The Role of Sense of Coherence During the COVID-19 Crisis: Does it Exercise a Moderating or a Mediating Effect on University Students' Wellbeing?

The COVID-19 crisis caused extensive mental health strains. Sense of coherence (SOC) is considered a protective factor for mental health in crisis that might also be decisive during the COVID-19 pandemic, but the mechanisms are not yet well understood. Using longitudinal survey data of 117 Austrian university students collected in 2020, we tested both moderating and mediating effects of SOC for the association of different stressors with later wellbeing. SOC did not buffer but mediated the effects of stressors on wellbeing. Students especially suffered from reduced feelings of manageability when confronted with financial strains, dissatisfying study situations, or disrupted plans. Supporting them in managing the difficulties of the crisis should therefore be considered a crucial part of psychosocial support.

Using an Intersectional Lens on Vulnerability and Resilience in Minority and/or Marginalized Groups During the COVID-19 Pandemic: A Narrative Review.

Throughout the pandemic, the media and scholars have widely discussed increasing social inequality and thereby publicly pointed to often hidden and neglected forms of inequality. However, the "newly" arisen awareness has not yet been put into action to reduce this inequality. Dealing with social inequality implies exploring and confronting social privileges, which are often seen as the other side of inequality. These social constructs, inequality and privilege, are often discussed in light of vulnerability and resilience. This is particularly important in the context of the worldwide coronavirus disease 2019 (COVID-19) pandemic and efforts to end the pandemic, as both constructs are discussed regarding access to healthcare, vaccination, and education and knowledge, misinformation, social resources, economic resources, and so forth. Minority and/or marginalized groups may be particularly vulnerable to the impact of the COVID-19 pandemic. However, resilience factors in these groups may be neglected and underreported. This narrative review aims at illustrating the specific and intertwined aspects of resilience and vulnerability in minority and/or marginalized groups during the COVID-19 pandemic. To achieve this, we use an intersectional lens based on recommendations made by Moradi and Grzanka. A total of 48 articles were included in the narrative review. Most of them were commentaries focusing on social inequality, vulnerability, and/or resilience. Based on the dissection of articles at structural, systemic, and individual levels, we propose three hypothesis on vulnerability and resilience in minority and marginalized individuals and groups: (1) social inequality must be considered at a global level; inequality at a global level translates into a vulnerable context for an individual; (2) vulnerability is historically situated: vulnerability (experienced during the pandemic) is maintained and reinforced by history; (3) strength through collective (historical) hardship: vulnerability is not the opposite of resilience but may serve as an aspect of resilience. The conclusions drawn from this review show that we need to include diverse voices to advance concepts, such as vulnerability and resilience, in minority and marginalized groups. Additionally, these concepts are not necessarily in opposition to each other, but vulnerability should be understood as an integral part of resilience.

Discovering emotional patterns for climate change and for the COVID-19 pandemic in university students.

The global crises of climate change and of the COVID-19 pandemic are straining young peoples' mental health and their mitigation behaviours. We surveyed German-speaking university students aged 18 to 30 years on their negative emotions regarding both crises repeatedly before and during the COVID-19 crisis. Different emotional patterns emerged for climate change and for COVID-19 with negative emotions regarding COVID-19 increasing during the pandemic. We were further able to differentiate between emotional responses associated with impaired wellbeing and those associated with mitigation efforts. Our findings emphasise the need to focus on a mixture of highly inactivating and activating emotions regarding COVID-19 as they are associated with both reduced wellbeing and mitigation behaviours. The findings broaden the understanding of how young adults react to the burden of two global crises and what role negative emotions play.

Midwives Perceiving and Dealing With Violence Against Women: Is It Mostly About Midwives Actively Protecting Women? A Modified Grounded Theory Study.

