Incidence of pre-neoplastic and neoplastic lesions of the cervix before and after the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic had significant effects on healthcare systems worldwide, including the disruption of routine screening programs for cervical cancer. This study aimed to compare the incidence of cervical intra-epithelial neoplasia (CIN)2 and CIN3 lesions, adenocarcinoma, and squamous carcinoma of the cervix before and after the COVID-19 pandemic. METHODS: A retrospective analysis was performed using archive data from the Policlinico di Bari, Unit of Gynecology and Obstetrics. The study included patients who tested positive for high-risk human papillomavirus (HPV) at the level I screening test (HPV test) and were subsequently referred to level II screening, which involves the Papanicolaou (Pap) test and colposcopic examination. We excluded individuals who did not comply with the recommended follow-up, patients with low-risk HPV infection, those with autoimmune diseases, oncologic diseases, or those undergoing immunosuppressive therapies. The time period spanned from January 2020 to December 2022. The incidence of CIN2/CIN3 lesions, adenocarcinoma, and squamous carcinoma of the cervix was compared between the pre-screening period (2017-2019) and the post-screening period (2020-2022). RESULTS: The study comprised a cohort of 1558 consecutive European sexually active women with a median age of 34 years (range 25-65) who underwent colposcopic evaluation of the uterine cervix as a level II screening program. The comparison between the pre-screening and post-screening periods showed an increase in the incidence of CIN2/CIN3 lesions, rising from 23.9 to 63.3 per 100 000 (HR 2.62, 95% CI 1.64 to 4.20; p<0.001). Additionally, although there was an absolute increase in the incidence of cervical carcinoma and adenocarcinoma, the comparison did not reach statistical significance (squamous carcinoma: 2017-2019, 2.5 per 100 000; 2020-2022 3.4 per 100 000, p=0.72; adenocarcinoma: 2017-2019, 3.5 per 100 000; 2020-2022 7.6 per 100 000, p=0.24). CONCLUSION: This study showed a significant increase in the incidence rate of CIN2/CIN3 lesions after the COVID-19 pandemic. Our findings may be attributed to the temporary suspension of follow-up programs during the pandemic, although the study does not rule out direct effects of SARS-CoV-2 on the risk of pre-neoplastic and neoplastic conditions of the cervix.

Secondary Structures of MERS-CoV, SARS-CoV, and SARS-CoV-2 Spike Proteins Revealed by Infrared Vibrational Spectroscopy.

All coronaviruses are characterized by spike glycoproteins whose S1 subunits contain the receptor binding domain (RBD). The RBD anchors the virus to the host cellular membrane to regulate the virus transmissibility and infectious process. Although the protein/receptor interaction mainly depends on the spike's conformation, particularly on its S1 unit, their secondary structures are poorly known. In this paper, the S1 conformation was investigated for MERS-CoV, SARS-CoV, and SARS-CoV-2 at serological pH by measuring their Amide I infrared absorption bands. The SARS-CoV-2 S1 secondary structure revealed a strong difference compared to those of MERS-CoV and SARS-CoV, with a significant presence of extended ß-sheets. Furthermore, the conformation of the SARS-CoV-2 S1 showed a significant change by moving from serological pH to mild acidic and alkaline pH conditions. Both results suggest the capability of infrared spectroscopy to follow the secondary structure adaptation of the SARS-CoV-2 S1 to different environments.

High Sensitivity Monitoring of VOCs in Air through FTIR Spectroscopy Using a Multipass Gas Cell Setup.

Human exposure to Volatile Organic Compounds (VOCs) and their presence in indoor and working environments is recognized as a serious health risk, causing impairments of varying severities. Different detecting systems able to monitor VOCs are available in the market; however, they have significant limitations for both sensitivity and chemical discrimination capability. During the last years we studied systematically the use of Fourier Transform Infrared (FTIR) spectroscopy as an alternative, powerful tool for quantifying VOCs in air. We calibrated the method for a set of compounds (styrene, acetone, ethanol and isopropanol) by using both laboratory and portable infrared spectrometers. The aim was to develop a new, and highly sensitive sensor system for VOCs monitoring. In this paper, we improved the setup performance, testing the feasibility of using a multipass cell with the aim of extending the sensitivity of our system down to the part per million (ppm) level. Considering that multipass cells are now also available for portable instruments, this study opens the road for the design of new high-resolution devices for environmental monitoring.

The association between level of personality organization and problematic gaming: Anxiety, depression, and motivations for playing as mediators.

