The psychological impact of COVID-19 among primary care physicians in the province of Verona, Italy: a cross-sectional study during the first pandemic wave.

BACKGROUND: Among healthcare professionals working with COVID-19 patients, general practitioners (GPs) are under considerable pressure and may develop adverse mental health outcomes. OBJECTIVES: To assess mental health outcomes on GPs working during the COVID-19 pandemic and to explore their associations with personal characteristics and features of GP practices. METHODS: Observational cross-sectional study conducted on a sample of GPs working in Verona province (Italy) during the first pandemic wave. Participants were invited to complete a web-based form addressing socio-demographic and work-related information, previous practice organization, practice re-organization during the COVID-19 pandemic, and a set of measures for post-traumatic stress (IES-R), anxiety (SAS), depression (PHQ-9), and burnout (MBI-GS). RESULTS: A total of 215 GPs (38.3% of the eligible population) participated. Overall, 44.7% reported COVID-19-related traumatic events; among these, 35.9% (95% CI, 26%‒46%) developed symptoms of post-traumatic distress. Furthermore, 36% (95% CI, 29%‒43%) reported symptoms of anxiety, 17.9% (95% CI, 12%‒23%) symptoms of at least moderate depression, and 25.4% (95% CI, 19%‒32%) symptoms of burnout. Multivariate regressions showed that being quarantined or admitted for COVID-19 was associated with all the mental health outcomes considered. Being female, working in rural settings, and having less professional experience were associated with higher anxiety and depression. The ability to diagnose COVID-19 increased self-perceived professional efficacy, thus contributing to burnout reduction. CONCLUSION: The high prevalence of adverse mental health outcomes among GPs during the pandemic highlights the importance of timely interventions in this population and promoting targeted preventive actions in the event of future healthcare crises.

[The new Maugeri diagnostic protocol for work-related stress and mobbing (MASD-2)]. / Il nuovo protocollo diagnostico Maugeri per stress lavoro-correlato e mobbing (MaSD-2).

SUMMARY: Occupational stress can exceed the workers' individual capacity to adapt, and cause psychopathological conditions, including adjustment disorder (AD) and post-traumatic stress disorder (PTSD), for which medico-legal reporting is mandatory by law. Since the early 2000s, an interdisciplinary diagnostic protocol has been in use at our Institute to address patients towards an appropriate therapeutic path, in order to promote their psychological well-being and work reintegration. In 2017, the protocol was updated and expanded. The current version (MaSD-2) includes: occupational medicine examination, psychological counselling, psychiatric interview, and psychodiagnostic testing: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA-2.0), SCID (Structured Clinical Interview for DSM: Diagnostic and Statistical Manual of Mental Disorders), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Maugeri Stress Index - Reduced form (MASI-R). Between 2017 and 2019, we used the MaSD-2 to assess, for suspected psychopathological work-related problems, 198 patients (120 women and 78 men; mean age SD: 47.9 9.0 years). Nine (4.5%), already examined with the original version of the protocol, received diagnostic confirmation (2 cases of paranoid personality disorder, 7 of work-related anxiety-depressive disorder). Of the other 189 subjects, three (1.6%) were not affected by psychiatric disease, 12 (6.3%) had a psychiatric disorder (e.g., anxiety disorder, mood disorder, personality disorder) independent of work, 160 (84.7%) a work-related anxiety and/or depressive disorder. DA was identified in 12 cases (6.3%), and two patients (1.1%) were diagnosed with DA in pre-existent DPTS, for a total of 14 medico-legal reports of occupational disease. Compared to the past, the case record presents a much higher percentage of psychiatric disorders related to occupational stress. This may be due to a greater sensitivity of the new diagnostic protocol, and to a better selection of the patients referred to us. Women and tertiary workers continue to be at greater risk, with significant involvement of health professionals. Diagnoses of DA and DPTS remain rare, confirming the need for a rigorous and cautious interdisciplinary approach, aimed at selecting the cases for which to start medico-legal procedures. Finally, the study calls for adequate preventive measures.

Work-related post-traumatic stress disorder: report of five cases.

Post-traumatic stress disorder (PTSD) may arise after events involving a risk to physical integrity or to life, one's own or that of others. It is characterized by intrusive symptoms, avoidance behaviors, and hyper-excitability. Outside certain categories (e.g., military and police), the syndrome is rarely described in the occupational setting. We report here five unusual cases of work-related PTSD, diagnosed with an interdisciplinary protocol (occupational health visit, psychiatric interview, psychological counselling and testing): (1) a 51-yr-old woman who had undergone three armed robbery attempts while working in a peripheral post office; (2) a 53-yr-old maintenance workman who had suffered serious burns on the job; (3) a 33-yr-old beauty center receptionist after sexual harassment and stalking by her male employer; (4) a 57-yr-old male psychiatrist assaulted by a psychotic outpatient; (5) a 40-yr-old woman, sales manager in a shoe store, after physical aggression by a thief. All patients required psychiatric help and pharmacological treatment, with difficulty of varying degrees in resuming work. We conclude that PTSD can develop even in professional categories generally considered to be at low risk. In such cases, a correct interdisciplinary diagnostic approach is fundamental for addressing therapy and for medico-legal actions.