Violence against women (VAW) affects pregnancy, birthing, and puerperium. In this sense, domestic violence (DV) or intimate partner violence (IPV) may increase during pregnancy, sexual child abuse may affect the birthing process, and obstetric violence may occur during birthing. Thus, consideration of violence during pregnancy and puerperium is essential to providing optimal care for women. This implies that midwives should be able to identify women affected by VAW. Therefore, this study explored VAW as perceived by midwives in one region of Austria. Interviews with 15 midwives (mean age 38.7 years) were conducted in Tyrol, Austria, between December 2014 and December 2015. Data were analyzed with a modified version of Grounded Theory. The core category "protecting but walking on eggshells" showed the caution with which midwives approached VAW and in particular DV or IPV. Including VAW in midwifery was connected to midwives being active protectors of women in their care. This meant being an intuitive, sensible, guiding, and empowering midwife to the woman. Staying active was necessary to fulfill the protective role also with regard to DV. However, this was influenced by the visibility of the connection between VAW, pregnancy, childbirth, and puerperium. The key to including VAW and particularly DV was midwives' professional role of actively protecting women. Neglecting DV during pregnancy, labor, and puerperium meant further silencing DV, and keeping it hidden. Considering these aspects in planning and implementing actions to prevent VAW is expected to support sustainability and motivation to ask women about all forms of violence during and after pregnancy.

University students' adherence and vaccination attitudes during the COVID-19 pandemic: Focusing on costs and benefits.

Numerous measures were implemented to contain the COVID-19 pandemic. Adhering to these measures as well as getting vaccinated is associated with subjective costs and benefits. Since young people like university students largely feel less vulnerable to the virus, other costs and benefits than health might be more decisive for them. This article combines the results of a qualitative and a quantitative longitudinal study conducted with university students mainly living in Tyrol, Austria. The studies focused on the second wave of infections of the COVID-19 pandemic. Health concerns, altruistic concerns, worrying about the economic consequences of the measures and reactance played an important role for students in deciding what measures to follow and their vaccination attitudes. The effects were partially mediated by understanding the measures' necessity. Qualitative results enabled further insights into thought processes during these decisions and revealed additional aspects, such as concerns about mental health consequences. This research suggests that students make their decisions about adherence and vaccinations based on a variety of aspects that they weigh against each other. Understanding the individual assessments of costs and benefits is crucial to promote both adherence to the measures against the COVID-19 pandemic and vaccination readiness.

Communicative and social competence in the medical curriculum of the Medical University of Innsbruck: learning objectives, content, and teaching methods.

Aim: The Austrian Competence Level Catalogue for Medical Skills clearly states the importance of teaching communicative and social competence in the different subject areas of undergraduate medical and dental education. This paper aims to present an overview of the academic courses at the Medical University of Innsbruck that explicitly address the promotion of communication and social skills in medical students. Method: This paper focuses on educators' descriptions of how communicating with patients is taught. The Medical University's longitudinal curriculum on medical interviewing is presented in detail. The courses on ethical principles in the dissection course, palliative medicine, and gender medicine are also outlined as examples. In addition, lecturers (n=536) participated in an online survey to determine the teaching and testing content regarding patient communication and to measure the value attached to the associated teaching and learning methods. Results: The examples given by educators to illustrate learning objectives, educational content, and the teaching methods used to impart communicative and social competence provide an overview of the courses which focus on this topic or intentionally address it during the course. The results of the online survey offer a broad overview of the awareness of the topic at the university. Different testing formats are used to assess the skills being taught. Conclusion: Familiarity with the various teaching methods used in the different courses is important for developing communicative and social competence in medical education. Active networking is necessary to anchor communicative and social competency as a major thread throughout an entire medical curriculum.

Austrian male patients' gender role conflict is associated with their wish for interpersonal violence to be addressed during patient-physician conversations: a questionnaire study.

