Estimate and needs of the transgender adult population: the SPoT study.

BACKGROUND: Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population. METHODS: A web-based questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access. RESULTS: A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons. CONCLUSIONS: Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.

Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population.

PURPOSE: Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. METHODS: A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). RESULTS: TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. CONCLUSIONS: Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Effects of hormonal treatment on dermatological outcome in transgender people: a multicentric prospective study (ENIGI).

PURPOSE: The aim of our study was to assess dermatological changes in transgender people after the start of gender-affirming hormonal treatment (GAHT) and to investigate whether various hormonal preparations differently affect dermatological changes in trans AFAB (assigned female at birth) people. METHODS: In a multicenter prospective study, 484 participants (193 assigned male at birth/AMAB and 291 AFAB) were evaluated at baseline (T0), 6 (T1) and 12 months (T2) after the start of GAHT. Hair growth was assessed by the Ferriman-Gallwey (FG) score, acne by the Global Acne Grading Scale (GAGS), and alopecia by the Norwood Hamilton (NH) score. RESULTS: In AFAB people, a significant increase in FG score and NH grade was observed across time, as well as in GAGS score in a subsample of 71 individuals (p < 0.001). Testosterone (T) undecanoate and esters showed a higher increase in hair distribution at T2 vs. T1 as compared to T gel (p < 0.01). T esters showed a significantly higher impact in GAGS score modifications at T1 and at T2 vs. T0 compared to T gel (p = 0.021 and p = 0.003, respectively). In trans AMAB people, a significant decrease of FG score was observed across time (p < 0.001), although 51.3% of individuals still reported an FG score higher than eight after 12 months. CONCLUSION: T treatment increased hair growth, acne and alopecia prevalence in AFAB people, with T undecanoate and esters influencing hair growth more than T gel. Opposite dermatological changes were observed in AMAB people.

Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI).

In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.

SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people.

PURPOSE: Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS: According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS: In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION: In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.

Apparent autistic traits in transgender people: a prospective study of the impact of gender-affirming hormonal treatment.

PURPOSE: We evaluated differences in Autism Spectrum Quotient (AQ) scores between a sample of hormone-naïve transgender and cisgender people and the impact of gender-affirming hormonal treatment (GAHT) on AQ scores across time. Furthermore, we assessed alexithymia and social anxiety as possible mediators of changes in AQ scores. METHODS: A cross-sectional comparison between cisgender and transgender people before GAHT and a prospective study on the effects of GAHT over time were performed. Transgender and cisgender people completed several psychometric tests. A total sample of 789 persons (n = 229 cismen; n = 172 ciswomen; n = 206 transmen; n = 182 transwomen) referring to the Florence and Rome Gender Clinics between 2018 and 2020 was enrolled. Of these, 62 participants referring to the Florence Gender Clinic were evaluated in a prospective study at baseline and 12 months after GAHT. RESULTS: Groups showed significant differences in terms of autistic traits: ciswomen showed lower scores of AQ, while cismen reported higher scores of AQ than all other groups. Transgender individuals showed significant higher levels of Gender Dysphoria (GD), body uneasiness, alexithymia and social anxiety, compared to cisgender ones. No significant differences in general psychopathology were found between groups. Across time, transmen and transwomen showed a significant reduction in AQ scores. The decrease in alexithymia and social anxiety after GAHT did not predict the change in AQ scores. CONCLUSIONS: The autistic traits in our sample may represent an epiphenomenon of GD rather than being part of an Autism Spectrum Disorder (ASD) condition, since they significantly decreased after 12 months of GAHT.

Molecular epidemiology and antimicrobial resistance profiles of Salmonella isolates from dairy heifer calves and adult lactating cows in a Mediterranean pasture-based system of Australia.