Problematic gaming is a topic of great clinical and social relevance, so it is particularly important to identify its protective and risk factors. Literature already showed that maladaptive personality favors problematic gaming. In the light of Kernberg's model of personality organization, the present cross-sectional study aimed to evaluate the mediational process through which low level of personality organization associates with problematic gaming, exploring the role of depressive and anxious symptoms and of motivations for playing. A sample of 1036 video gamers filled in an online survey regarding: level of personality organization; depressive and anxious symptoms; socializing, achievement, and immersion motivations for playing; problematic gaming. The path analysis showed that lower level of personality organization associated with greater problematic gaming and that depressive (but not anxious) symptoms, and socializing and achievement (but not immersion) motivations positively mediated this relationship. Furthermore, results showed that psychopathological symptoms and achievement motivations sequentially mediated the relationship between low level of personality organization and problematic gaming, highlighting that depressive symptoms secondary to a low level of personality organization could lead to a risky use of video games, i.e., they could push to use video games to self-enhance oneself, a dysfunctional strategy that exposes to problematic gaming. The study gives some indications on the variables that associate with problematic gaming and has some practical relevance, providing suggestions in the design of effective problematic gaming prevention and treatment interventions.

Heteronormativity and the Justification of Gender Hierarchy: Investigating the Archival Data From 16 European Countries.

Within the framework of the System Justification Theory, this study tested on the archival data from 16 European countries the general hypothesis that homonegativity (HN), as an expression of gender binarism and heteronormativity, works as a legitimizing myth of gender hierarchy. Specifically, we hypothesized that (1) system justification (SJ) would positively relate to HN and (2) this relation would depend on the country level of gender hierarchy, (3) on the gender of respondents, and (4) on the interaction between gender hierarchy and gender. We selected the Gender Equality Index (GEI) as an indicator of the gender hierarchy of the country system and the items from the European Social Survey-Round 9 (ESS-9) as the indicators of the gender of respondents and the levels of SJ and HN. The Hierarchical Linear Modeling (HLM) partially confirmed the hypotheses, suggesting HN to work as a blatant prejudice and being more viable as a legitimizing myth in females from countries with higher gender hierarchy and in males from more gender-equal countries. In both cases, HN serves as a myth to justify the ontological premise of participants that the world is fair and to counteract the cognitive dissonance generated by the perception of a gender-unequal system (in the case of a woman) or by the perception of a gender-equal system that can threaten gender privileges (in the case of a man).

The Cassandra Experience: A Mixed Methods Study on the Intragroup Cognitive Dissonance of Italian Expatriates During the First Wave of COVID-19.

In March 2020, Italy was the first European country to be hit severely by the first wave of coronavirus disease 2019 (COVID-19) and to put in place moderate-high containment measures. 594 Italian expatriates participated in a cross-sectional mixed-methods survey focusing on the period that goes from the beginning of March 2020 to the beginning of April 2020. The survey aimed to describe the experiences of participants when it comes to conflicting beliefs and behavior with the Italian or host country communities in relation to COVID-19, using the Intragroup Cognitive Dissonance (ICD) framework. We explored: (1) COVID-19 risk perception (assessed for themselves, the Italian community, and the host country community); (2) COVID-19 risk meta-perception (participants' perception of the Italian and host country communities' risk perception); (3) intensity of emotions (assessed for themselves); (4) national group identification (assessed for themselves in relation to the Italian and host country communities) before and after the first wave of COVID-19 in Italy. An inductive thematic analysis of three open-ended questions allowed an in-depth understanding of the experiences of Italian expatriates. Results describe the ICD of participants with the Italian or host country communities, expressed as a difference between COVID-19 risk-perception and risk meta-perception. ICD predicts that when a dissonance of beliefs and behavior is experienced within an individual's group, a shift in identification with another more consonant group will happen, if identity enhancing strategies with the dissonant group are unsuccessful. Our findings showed that when the ICD was experienced with the host country community, this was solved through a disidentification strategy and mediated by negative emotions. Identity enhancing strategies with the host country community were unsuccessfully enacted as described by the qualitative answers of participants referring to episodes of racism, ridicule, and to a Cassandra experience: predicting a catastrophic future without being believed. Unexpectedly, participants experiencing the ICD with the Italian community did not enact a disidentification strategy. An increase in virtual contacts, enhanced sense of belonging, a stronger identification baseline, and different features of the two ICDs can be responsible for these results. This study sheds light on the relevance of ICD in natural settings and on international communities, during global crises.