BACKGROUND: Experiencing interpersonal violence and disclosing this experience to physicians can be associated with fear, shame, denial or emotional turmoil. Expressions of such feelings additionally conflict with masculine gender role ideologies and may be experienced as masculine gender role conflict. Masculine gender role conflict is often associated with men's unwillingness to seek professional help. The current study analyzed the association between masculine gender role conflict and men's wish for patient-physician conversations to include questions about interpersonal violence they might have experienced. METHODS: In structured closed-ended interviews conducted at an Austrian hospital 129 male patients (Mage = 59.4, SD = 14.7) were asked what forms of interpersonal violence they had experienced. Additionally, a study-specific questionnaire was used to find out whether male patients wanted future physician-patient conversations to include questions about interpersonal violence they might have experienced. Men's gender role conflict was assessed with the Gender Role Conflict Scale-Short Form. RESULTS: Half of the male patients (50%) reported having experienced at least one form of interpersonal violence. Nearly half of the men (48%) wanted their physician to ask them in future about any violence they might have experienced. One pattern of gender role conflict was positively associated with men's wish to be asked in patient-physician conversations about potential interpersonal violence. Namely, men who reported conflicts between work and family relations were more likely to state that they wanted such conversations (OR = 1.6, 95%CI = 1.1-2.4) than were men who did not often experience this pattern of gender role conflict. CONCLUSIONS: Experiences of interpersonal violence should be an important part of physician-patient conversations with male patients. Overall, male patients would welcome their physician initiating a potential conversation about violence. Using an approach that takes consideration of masculine gender role ideologies may further increase some men's willingness to approach the topic of interpersonal violence. Men who adhere to the norm of being preoccupied with work may be more willing to talk about this subject if healthcare situations are framed in a way that men perceive the possibility to uphold masculine gender role ideologies of self-sufficiency or of being in control.

Does diversity go beyond sex and gender? Gender as social category of diversity training in health profession education - a scoping review.

Background: Sex and gender are social categories of diversity. Diversity can be perceived with an intersectional framework as it demonstrates the intersecting categories that might contribute to oppression, inequality, power and privilege. This article focused on what aspects were considered in diversity training programmes for health professions and the role of sex/gender in this context. Method: This scoping review focuses on the social categories mentioned in diversity education of health professionals. Articles on diversity training for health professionals were searched for in the Web of Science database using the keywords gender, diversity, training, education and health professions. Twelve articles were finally included in this review. Thematic analysis was employed to summarise information deduced from articles. Findings: Gaps in the aspects included in diversity training were identified. Findings show that culture was mostly discussed, whereas sex/gender and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) were focused on only to a minor extent. Cultural diversity training includes self-reflection on one's own culture, whereas a comparable tool for sex/gender and LGBTQI is missing. Additionally, other social categories of diversity, such as disability or age, are largely absent. Conclusion: Diversity should be incorporated in its full breadth in health profession education and not fragmented. Additionally, other social categories such as gender might benefit from including self-reflection on these categories in addition to reflecting on the role of power and privilege in order to increase self-awareness for diversity. In this way, othering of the population might be prevented and healthcare can be improved for all.

Dimensions of posttraumatic growth in a German-speaking sample using mixed methods.

Background: Highly adverse events can shatter fundamental assumptions about one's self and the expected course of life actuating a process of adjustment regarding new appraisals. This struggle in the aftermath of adversity might yield posttraumatic growth (PTG), which refers to positive transformation within the person. PTG is a concept that has been established within a Western cultural framework and has both universal and culture-specific characteristics. Although across cultures individuals perceive benefits from their struggles with life crises, the nature of PTG might be coloured by cultural factors. Objective: This study aimed to identify aspects of PTG in a German-speaking sample (Austria and Germany) that are unique to this individualistic culture and not yet covered by the Posttraumatic Growth Inventory (PTGI). Method: We used a convergent parallel mixed methods design. In sum, 188 German-speaking adults were recruited via snowball sampling. They reported on their worst experience ever and completed the PTGI, and 54 participants detailed in open-ended questions possible positive changes additionally to the questionnaire. Results: The existing growth dimensions of the German PTGI were confirmed by participants' qualitative statements. Additionally, qualitative data analysis revealed the elaboration of two PTGI dimensions, and the emergence of two new domains: (1) 'lessons learned', which involves newfound knowledge about oneself and one's life, and (2) 'processing of adversity with potential growth experiences', which illustrates the tightrope walk of growth. Conclusions: The results support Tedeschi and Calhoun's model of the process and outcomes of PTG. By including qualitative methodology this study contributed to (1) revealing culture-specific growth experiences (i.e. different sub-forms of individualism were identified), and (2) underscoring the importance of 'potential growth' so that further promotion of growth is possible at an early stage of processing adversities.