Dairy cows can be reservoirs of foodborne pathogens such as Salmonella that pose serious public health risks to humans. The study was designed to examine the molecular epidemiology and antimicrobial resistance profiles of Salmonella isolates from dairy heifer calves and adult lactating cows in the pasture-based system of Australia. A total of 838 animals (328 heifer calves and 510 lactating cows) from 22 farms were sampled. Overall, 54 Salmonella isolates were recovered (calves 28/328 and cows 26/510). A herd-level Salmonella prevalence of 50% (95% confidence interval: 31%-69%) was recorded. Within-herd prevalence for Salmonella ranged between 4%-29% and 4%-45% among the heifer calves and adult lactating cows, respectively. Three different serovars were identified with Salmonella Infantis being the most common serovar (n = 33, 61%) followed by Salmonella Kiambu (n = 20, 37.0%) and one isolate of Salmonella Cerro (2%). The highest antimicrobial resistance prevalence of Salmonella isolates was found against streptomycin (n = 31, 57%), followed by cefoxitin (n = 12, 22%), ceftriaxone (n = 2, 4%), and chloramphenicol (n = 1, 2%). Multiple class resistance was observed on 4 isolates against cefoxitin, chloramphenicol, and streptomycin. Multilocus sequence types ST32 (61%), ST309 (37%), and ST367 (2%) were strongly linked to the serovars Salmonella Infantis, Salmonella Kiambu, and Salmonella Cerro, respectively. Whole genome sequencing of Salmonella isolates detected only 2 resistance genes: aac(6') gene that confers resistance against aminoglycosides among 40.7% of the isolates, and a single isolate positive for the blaDHA-16 gene. Two distinct clusters among the serovars were observed suggesting 2 independent sources of spread. Despite the low prevalence of antimicrobial resistance among Salmonella from the dairy farms, our findings contribute to the regional and national understanding of antimicrobial resistance in dairy herds in Australia. There is need for continued antimicrobial resistance stewardship and surveillance programs to ensure the production of high-quality food products and the long-term protection of both animal and human health.

A survey of calf rearing practices in the south-west region of Western Australia.

AIMS: To gather data on the calf management and rearing practices of a subset of dairy farmers in the south-west region of Western Australia. METHODS: A 30-minute face-to-face survey was conducted with dairy cattle producers in the south-west region of Western Australia from April-June 2019 to determine pre-weaning calf rearing practices. Participation was voluntary, using a self-selected subset of dairy farmers registered with a regional extension group. The questionnaire assessed three broad categories: farm demographics, colostrum harvesting and management and calf rearing practices. RESULTS: The study response rate was 34/140 (24%). The following key areas were identified where there were deviations from recognised best practice: Precalving: no transition diet was fed pre-calving on 4/34 (12%) of farms, and on a further 5/34 (15%) it was fed for less than 3 weeks; mixing of heifers and adult cows in the calving paddocks occurred in 24/34 (70%) of the farms, with 15% (5/34) of the farms using calving induction. During calving 14/34 (41%) of the farms did not disinfect navels of new-born calves; although 23/34 farmers stated that they collected calves within 6 hours of birth, data on frequency of calf pick-up (2/34 did not separate calves and dams and 19/34 picked up only once per day) indicated that on 21/34 farms (62%) the reality was that calves were picked up >12 hours after birth. Colostrum quality was not assessed appropriately on 18/34 (53%) farms and farmers overestimated how soon after birth it was administered: 23/34 (68%) reported feeding it within 6 hours of calving, despite 62% picking up calves >12 hours after calving. Regarding calf rearing practices, no pain relief before or after dehorning was used on 20/34 (59%) farms, calf bedding was removed infrequently (

Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS).

Premature ejaculation (PE) is the most prevalent male sexual dysfunction, and the most recently defined. PE is often mistakenly considered a purely psychosexological symptom by patients: the lacking awareness in regards to the pathophysiology and treatments often lead to resignation from the patients' side, making PE the most underdiagnosed sexual complaint. However, an ever-growing body of evidence supporting several organic factors has been developed in the last decades and several definitions have been suggested to encompass all defining features of PE. In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), we propose 33 recommendations concerning the definition, pathophysiology, treatment and management of PE aimed to improve patient care. These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions, such as prostate inflammation, endocrine disorders, and other sexual dysfunctions, and suggest how to associate pharmacotherapies and cognitive-behavioral therapy in a couple-centered approach. New therapeutic options, as well as combination and off-label treatments, are also described.

5α-Reductase-2 deficiency: is gender assignment recommended in infancy? Two case-reports and review of the literature.

