COVID-19 Government Response Tracker (OxCGRT) source retrieved from October 1st, 2020 to January 10, 2021. Thirteen specific indicators related to measures adopted were considered. Four European countries were taken into account: Italy, German, Spain and UK. A vector autoregression (VAR) model and the Granger Causality test were performed to allow for an assessment of any possible effect induced by each control measure against the overall pandemic growth. Wald test was conducted to compute p-values. No correlation between the applied measures and incident cases in the four countries was shown by the Granger causality test. Only closings of workplaces (C2) and limits on private gatherings showed (C4) a significant correlation with incident cases in UK and restrictions on internal movement between cities/regions in Germany. The Granger causality also tested that C2 and C4 forecasted the decrease of incident cases after a time lag of 6-30 days in UK and Germany, respectively. Policy makers must analyze the context in which policies are set because of effectiveness of interventions can be influenced by local context and, especially, by socio-economic and demographic characteristics, and make a proper communication to support the resilience of the population capable of guaranteeing adherence to the interventions implemented.

Prevalence of post-traumatic stress disorder (PTSD) symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave: a cross-sectional survey.

OBJECTIVES: to assess the prevalence of post-traumatic stress disorder (PTSD) symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave and its association with sociodemographic characteristics, housing conditions, and lifestyles modifications. DESIGN: cross-sectional survey. SETTING AND PARTICIPANTS: between 21st April and 7th June 2020, a self-administered online questionnaire aiming at investigating mental well-being and lifestyle habits during the lockdown period was disseminated online. Respondents were recruited through a snowball sampling. MAIN OUTCOME MEASURES: PTSD symptoms were assessed using a validated screening tool, the SPAN (Startle, Physiological arousal, Anger, Numbness) questionnaire. RESULTS: the study population is composed of 6,687 participants, of whom 71.5% were females. The mean age of the sample was 48.7 years. Globally, 43.8% of the participants reported symptoms of PTSD, especially females. PTSD prevalence showed a decreasing trend across age groups. The likelihood of PTSD symptoms was higher among those who increased alcohol consumption, decreased physical activity, and experienced restless sleep. CONCLUSIONS: a high prevalence of PTSD symptoms emerged from this survey, especially among women and younger subjects. Preventive strategies should be implemented to protect the mental health of the most vulnerable citizens in a period of emergency.

The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review.

The primary aim was to evaluate the burnout prevalence among healthcare workers (HCWs) in intensive care units (ICUs) and emergency departments (EDs) during the COVID-19 pandemic. The secondary aim was to identify factors associated with burnout in this population. A systematic review was conducted following PRISMA guidelines by searching PubMed, Embase, PsychINFO, and Scopus from 1 January to 24 November 2020. Studies with information about burnout prevalence/level during the pandemic regarding ICU/ED HCWs were eligible. A total of 927 records were identified. The selection resulted in 11 studies. Most studies were conducted in April/May 2020. Samples ranged from 15 to 12,596 participants. The prevalence of overall burnout ranged from 49.3% to 58%. Nurses seemed to be at higher risk. Both socio-demographic and work-related features were associated with burnout. Many pandemic-related variables were associated with burnout, e.g., shortage in resources, worry regarding COVID-19, and stigma. This review highlighted a substantial burnout prevalence among ICU/ED HCWs. However, this population has presented a high burnout prevalence for a long time, and there is not sufficient evidence to understand if such prevalence is currently increased. It also outlined modifiable factors and the need to improve emergency preparedness both from an individual and structural level.

Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM).

BACKGROUND: Pre-exposure prophylaxis (PrEP) is suitable for high human immunodeficiency virus (HIV)-infection risk people, foremost among whom are males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. No previous study has assessed this issue; Methods: An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour and habits, HIV/acquired immune deficiency syndrome (AIDS) knowledge and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify factors associated with PrEP knowledge; Results: A total of 196 MSM participated in this survey. Overall data showed that 87.2% of participants knew what PrEP is, but only 7.5% have ever used it. The main reason for not using PrEP was the cost of the therapy (26.9%). The principal source of PrEP information was the Internet (68.4%). Being regularly tested for HIV was significantly associated with PrEP knowledge (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions: Knowledge regarding PrEP was well established, but PrEP use was not equally widespread. It is necessary to improve research on PrEP usage in order to PrEP access to be granted.

Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia.

PURPOSE: To evaluate the features of arterial enhancement pattern of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC) by triple-phase arterial magnetic resonance imaging (MRI). METHODS: Data were retrospectively collected from 52 consecutive patients who underwent triple-phase arterial MRI using hepatocyte-specific contrast agents (Gd-EOB-DTPA) from January 2017 to October 2017, with a MR imaging diagnosis of HCC or FNH. The images were independently assessed by two blinded readers. Contrast enhancement ratio (CER) and liver-to-lesion contrast ratio (LLCR) were calculated. The lesions were classified visually and also based on the peak of LLCR into the following groups: (1) early arterial, (2) middle arterial and (3) late arterial. Data were eventually analysed using nonparametric tests. RESULTS: The CER analysis showed no significant difference between HCC and FNH patients (p > 0.05). LLCRFNH were significantly higher than LLCRHCC in the early arterial (p = 0.01), but not in the middle and late arterial phases (p = 0.20 and p = 0.82, respectively). LLCRHCC presented a meaningful increase from early to middle arterial phase (p = 0.009), whereas LLCRFNH showed a decrease from middle to late arterial phase (p = 0.004). Based on the peak of LLCR, 17 (55%) FNHs were classified into early, 11 (35%) in middle and only 3 (10%) in late arterial phase groups. Similarly, 14 (34%) HCCs were categorized into early, 13 (32%) in middle and 14 (33%) in late arterial phase groups. There was a good agreement between qualitative analysis and LLCR in 85% of cases. CONCLUSION: The optimal visualization of FNH has been detected in early and middle arterial phases while HCC has been best observed during middle and late arterial phases.