Support for rejection and reception policies toward asylum seekers in Italy: The role of conservative ideologies and legitimizing myths.

Based on Social Dominance Theory (SDT), this study investigates the relationships between ideologically conservative attitudes (social dominance orientation, SDO; right-wing authoritarianism, RWA), legitimizing myths (false belief in asylum seekers as bogus; perception of in-group threats), and citizens' support for restricted reception and rejection of asylum policies. A sample of 539 people living in Italy filled in an anonymous questionnaire administered using a cross-sectional design. The results support the expectations, showing that people high in SDO and RWA were more likely to hold the belief that asylum seekers are making false claims and to perceive that the latter pose a threat to the in-group, which in turn increased support for both of restrictive policies. Findings suggest that conservative ideologies can positively affect citizens' support for restrictive asylum seeker policies based on both rejection and restricted reception by supplying ideological justification for not accommodating them in the host society.

The opportunities and risks of mobile phones for refugees' experience: A scoping review.

Although mobile phones (MPs) are inexorably changing the forced migration experience, the realm of digital migration studies is still fragmented and lacking an analytical focus. Many research areas are still unexplored, while no narrative, scoping or systematic reviews have been conducted on this topic to date. The present review analyzed scientific contributions in Humanistic and Social Sciences with the aim to provide an overview of existing studies on the role of mobile phones (MPs) on refugees' experience, and to inform practice and policymaking for advancing the use of MPs for the protection of migrants' human rights. A scoping review was conducted using the Arksey and O'Malley framework and the JBI Reviewer's Manual recommendations. A three-step search was carried out in four bibliographic databases by three independent reviewers. Review selection and extraction were performed using an interactive team approach. Forty-three theoretical and empirical contributions were selected, and their content analyzed. The contributions ranged from 2013 to 2018 and varied in terms of disciplines, objectives, methodology, contexts, and migrants' origin, with the most studied group being Syrians. Five different topics concerning refugees' experience and MPs' usage emerged: (a) media practices in refugees' everyday lives; (b) opportunity and risks of MPs during the migration journey; (c) the role of MPs in maintaining and developing social relations; (d) potential of MPs for refugees" self-assertion and self-empowerment; (e) MPs for refugees' health and education. The results showed that modern devices, such as mobile phones, bring both risks and opportunities for refugees' experience, thereby both favouring and threatening asylum seekers' and refugees' human rights. Recommendations to policymaking and services and associations for advancing the use of MPs for the protection of the rights of migrants have been proposed.

Maladaptive Personality Functioning and Psychopathological Symptoms in Problematic Video Game Players: A Person-Centered Approach.

BACKGROUND: A need exists to increase our understanding of the association between maladaptive personality traits, psychopathological symptoms, game preference, and different types of video game use. In the present study, we used a person-centered approach to identify different subtypes of video game players and we explored how they differ in personality profiles, clinical symptoms, and video game usage. METHODS: We assessed problematic gaming via the nine-item Internet Gaming Disorder Scale and self-reported screen time playing video games in a sample of 366 adolescents and young adult gamers. Participants also completed measures on maladaptive personality domains (Personality Inventory for DSM-5 Brief Form), alexithymia (Toronto Alexithymia Scale-20 items), and psychopathological symptoms (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure) and reported which genre of video games they preferred. RESULTS: Using a person-centered, cluster-analytic approach, we identified four clusters of video game players (Occasional, Passionate, Preoccupied, and Disordered) presenting peculiar combinations of problematic gaming scores and time spent online playing video games. Non-problematic gamers (Occasional and Passionate) represented the majority of the sample (62.3% of the participants). Highly involved gamers who exhibited excessive screen time playing video games (Disordered gamers) presented the highest level of maladaptive personality traits and psychopathological symptoms, and were characterized by the greatest use of Multiplayer Online Battle Arena (MOBA) games. CONCLUSION: These results have clinical implications on suggesting the importance to determining whether or not problematic gaming activities reflect a dysfunctional emotion-focused coping strategy to avoid inner unpleasant emotional or a more generally compromised emotional and social functioning.

Settlement approaches in the Italian Asylum System from the point of view of health professionals and social workers.