Antecedentes: Los eventos altamente adversos pueden destruir las suposiciones fundamentales sobre uno mismo y el curso de vida esperado, activando un proceso de adaptación con respecto a las nuevas valoraciones. Este conflicto después de la adversidad podría producir un crecimiento postraumático (CPT), que se refiere a la transformación positiva dentro de la persona. CPT es un concepto que se ha establecido dentro de un marco cultural occidental y tiene características tanto universales como específicas de la cultura. Aunque en todas las culturas las personas perciben los beneficios de sus conflictos con las crisis de la vida, la naturaleza del CPT puede verse influida por factores culturales.Objetivo: Este estudio tuvo como objetivo identificar aspectos de CPT en una muestra de habla alemana (Austria y Alemania) que son exclusivos de esta cultura individual y que aún no están cubiertos por el Inventario de crecimiento postraumático (ICPT).Método: Utilizamos un diseño de métodos mixtos paralelos convergentes. En total, 188 adultos de habla alemana fueron reclutados mediante muestreo de bolas de nieve. Informaron sobre su peor experiencia y completaron el ICPT, y 54 participantes detallaron en preguntas abiertas posibles cambios positivos adicionales al cuestionario.Resultados: Las dimensiones de crecimiento existentes del ICPT alemán fueron confirmadas por las declaraciones cualitativas de los participantes. Además, el análisis de datos cualitativos reveló la elaboración de dos dimensiones ICPT y la aparición de dos nuevos dominios: (1) 'lecciones aprendidas', que implica un nuevo conocimiento sobre uno mismo y la propia vida, y (2) 'procesamiento de la adversidad con potenciales experiencias de crecimiento', que ilustra el camino del crecimiento en la cuerda floja.Conclusiones: Los resultados apoyan el modelo de Tedeschi y Calhoun del proceso y los resultados de CPT. Al incluir una metodología cualitativa, este estudio contribuye a (1) revelar experiencias de crecimiento específicas de la cultura (es decir, se identificaron diferentes subformas individualismo) y (2) subrayar la importancia del 'crecimiento potencial', de modo que sea posible una mayor promoción del crecimiento en una etapa temprana de procesamiento de adversidades.

Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University.

INTRODUCTION: The quantity and quality of education in the field of human sexuality vary greatly in medical education programs in the United States and Europe. AIM: The current state of medical school education with regard to human sexuality was assessed at an Austrian medical university. METHODS: Self-constructed questionnaires and the Beliefs About Sexual Functioning Scale were filled out by 391 medical students (mean age = 24.0, SD = 2.5; 52.4% women, 47.6% men). Descriptive statistics are reported for summarizing students' responses, and structural equation models were calculated to reveal associations between variables of interest. MAIN OUTCOME MEASURES: The outcome variable in the structural equation models was students' confidence in addressing sexual health concerns of patients. RESULTS: Most students were not instructed in sexual history taking (96.9%), sexual behavior (94.3%), love (97.4%) or sexuality in elderly persons (95.1%), and they reported having poor knowledge of these topics. Most students (72.5%) reported having little or no confidence in addressing patients' sexual health concerns. The number of addressed topics was positively associated with male (ß = 0.47, P < .001) and female students' (ß = 0.52, P < .001) knowledge. Knowledge was positively associated with male (ß = .49, P < 0.001) and female students' (ß = 0.33, P < .001) confidence in addressing sexual health concerns and was negatively associated with stereotypical sexual functioning beliefs in the male subsample (ß = -0.26, P = .009). CONCLUSIONS: Most medical students revealed that the teaching of important sexual health content (eg, sexual history taking) was deficient at this medical university. Education in sexual health issues needs to be increased to positively influence students' knowledge of and consequently their confidence regarding dealing with patients' sexual health concerns. Komlenac N, Siller H, Hochleitner M. Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University. Sex Med 2019;7:318-325.