PURPOSE: Gender assignment represents one of the most controversial aspects of the clinical management of individuals with Differences of Sex Development, including 5α-Reductase-2 deficiency (SRD5A2). Given the predominant female appearance of external genitalia in individuals with SRD5A2 deficiency, most of them were assigned to the female sex at birth. However, in the last years the high rate of gender role shift from female to male led to recommend a male gender assignment. METHODS: We here describe two cases of subjects with SRD5A2 deficiency assigned as females at birth, reporting their clinical histories and psychometric evaluations (Body Uneasiness Test, Utrecht Gender Dysphoria Scale, Bem Sex-Role Inventory, Female Sexual Distress Scale Revised, visual analogue scale for gender identity and sexual orientation) performed at the time of referral at the Florence Gender Clinic. RESULTS: Both patients underwent early surgical interventions without being included in the decision-making process. They had to conform to a binary feminine gender role because of social/familiar pressure, with a significant impact on their psychological well-being. Psychometric evaluations identified clinically significant body uneasiness and gender incongruence in both subjects. No sexually related distress and undifferentiated gender role resulted in the first subject and sexually related distress and androgynous gender role resulted in the second subject. CONCLUSIONS: The reported cases suggest the possibility to consider a new approach for gender assignment in these individuals, involving them directly in the decision-making process and allowing them to explore their gender identity, also with the help of GnRH analogues to delay pubertal modifications.

The effects of herd size on the welfare of dairy cows in a pasture-based system using animal- and resource-based indicators.

Animal welfare assessments were conducted on 50 Australian pasture-based dairy farms of varying herd sizes: 16 small (<300 cows), 15 medium-sized (300-500 cows), 11 large (501-750 cows), and 10 very large (751+ cows). A protocol based on elements of Welfare Quality adapted for Australian conditions was developed to assess the broad categories of good feeding, housing, health, and appropriate behavior. Farm records, body condition scores, integument injuries, fecal plaques, avoidance distance of humans, and fecal pat scoring for acidosis assessment were undertaken. The mean maximum kilograms of grain fed per day significantly increased with herd size, from 5.2 ± 0.38 (small), 7.7 ± 0.29 (medium-sized), 8.8 ± 0.45 (large), to 10.1 ± 0.80 kg (very large). Acidosis was not related to herd size based on either farm records or fecal pat scoring. All cows had access to water for more than 12 h in a 24-h period. More larger farms had water points on the farm tracks or at the dairy. Very large farms (90%) were more likely than others (36-39%) to provide water suitable for human consumption. Integument lesions were not related to herd size and were uncommon; 56 and 84% of farms had no cows with lesions or hairless areas, respectively, and no farm had >6% integument lesions. Heat stress is an important welfare risk in Australia. All farms had some form of cooling strategy; shade in all paddocks was more common on smaller farms (>90%) than others (<75%). Sprinklers were more common on large or very large farms (>80%) than others (<65%). Mastitis and lameness were the most common health conditions, followed by dystocia, downer cows, and gastrointestinal diseases. Prevalence of lameness, mastitis, downer cows, dystocia, and gastrointestinal disease were not related to farm size. Larger farms were more likely to have electronic infrastructure to monitor or electronically draft cows for inspection. We found wide variation in the avoidance distance of humans, but this was not related to farm size. Larger farms had longer walking distances to pasture and longer time away from pasture, which could affect the time available for behaviors such as lying down. Animal welfare risks differ on Australian farms compared with housed cattle. As animal welfare is multidimensional, both animal- and resource-based indicators can be useful. Animal-based indicators have strengths in that, when measured accurately, they genuinely reflect the outcome being measured, but they also have weaknesses in that the point-estimate of a disease prevalence on a given day may not be representative of other times of year or differences in case definition may exist when farm records are used. Similarly, resource-based indicators have strengths in that they may be applicable to longer periods, but weaknesses because the fact a resource is present does not guarantee it is being used. Identifying the major risks to animal welfare on individual farms and ensuring a plan is in place to effectively manage them should be an important element of any on-farm animal welfare assessment protocol.

Lame cows on Australian dairy farms: A comparison of farmer-identified lameness and formal lameness scoring, and the position of lame cows within the milking order.