BACKGROUND AND AIM: Medical and inclusion/exclusion settlement approaches are the two main approaches characterizing the reception practices into the Western host societies. These settlement approaches guide how professionals take care for forced migrants and favor or obstacle autonomy and integration of asylum seekers and refugees into host societies. Still, few studies have analysed how professionals perceive the settlement approaches that guide their work with forced migrants. This study aimed to analyse the representations that a sample of 256 Italian health professionals and social workers working in both governmental and non-governmental organisations had of the settlement approaches that guided their work in the Italian Asylum System (IAS). METHODS: Semi-structured interviews were conducted and content and lexically analysed, focusing on the professionals' perceptions of the critical issues in the access of forced migrants into the IAS services. RESULTS: Professionals perceived four types of critical issues, making more often reference to organisational weakness than to legal-normative-procedural, relational, and professional weakness. Such critical issues linked to four different perceptions of settlement approaches -social exclusion, medical, relational, and organisational- that guided, sometimes simultaneously, the professionals' practices depending on the work area, the institution/association in which they worked, and their role in the organisation. Conclusion and practical implications: Guiding the professionals' work, settlement approaches could favor or obstacle autonomy and integration of asylum seekers and refugees into host societies. The results may inform policy and future services highlighting potential prospects for services oriented toward autonomy and integration of this growing population.

Does the readiness for interprofessional education reflect students' dominance orientation and professional commitment? Evidence from a sample of nursing students.

BACKGROUND: Interprofessional education is an important factor in facilitating subsequent interprofessional collaboration. Therefore, implementing this teaching strategy is important to increase the chances that future professionals will work effectively together. Group membership, status and the power differential among professional groups are factors that can hinder both interprofessional education and collaboration. From a psychosocial point of view, interprofessional education may be described as an intergroup context in which members of different status groups interact. It involves at least two main psychosocial processes: commitment to the profession and acceptance or challenge of interprofessional hierarchy. OBJECTIVES: The purpose of this research was to analyse the effects of professional commitment and social dominance orientation on attitudes toward interprofessional education. DESIGN: A cross-sectional design was conducted. PARTICIPANTS: A total of 137 nursing science students from an Italian university were enrolled in this research. METHODS: Participants were surveyed using a questionnaire measuring attitudes toward interprofessional education, professional commitment and social dominance orientation. RESULTS: The more that students showed social dominance orientation, the less they were willing to engage in interprofessional education. This effect was qualified by an interaction with professional commitment. When professional commitment was higher, social dominance orientation was weakly related to attitude toward interprofessional learning. CONCLUSIONS: These results suggest that there is a belief that professional hierarchy is deserved and that this may decrease a nursing student's engagement in interprofessional education; however, this may be contrasted by an increased professional commitment.

Does contact at work extend its influence beyond prejudice? Evidence from healthcare settings.

This article reports on two studies investigating the role of intergroup contact on the reduction of prejudice against migrants and on organizational and health outcomes. Study 1 enrolled 624 native healthcare professionals and showed that frequent and positive contact with non-native co-workers was associated with a decrease in the professionals' prejudice and an increase in the professionals' perception of team functioning. These effects were mediated by reduced in-group threat perception. Study 2 enrolled 201 native patients and showed that frequent and positive contact with non-native healthcare providers was associated with a decrease in patients' prejudice and an increase in patients' satisfaction for the care received. These effects were mediated by reduced in-group threat perception. These novel findings showed that frequent and positive contact with non-native individuals can improve health and organizational outcomes along with facilitating positive intergroup relations.

Variants of biculturalism in migrant and host adolescents living in Italy and Spain: Testing the importance of life domains through the Relative Acculturation Extended Model.

Several variants of biculturalism have recently been proposed (Schwartz, Birman, Benet-Martínez, & Unger, 2016). Nevertheless, few studies have identified different types of bicultural individuals, and no one has addressed the possibility that these types could depend on acculturation domains. By using the Relative Acculturation Extended Model (RAEM), this study aimed to explore if different variants of biculturalism could be individuated, and if some of these variants were sensitive to life domains. Four samples of migrant and host adolescents living in Italy (n = 173 and n = 186) and Spain (n = 139 and n = 156) answered a questionnaire about acculturation perceptions and preferences in central and peripheral life domains. Together with acculturation options consistent with Berry's (1997) model (full-assimilation, full-separation and full-marginalisation), some variants of biculturalism emerged from the latent class analysis: full-high and full-low integration, which were not sensitive to life domains; and "alternate" acculturation options that were sensitive to life domains, with participants switching from their original culture to the host culture according to the peripheral and central domains. Acculturation options varied across the four samples, with Italians switching more from one culture to another, and Spanish adolescents being more full-high or full-low integrated.