Parenthood does not explain the gender difference in clinical position in academic medicine among Swedish, Dutch and Austrian physicians.

Studies have continuously shown that fewer women than men achieve leadership positions in academic medicine. In the current study we explored gender differences in clinical position among academic physicians at three university hospitals, each in a different European country. These countries, Sweden, the Netherlands and Austria, differ in terms of gender equality. We analyzed whether the number of children, working hours or publications could explain gender differences in physicians' clinical position. In this cross-sectional questionnaire study 1333 (54% female) physicians participated. Physicians were asked about their gender, age, number of children, working hours and clinical position. We used structural equation models to explore the influence of gender on the physicians' clinical position in each of the three countries. We explored whether the association between gender and clinical position could be explained by number of children, working hours or publication activity. The analyses revealed that at all three university hospitals gender influenced clinical position. These gender differences in clinical position could be partly explained by gender differences in publication activity. Female physicians as compared to male physicians were likely to publish fewer articles, and in turn these lower publication numbers were associated with lower clinical positions. The number of children or working hours did not explain gender differences in publication activity or clinical position. Therefore, factors other than unequal allocation of household labor, such as the academic working environment, may still disproportionately disadvantage women's progress, even at universities in countries with high rates of gender equality such as Sweden.

The importance of equal treatment: Medical students'opinions on affirmative action, equal treatment and discrimination.

We assessed medical students' opinion of affirmative action programs (AAPs), perception of gender equality and discrimination. 276 medical students (56.2% female) participated. Women considered AAPs to be more important than did men. Most women (62.6%) and men (71.9%) received equal treatment, but significantly more women (22.6%) than men (11.6%) experienced discrimination. It is necessary to convey the importance of gender equality and equal treatment, including discrimination and mistreatment. Thus, we have to raise awareness for gender equality and equal treatment not only in staff, in students or in health care but also among each other.

Validation of the Internal Structure of a German-Language Version of the Gender Role Conflict Scale - Short Form.

The Gender Role Conflict Scale - Short Form (GRCS-SF) assesses a person's masculine gender role conflict. Masculine gender role conflict results when a person experiences discomfort showing a certain behavior because it is in conflict with masculine norms. The aim of the study was to test the questionnaire's psychometric properties in an Austrian sample of older men. Three alternative structural models of the GRCS-SF were tested with confirmatory factor analyses (CFA). The maximum-likelihood method and the Bollen-Stine Bootstrap Method were used to estimate the fit indices of the CFA. Convergent validity was tested by correlating the GRCS-SF with the Sexual Performance Belief Scale (SPBS). Participating in the study were 127 male in-patients of a university hospital. Men's average age was 59.5 (SD = 14.6) years. The one-factor model did not fit the empirical data well. In contrast, both the four-factor structure model and the bifactor structure model were supported. Good internal consistencies indicated acceptable reliabilities of the questionnaire's scales. As expected, moderate to large correlations with the SPBS were detected. These findings support the claim that the GRCS-SF is a reliable and valid tool for assessing men's gender role conflict also in a sample of older men in Austria.

Promoting gender in medical and allied health professions education: Influence on students' gender awareness.

In this study, we explored whether attendance at lectures on Gender Medicine, students' gender or university affiliation influenced students' gender awareness in medicine. We recruited 483 students (352 women/131 men) of medicine, allied health profession with focus on patient contact and allied health profession students with focus on laboratory work. Students with focus on laboratory work profited the most from Gender Medicine lectures as their gender sensitivity was positively associated with lecture attendance. Men profited more from Gender Medicine lectures than did women. We underline the importance of implementing Gender Medicine lectures in study programs of health care professions.

Gender differences and similarities in medical students' experiences of mistreatment by various groups of perpetrators.