On Australian pasture-based farms, where cows may often walk several kilometers and stand for several hours per day in a crowded concrete yard while they wait to be milked, the potential for lameness to negatively affect animal welfare is of ongoing concern. Several studies have shown that farmers tend to underestimate the incidence of lameness. Further, improving farmer diagnosis/identification of lameness is likely to result in more prompt treatment, which in turn will improve clinical and animal welfare outcomes. We scored 19,154 cows over 50 farms for lameness, in herd groups ranging from approximately 100 to 1,000 cows, as they left the milking parlor. We compared these results with farmer-diagnosed lameness records on the same day. We used a scoring system of 0, walks normally; 1, walks unevenly; 2, lame; and 3, very lame. All very lame cows had been detected by the farmer, but overall, farmers detected only 24% of cows identified by lameness scoring. An analysis of the position of lame cows within the milking order showed that lameness scoring of the entire herd was necessary to detect all the lame cows as only 60% of lame cows appeared in the last 30% of cows to be milked. However, lameness scoring only the last 200 cows to be milked could be used as a screening test to identify herds with a lameness prevalence below a given threshold.

Associations between immune competence, stress responsiveness, and production in Holstein-Friesian and Holstein-Friesian × Jersey heifers reared in a pasture-based production system in Australia.

The objectives of this study were to assess antibody and cellular immune responses in first-lactation dairy heifers reared under a pasture-based production system and to investigate associations between immune competence and stress responsiveness, health, and productivity. A commercial vaccine was used to induce antibody and cellular immune responses and, based on measured responses, animals were classified as above average, average, and below average for each trait independently and in combination (overall immune competence). Overall immune competence phenotypic rankings were generated by combining standardized residual values for antibody and cellular responses measured in individual heifers. Cortisol responses to handling and yarding were used to assess stress responsiveness, worm egg counts were used to assess internal parasite burden, somatic cell counts to assess udder health and estimates of total daily milk volume, and milk fat and milk protein contents to assess productivity. A total of 393 Holstein-Friesian and Holstein-Friesian × Jersey crossbred heifers from 2 herds practicing seasonal calving in a pasture-fed production system were enrolled in the study. The immune competence phenotypes of individual heifers were assessed before their first mating and their subsequent performance during their first lactation was monitored. Animals with below-average antibody and cellular immune competence had higher serum cortisol concentrations compared with their counterparts following handling, suggesting they had a reduced ability to cope with management-induced stress. Furthermore, a significant negative (favorable) correlation was observed between antibody responses and stress responsiveness. Similarly, correlations between antibody responses and internal parasite burden were significant and negative (favorable). No correlations were observed between overall immune competence and milk yield, milk fat, and milk protein content.

Clinical findings from 104 cases of calving paralysis in dairy cows from Gippsland, Australia.

Case History: Dairy cows recumbent following calving on farms in South Gippsland, Australia were examined during two 3-month seasonal calving periods in 2011 and 2012 as part of a larger study of 218 recumbent cows. A cohort of 104 cows diagnosed with calving paralysis following dystocia was derived from the larger group, which were examined with 3 days of becoming recumbent. A thorough medical and musculoskeletal clinical examination was performed on each cow including flexor-withdrawal and patellar reflex tests, and postural assessment in the lifted position, unless the facilities were not available. Cows were diagnosed with one or more neurological syndromes: sciatic, tibial paresis, obturator or femoral, based on clinical findings consistent with damage to these peripheral nerves or their nerve roots. Clinical Findings: Evidence of sciatic syndrome was found in 100/104 (96.2%) cows and 146/172 (84.9%) affected hind limbs either as the sole neuropathy or in combination with tibial paresis, obturator or femoral syndromes. Pelvic damage was also present in 3/104 (2.8%) cows. Obturator syndrome was diagnosed in 30/104 (29%) cows and 45/172 (26.2%) affected hind limbs but not apparently as the sole reason for the recumbency. Femoral syndrome occurred in 16/104 (15.4%) cows and 21/172 (12.2%) affected hind limbs and was the only syndrome recorded in one cow. Clinical Relevance: Sciatic syndrome was the most common neurological syndrome observed in cows with calving paralysis. The other major nerves arising from the lumbo-sacral plexus were also affected and the various syndromes associated with damage to these nerves or their ventral nerve roots occurred in many combinations. Calving paralysis should be thought of as a paresis or paralysis resulting from damage to the ventral nerve roots of the lumbo-sacral plexus as any of the nerves originating from this plexus can be damaged during dystocia either individually or in combination with other nerves from the plexus.