Intergroup contact and team functioning among nursing students: the mediation role of intergroup anxiety.

BACKGROUND AND AIM OF THE WORK: The improvement of team effectivity is one of the main concerns for healthcare organizations. Moreover, healthcare organizations must cope with increasing multicultural composition of both workforce and patients. The intergroup contact theory suggests that frequent and positive face-to-face contact among professionals or students with different cultural heritage can help to reach both increasing team effectiveness and adequate care in a multicultural setting. The aim was then to verify whether intergroup contact during practical training would decrease intergroup anxiety and then increase team functioning. METHODS: A cross-sectional design was used in which a questionnaire was delivered to 83 nursing students. RESULTS: According to the intergroup contact theory, frequent and positive contact with non-native professionals decreased the intergroup anxiety which, in turn, increased prejudice and, more importantly, decreased team functioning. Moreover, intergroup anxiety showed a complete mediation effect on the relations between intergroup contact during practical training and both negative attitude toward immigrants and team functioning. CONCLUSIONS: Intergroup contact with non-native professionals or students during practical training is able to indirectly decrease prejudice and improve team functioning by lowering the anxiety that is aroused by encounter with non-native individuals.

The role of ingroup threat and conservative ideologies on prejudice against immigrants in two samples of Italian adults.

This research investigated the relationship among perception of ingroup threats (realistic and symbolic), conservative ideologies (social dominance orientation [SDO] and right-wing authoritarianism [RWA]), and prejudice against immigrants. Data were collected with a cross-sectional design in two samples: non-student Italian adults (n = 223) and healthcare professionals (n = 679). Results were similar in both samples and indicated that symbolic and realistic threats, as well as SDO and RWA, positively and significantly predicted anti-immigrant prejudice. Moreover, the model considering SDO and RWA as mediators of threats' effects on prejudice showed a better fit than the model in which ingroup threats mediated the effects of SDO and RWA on prejudice against immigrants. Accordingly, SDO and RWA partially mediated the effect of both symbolic and realistic threats, which maintained a significant effect on prejudice against immigrants, however.

The Role of Rigidity in Adaptive and Maladaptive Families Assessed by FACES IV: The Points of View of Adolescents.

Previous studies using Olson's Circumplex Model and FACES IV, the self-report assessing family functioning, did not clarify the role of rigidity, a dimension of this model. Rigidity emerged as ambiguous: it was considered either as a functional or as a dysfunctional dimension. Building upon the results of previous studies, we provided a contribution intended to disambiguate the role of rigidity considering adolescents' perceptions and using a non-a priori classification analysis. 320 Italian adolescents (13-21 years) participated in this study and responded to a questionnaire containing scales of the study variables. A latent class analysis was performed to identify the association of rigidity with the other dimensions of Olson's model and with indicators of adaptive family functioning in adolescence: parental monitoring and family satisfaction. We found six clusters corresponding to family typologies and having different levels of functioning. Rigidity emerged as adaptive in the typologies named rigidly balanced and flexibly oscillating; it was associated with positive dimensions of family functioning, i.e. flexibility, cohesion, parental monitoring, and high levels of family satisfaction. Differently, when rigidity was associated with disengagement, low cohesion and flexibility, and lack of parental supervision, emerged as maladaptive. This was the case of two typologies: the rigidly disengaged and the chaotically disengaged. Adolescents of these families reported the lowest levels of satisfaction. In the two last typologies, the flexibly chaotic and the cohesively disorganized, rigidity indicated a mid-range functionality as these families were characterized by emotional connectedness but lack of containment. Clinical implications are discussed.

The role of professional and team commitments in nurse-physician collaboration.

AIM: To analyse the effect of both professional and care unit commitments on attitudes towards interprofessional collaboration between nurses and physicians. BACKGROUND: The effects of both professional and care unit commitment on inter-professional collaboration have not been taken into account together, and previous research has analysed only one profession at a time, neglecting the nurse-physician comparison. METHOD: A cross-sectional survey of 138 physicians and 359 nurses was used. RESULTS: For physicians, professional commitment decreased attitudes towards interprofessional collaboration whereas care unit commitment had a positive influence. Conversely, for nurses, the professional commitment had a significant positive effect on attitudes towards interprofessional collaboration whereas care unit commitment had no significant effect. CONCLUSION: Intergroup relations affect the extent to which nurses and physicians are inclined to engage in interprofessional collaboration. Professional and care unit commitments had different effects on attitude toward the inter-professional collaboration of nurses and physicians. IMPLICATION FOR NURSING MANAGEMENT: Inter-professional collaboration is affected by the relationship between physicians and nurse at the professional group level. Managers who want to change and improve inter-professional collaboration should pay close attention to the interplay between changes they are introducing and well-established identities and practices between professionals.