Docencia universitaria en salud: análisis de la distribución entre tipos de cargo y género / University teaching in health: analysis of the distribution between job types and gender

Introduction: Despite the great contribution of women to health systems, men still occupy most leadership positions. The gender gap in leadership roles in healthcare is prevalent worldwide. Methods: This is a cross-sectional study that analyses the distribution of the types of appointments defined by hierarchy, duration of employment, and percentage of FTE and the positions occupied by women faculty compared with male counterparts. The unit of analysis corresponds to faculty positions in 2018 since each faculty can have more than one position with different hierarchy, duration, and percentage of FTE. We used logistic multivariate analysis to assess associations, considering the model with the lowest AIC. Results: Age group 31 to 50 years (AOR: 0.66; IC 95%: 0.50-0.87) and FTE appointments (AOR: 0.43; IC 95%: 0.29- 0.64) are significantly associated with positions assigned to women. For appointment type defined by hierarchy TA, is significantly occupied by a female when compared to each group of increased hierarchy, Assistant professor (AOR: 1.39; IC 95%: 1.14-1.70), Associate professor (AOR: 2.67: IC 95%: 1.95- 3.67), Full professor (AOR: 3.47; IC 95%: 2.27-5.30) and authorities (AOR: 5.57; IC 95%: 3.53-8.79). Conclusions: There is almost no representation of women in the highest-ranking positions, which are associated with academic recognition, decision-making, and higher pay. The higher prevalence of full-time positions occupied by women could be linked to women still being responsible for household and family tasks

Introducción: A pesar de la gran contribución de las mujeres a los sistemas de salud, a nivel mundial los hombres son mayoría en los puestos de liderazgo. A nivel mundial, la brecha de género en los cargos de liderazgo en atención médica es persistente. Métodos: Estudio de corte transversal que analiza la distribución de los tipos de cargos docentes ocupados por mujeres de la Facultad de Medicina de la Universidad de Buenos Aires según jerarquía, dedicación y regularidad, comparados con su contraparte masculina. La unidad de análisis corresponde a las posiciones, ya que cada docente puede tener más de un cargo. Usamos regresión logística considerando el modelo con el AIC más bajo. Resultados: Grupo de edad de 31 a 50 años (ORA: 0.66; IC 95%: 0.50 a 0.87) y la dedicación exclusiva (ORA: 0.43; IC 95%: 0.29 a 0.64) están significativamente asociados con posiciones ocupadas por mujeres. Para el tipo de cargos definidos por jerarquía, "ayudante de cátedra" está ocupado significativamente por mujeres, en comparación con cada grupo de jerarquía creciente, Jefe de Trabajos Prácticos (ORA: 1.39; IC 95%: 1.14 a 1.70), Profesor Adjunto (ORA: 2.67; IC 95%: 1.95 a 3.67), Profesor Titular (ORA: 3.47; IC 95%: 2.27 a 5.30) y autoridades (ORA: 5.57; IC 95%: 3.53 a 8.79). Conclusiones: Escasa representación femenina en los puestos de mayor rango asociados con reconocimiento académico, toma de decisiones y mejor salario. La dedicación exclusiva en las mujeres podría estar relacionada con que ellas que siguen siendo responsables de las tareas domésticas y familiares

Effect of apoptogenic stimuli on colon carcinoma cell lines with a different c-myc expression level.

We have recently demonstrated that a high c-myc endogenous amplification level confers an apoptosis-prone phenotype to serum-deprived colon carcinoma SW613-S cells. The aim of this study was to gain new insights into the features of c-myc-dependent apoptosis, by extending our analysis to different apoptogenic stimuli. The study was carried out on clones, derived from the human colon carcinoma SW613-S cell line, which harbor different levels of endogenous c-myc amplification, and on isogenic cell lines with an enforced c-myc overexpression. Our results indicate that cells with endogenous or transfected exogenous c-myc overexpression (SW613-12A1 and -2G1mycP2Tu1 cell lines, respectively), activate the apoptotic machinery in response to the treatment with etoposide, doxorubicin and vitamin D3, which induce apoptosis through the death receptor Fas. The low levels of c-myc expression present in SW613-B3 and -B3mycC5, seem to be unable to activate Fas-mediated apoptosis, thus suggesting that only a high c-myc expression can bypass the lack of Fas receptor. Apoptosis induction mediated by DNA damage and long-term culture was independent of c-myc expression. A pathway of apoptosis characterized by the activation of the enzyme L-DNase II, was observed in both 12A1 and B3 cell lines.