Implications of prolonged milking time on time budgets and lying behavior of cows in large pasture-based dairy herds.

In large Australian pasture-based dairy herds, it is common for the time taken to milk a herd of cows to be up to 4 h. Cows are collected from the paddock as a group, wait in turn in the dairy yard to be milked, and then return individually to the paddock or feed pad immediately after leaving the milking parlor. In such herds, we previously found a consistent milking order, resulting in some cows being regularly away from pasture for several hours per day more than others. Increased time away from pasture may affect the time budgets of cows because of decreased opportunity for grazing or lying down. Lying behavior is a high-priority behavior for cows, and the duration of lying has been used as an important measure of their welfare. We applied activity monitors for 7 d to 15 cows toward the beginning and 15 cows toward the end of the milking order in 10 dairy herds milking 500 to 730 cows as a single group to understand the effect of extra time spent in the dairy on lying behavior. Study cows typically produced 6,000 to 8,000 L in a 300-d lactation on rotary dairy platforms with 40 to 80 units, being fed 2.5 to 6 kg of grain mix in the milking parlor daily, with the rest of the diet being supplied as pasture or forage provided in the pasture or close to the exit of the dairy. Over the 10 farms, 1,948 cow-days were available for analysis. The furthest paddocks on each farm were 1.8 to 3.5 km walking distance from the dairy. A wide range of steps were taken each day, ranging from 1,705 to 15,075 (mean = 5,916). The main predictor of the number of steps was the farm on which the cows were located. Cows that spent less than an hour waiting to be milked (and would be unlikely to have their ability to lie down affected by the milking process) laid down for a mean of 9.8 h/d. Steps walked and delay in the dairy waiting to be milked were both significantly associated with lying time, but the effect was not large. A regression model accounting for the waiting time at the dairy, steps taken, cow age, and farm was used to investigate the relationship with daily lying time. For every 1,000 steps, lying time reduced by 0.49 h; however, the number of steps explained only 1% of the variation in lying time. For every hour increase in waiting time at the dairy, lying decreased by approximately 14 min, but this explained only 14% of the variation in lying. We concluded that milking time durations of 2 to 4 h, common in large Australian pasture-based dairy herds, did not significantly affect the time budget for lying of individual cows in our study herds. Whereas the effect of long milking times does not appear to be a major risk to animal welfare in terms of lying time, the effect on cow health and production warrants further investigation.

Short communication: Milking order consistency of dairy cows in large Australian herds.

We used on-farm records from dairy infrastructure to examine the consistency of the milking order over 150 d in 5 Australian dairy herds that were milking more than 500 cows as a single group. Within a single day the difference in milking order rank position was less than 20 percentage points for 72% of cows. The correlation coefficient comparing milking rank position in the morning and afternoon was 0.72, with the position of cows at the beginning and end of the milking order being more consistent than cows toward the middle of the milking order. Over a period of 150 d, cows with a mean position in the first and last 20% of the milking order maintained their position more consistently than cows in the middle of the milking order. Milking position of cows between one month and the next was highly correlated (r = 0.88). In large herds, subpopulations of cows are regularly milked toward the beginning and the end of the milking order. It is common for cows to be collected from the paddock as a group, to wait as a group in the dairy yard to be milked, and to return individually to the paddock or feed pad immediately after they have been milked. Thus, cows milked later in the milking order are likely to be away from the paddock for several hours longer than cows milked earlier in the milking order. This may affect their welfare though differences in time available for lying down, equality of pasture eaten, and time spent standing in the dairy yard.

Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers.