BACKGROUND: Mistreatment of medical students during medical education is a widespread concern. Studies have shown that medical students report the most mistreatment compared to students of other study programs and that the prevalence of mistreatment peaks during clinical training. For this reason, a study was conducted to assess prevalence of mistreatment among medical students committed by various groups of people. The focus was to identify whether gender was associated with the experience of mistreatment. Additionally, students' perception of university climate for reporting sexual harassment was assessed. METHOD: In the study 88 medical students (45 women, 43 men) participated. A modified version of the Questionnaire on Student Abuse was used to assess students' experience of various types of mistreatment and associated distress during medical education. To explore factors that could be associated with this experience the organizational climate for reporting sexual harassment was assessed with the Psychological Climate for Sexual Harassment. RESULT: The most often cited perpetrators of mistreatment were strangers (79.5%), friends (75.0%) and university staff (68.2%). Strangers mostly committed psychological mistreatment and sexual harassment, whereas friends additionally engaged in physical mistreatment of medical students. The most common form of mistreatment conducted by university staff was humiliation of students. These kinds of psychological mistreatment were reported to be distressing (43%). Gender differences were found in the prevalence of mistreatment. Women experienced more sexual harassment and humiliation than did men. On the other hand, men experienced more physical mistreatment than did women. Women reported experiencing more distress from mistreatment experiences than did men and also more often reported being mistreated by university staff than did men. Women perceived a greater risk in reporting sexual harassment to the organization than did men. CONCLUSION: Mistreatment of female and male students should be focused on using a gender perspective because types of mistreatment can differ by gender. Additionally, interventions should include the societal level as there was a high prevalence of mistreatment perpetrated by strangers. Also the issue of trust in the university needs to be addressed and the organization is called on to visibly demonstrate that it represents and protects its students as well as its staff.

Abortion as one aspect of Women's Health.

Women's Health is closely tied to sexuality. In the European context the European Women's Rights Movement fought for women's sexual rights and the right of women to self-determination over a woman's own body. However, there appears to still be an ongoing struggle to have such rights (e.g. abortion) reflected in legislation. In response to the article "Women's Health as an Ideological and Political Issue: Restricting the Right to Abortion, Access to In Vitro Fertilization Procedures and Prenatal Testing in Poland" (Zuk & Zuk, 2017 ), the potential influence of the Catholic Church on abortion legislation is discussed. In this connection Austria is used as example to illustrate differences in the influence of the Catholic Church in predominantly Catholic countries. Additional aspects of women's sexual and reproductive rights are included in this comment, such as access to contraceptives, emergency contraceptives, cost coverage and quality of health care. Given the development of the political situation in Europe, women's rights and Women's Health are in danger of becoming a victim of recent political developments. Thus, a close look at these matters is needed.

Turkish Migrant Women with Recurrent Depression: Results from Community-based Self-help Groups.

The study focuses on psychosocial functioning of female Turkish immigrants in Austria with recurrent depressive disorder participating in self-help groups. Self-help groups guided by group leaders of Turkish descent should increase autonomy in participants, providing the opportunity to follow their ethnic health beliefs. Turkish immigrant women (n = 43) with recurrent depressive disorder participated in self-help groups over four months. Qualitative data of participants and group leaders, containing interviews, group protocols and supervision protocols of group leaders were analyzed using the qualitative content analysis for effects on psychosocial function, such as interaction with others, illness beliefs and benefit from self-help group. Women reported feelings of being neglected and violated by their husbands. They stated that they had gained strength and had emancipated themselves from their husbands. Self-help groups functioned as social resources and support for changes in participants' lives. Further interventions should integrate the functional value of depressive symptoms and focus on social support systems and social networks.

How do we get gender medicine into medical education?

Gender medicine, which takes a differentiated look at human beings as individuals and aims to provide targeted, gender-specific medical care, is slowly gaining recognition and acceptance. Nevertheless, this medical science that cuts across all medical disciplines has been only marginally incorporated into medical education curricula. The authors will look at the incorporation of gender medicine into the curriculum of Innsbruck Medical University to discuss the factors and the strategy that helped to establish it.