Bio-clinical and psycho-social nursing practice. An experimental research in an Intensive Coronary Care Unit.

BACKGROUND AND AIM: The literature on patients with cardiovascular disease emphasizes the importance of providing a bio-medical and a psycho-social nursing care during the three phases of the nursing process (acceptance, assistance, education). How is his multidimensional nursing approach actually used during nursing practice? The present study aimed to evaluate the effects of a nursing educational training and it was finalized to implement a multidimensional care practice of nurses working in Intensive Coronary Care Unit (I.C.C.U.). METHOD: The entire nursing staff of the I.C.C.U of Parma Hospital (N = 17) took part in the research and it has been randomized in two subgroups. A group of 9 nurses participated as experimental group. They filled up a semi-structured questionnaire investigating the bio-clinical and psycho-social nursing activities, before (pre-test, time 1) and after (post-test, time 2) a professional training. 8 nurses participated as control group. They filled out the same questionnaire (at the time 1 and 2), but they did not participate at the professional training. RESULTS: Results indicated how the nursing practice was more related to the bio-clinical (e.g. blood pressure) than to the psycho-social (e.g. mood) activities at the time 1. After the professional training (time 2), only the experimental group changed its professional practice, by integrating the bio-medical with the psycho-social nursing. CONCLUSIONS: The data showed the importance to promote a multidimensional educational path for nurses that assess the impact of the professional training on the professional practice, in order to improve the quality of care delivered to patients affected by cardiovascular disease.

Ambivalent stereotypes of nurses and physicians: impact on students' attitude toward interprofessional education.

BACKGROUND AND AIM OF THE WORK: Nurse-physician stereotypes have been proposed as a factor hindering interprofessional collaboration among practitioners and interprofessional learning among nursing and medical students. Using socio-psychological theories about ambivalent stereotypes, the present work aimed to analyse: a) the content of nurse and physician stereotypes held by nursing and medical students and b) the role of auto-stereotype on students' attitude toward interprofessional education (IPE).  Methods. A cross-sectional on-line survey was adopted and a questionnaire was emailed to 205 nursing students and 151 medical students attending an Italian university. RESULTS: Nursing and medical students shared the stereotypical belief that nurses are warmer but less competent than physicians. Nurses and physicians were basically depicted with ambivalent stereotypes: nurses were seen as communal, socially competent and caring but less competent, not agentic and less autonomous, while physicians were seen as agentic, competent and autonomous, but less communal, less collectivist and less socially competent. Moreover, a professional stereotypical image impacted the students' attitude toward IPE. More precisely, when nurses and physicians were seen with classic ambivalent stereotypes, both nursing and medical students were less favourable towards interprofessional education programmes. CONCLUSIONS: The content of professional stereotypes of healthcare students was still linked to classical views of nurses as caring and physicians as curing. This seemed to limit students' attitude and intention to be engaged in IPE.

Threats to identity: lipodystrophy and identity changes in people with HIV/AIDS (PWA).

BACKGROUND AND AIM: PWA today have to face new problems associated with their disease state. One of these is tied to bodily changes that are related to HAART (lipodystrophy syndrome, LDS). Applying the Identity Process Theory (Breakwell, 1986), this research aimed to study the impact that LDS body changes may have on the identity of PWA. METHOD: One hundred and eight patients (79 M and 29 F, ranging from 35 to 75 years old) at a North Italian clinic completed a questionnaire composed of scales measuring the perception of threats to the identity of PWA, physicians' and patients' assessment of LDS, time from diagnosis, disclosure and perceived social support. RESULTS: Results showed that lipodystrophy changes represent a new aspect of the disease that PWA need to handle in terms of identity: the changes resulted in 'loss of the self' and constituted a particular threat to the dimension of personal identity whereby bodily changes called more into question the principles of self-esteem and distinctness. LDS, however, lead to a multiple identity threat that is aggravated by patients' perception of the severity of their bodily changes and by the perception of a lack of friendship and social support. CONCLUSIONS: The study highlights how complex, cyclical and dynamic are the effects that HIV status can have on the sick person: they are no longer only clinical, but also psychological and psychosocial.