PURPOSE: To date, few studies have addressed attitudes toward transgender individuals. In addition, little is known about health care providers' (HCP) attitudes toward sexual minorities. The aim of the present study is to compare attitudes toward homosexual and transgender individuals between gender dysphoric individuals (GDs), general population controls (C) and HCP. METHODS: A total of 310 subjects were considered, including 122 GDs (63 transwomen and 59 transmen), 53 heterosexual HCP (26 males and 27 females) and 135 C. Participants completed the Modern Homophobia Scale (MHS) and the Attitudes Toward Transgendered Individuals Scale (ATTI) in order to assess attitudes toward gay men and lesbian women and toward transgender individuals, respectively. In addition, GDs completed the Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA) and ATTI to measure, respectively, gender dysphoria levels and internalized transphobia. Religious attitudes were evaluated by means of the Religious Fundamentalism Scale (RFS), and Discrimination and Stigma Scale (DISC-12) was used to measure perceived discrimination. RESULTS: (1) Men showed significantly higher levels of homophobia and transphobia when compared to women (p < 0.001); (2) perceived discrimination was higher in lesbian women compared to gay men and in transwomen compared to transmen (p < 0.001 and p < 0.05, respectively); and (3) religious fundamentalism was associated with both homophobia and transphobia (both p < 0.001). CONCLUSIONS: Our results underline the need to promote awareness and acceptance of the sexual minorities, who are more at risk of discriminatory attitudes, which are strongly dependent on religious precepts and dogma.

Psychological characteristics of Italian gender dysphoric adolescents: a case-control study.

PURPOSE: Gender dysphoria (GD) is associated with clinically significant distress and impairment in social, scholastic, and other important areas of functioning, especially when early onset is reported. The aim of the present study is to assess the psychopathological features associated with GD in adolescence, comparing a group of gender dysphoric adolescents (GDs) with a group of non-referred adolescents (NRs), in terms of body uneasiness, suicide risk, psychological functioning, and intensity of GD. METHODS: A sample of 46 adolescents with GD and 46 age-matched NRs was evaluated (mean ± SD age = 16.00 ± 1.49 and 16.59 ± 1.11 respectively, p > 0.05). Subjects were asked to complete the Body Uneasiness Test (BUT) to explore body uneasiness, the Youth Self Report (YSR) to measure psychological functioning, the Multi-Attitude Suicide Tendency Scale (MAST) for suicide risk, and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) for GD assessment. RESULTS: Adolescents with GD reported significantly higher levels of body uneasiness (BUT-GSI, F = 380.13, p < 0.0001), as well as a worse psychological functioning (YSR, F = 13.06 and p < 0.0001 for "total problem scale" and F = 12.53, p = 0.001 for "internalizing" scale) as compared to NRs. When YSR subscales were considered, GDs showed significantly higher scores in the "withdrawal/depression", "anxiety/depression", and "social problems" (all p < 0.0001). In addition, GDs showed significantly higher levels in the "attraction to death" and "repulsion by life" scales and lower scores in the "attraction to life" scale (all p < 0.0001). Finally, GIDYQ-AA score was significantly lower (meaning a higher level of gender dysphoria symptoms) in GDs vs. NRs (p < 0.0001). CONCLUSIONS: GD adolescents reported significantly higher body dissatisfaction and suicidal risk compared to NRs. In addition, results confirmed a significant impairment in social psychological functioning in adolescents with GD.

Cross-cultural and socio-demographic correlates of homophobic attitude among university students in three European countries.

PURPOSE: The aim of this study was to investigate homophobic attitudes in three European countries: Italy, Albania, and Ukraine. One thousand and forty-eight students were recruited in Italian (n = 766), Albanian (n = 180), and Ukrainian (n = 102) university centers. METHODS: A socio-demographic questionnaire and Homophobia Scale (HS) were administered by our staff. RESULTS: Cross-cultural and significant differences among Italian, Albanian, and Ukrainian students were found on the Homophobia Scale (HS; Italy: mean = 22.26 ± 16.73; Albania: mean = 38.15 ± 17.28; Ukraine: mean = 59.18 ± 16.23). The analysis of socio-demographic characteristics revealed that the male gender emerged as main predictor of homophobic attitude in all the three countries, although also a conservative political orientation and the religious belief predict higher homophobia levels in Italy and Albania, particularly. CONCLUSIONS: This study revealed that in these European countries assessed, attitudes toward homosexuality are different. Ukrainians display higher levels of homophobia than Albanians and Italians, confirming the central role of cultural differences in homophobic attitudes. Nevertheless, some socio-demographic aspects such as identification as male have a similar influence on homophobic attitudes in all assessed populations.