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

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

Analysis of a direct access testing system for the detection of SARS-CoV-2 in the paediatric population attending school

Background

During the COVID-19 pandemic, the paediatric population plays a minor role in the spread of the SARS-CoV-2 virus. However, in order to keep schools open and reduce SARS-CoV spreading, it is necessary to identify and isolate early SARS-CoV-2 positive paediatric patients even if they are asymptomatic. The aim of this study was to describe a setting for SARS-CoV 2 testing based on the spontaneous presentation of paediatric patients attending school without a medical prescription and explore its appropriateness.

Study design

Cross-sectional study.

Methods

The study performed between September 2020 and March 2021 among a sample of 13,283 paediatric patients who underwent a swab in four different hospital settings (school hot spot, emergency department, day hospital setting and hospital wards). For each patients we collected: date of swab execution, type of swab, execution setting of the swab, result of the swab, information about community spread of the virus in the 14 days prior to the swab execution, sex and age.

Results

In our sample, females accounted for 45.8%. The median age was 6.8 years (IQR 3.0-11.2) and the most frequent age category was between 6 and 11 years (27.9%). At multivariable models with a swab tested positive as outcome. The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school hot spot setting. Compared with adolescents aged between 14 and 19 years old, new-borns below 3 months (adjOR 1.83, 95% C.I. 1.14-3) and patients aged between 11 and 14 years old (adjOR 1.32, 95% C.I. 1.07-1.63) reported a higher probability of a swab tested positive. Instead, children aged between 3 months and 3 years (adjOR 0.77, 95% C.I. 0.61-0.96) and children aged between 3 years and 6 years (adjOR 0.66, 95% C.I. 0.53-0.83) were less likely to result positive. The higher was the mean of pooled Rt in the 14 days preceding the swab, the higher was the likelihood of resulting positive (adjOR 1.75, 95% C.I. 1.53-1.99).

Conclusion

In conclusion, we found a high incidence of paediatric patients positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings during the period of observation. The free access modality to the nasopharyngeal swab was effective in identifying patients with COVID-19. Public health authorities should implement these testing modality in order to help reduce the spread of SARS-CoV-2 in school settings.

Analysis of a test system for the detection of SARS-CoV-2 in children attending school

Background

During the COVID-19 pandemic, in order to keep schools open and reduce SARS-CoV spreading, SARS-CoV-2 positive paediatric patients (PP) need to be isolated early. The aim of this study was to describe the appropriateness of school hot spot (HS) for SARS-CoV 2 testing based on open access of PP in a paediatric hospital in Turin, Italy.

Methods

A cross-sectional study was performed between September 2020 and March 2021. The data collected included: date of swab execution, type of swab, execution setting of the swab, result of the swab, sex, age of PP and the mean value of the Rt (reproductive number) of pandemic in the Piedmont region. We collected data about PP from four different hospital settings (HS, Emergency department, day hospital and hospital wards) of Regina Margherita Children’s Hospital (Turin, Italy). We analyzed a sample of 13,283 PP (aged 0-19 years) testing for SARS-CoV-2. The main outcome was the likelihood of testing positive in different settings and in different age groups.

Results

In Our sample, females were 45.8%. The median age was 6.8 years (IQR 3.0-11.2). The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school HS setting. Newborns below 3 months (adj OR 1.85, 95%CI 1.14 - 3) and patients aged between 11 and 13 years old (adj OR 1.32, 95%CI 1.07 - 1.63) reported a higher probability of a swab tested positive compared to adolescents. Instead, children aged between 3 months and 2 years (adj OR 0.77, 95%CI 0.61 - 0.96) and aged between 3 years and 5 years (adj OR 0.66, 95%CI 0.53 - 0.83) were less likely to result positive.

Conclusions

We found a high prevalence of PP positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings. The open access modality to the nasopharyngeal swab was effective in identifying PP with COVID-19. Public health authorities should implement this testing modality in order to reduce SARS-CoV-2 infections in PP.

Key messages

• Open access testing system to detect SARS-CoV-2 is important to do as many tests as possible to identify COVID-19 patients and isolate them in the pediatric population.

• The open access testing modality to detect COVID-19 patients saves time for doctors who, instead of carrying out the patient history, can devote themselves to other clinical activities.

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

OBJECTIVES

The health effects of work-time arrangements have been largely studied for long working hours, whereas a lack of knowledge remains regarding the potential health impact of reduced work-time interventions. Therefore, we conducted this review in order to assess the relationships between work-time reduction and health outcomes.

DESIGN

Systematic review of published studies. Medline, PsycINFO, Embase and Web of Science databases were searched from January 2000 up to November 2019.

OUTCOMES

The primary outcome was the impact of reduced working time with retained salary on health effects, interventional and observational studies providing a quantitative analysis of any health-related outcome were included. Studies with qualitative research methods were excluded.

RESULTS

A total of 3876 published articles were identified and 7 studies were selected for the final analysis, all with a longitudinal interventional design. The sample size ranged from 63 participants to 580 workers, mostly from healthcare settings. Two studies assessed a work-time reduction to 6 hours per day; two studies evaluated a weekly work-time reduction of 25%; two studies evaluated simultaneously a reduced weekly work-time reduction proportionally to the amount of time worked and a 2.5 hours of physical activity programme per week instead of work time; one study assessed a reduced weekly work-time reduction from 39 to 30 hours per week. A positive relationship between reduced working hours and working life quality, sleep and stress was observed. It is unclear whether work time reduction determined an improvement in general health outcomes, such as self-perceived health and well-being.

CONCLUSIONS

These findings suggest that the reduction of working hours with retained salary could be an effective workplace intervention for the improvement of employees' well-being, especially regarding stress and sleep. Further studies in different contexts are needed to better evaluate the impact of work-time reduction on other health outcomes.

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

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

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Background

Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students.

Methods

During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness.

Results

Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p < 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p < 0.05) and those who have received good example from tutors (coefB 0.14, p < 0.05) were more gender-sensitive. Older age (coefB 0.04, p < 0.05), a better knowledge on gender medicine (coefB 0.12, p < 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p < 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p < 0.05), male sex (coefB 0.12, p < 0.05) and older age (coefB 0.03, p < 0.05) were associated with more stereotypes towards doctors.

Conclusions

Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered.

Key messages

Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

Gender medicine: a cross-sectional survey on knowledge and curriculum among Italian medical students

Introduction

Gender and sex are important predictors of many attitudes and behaviours that have an impact on health and disease. Gender medicine is then a fundamental approach for better quality of care in Europe. Few information is available on Italian medical students and their knowledge about gender medicine. Our study aimed to investigate knowledge about gender medicine in a sample of Italian medical students in order to identify specific knowledge gaps and improve Medicine degree curricula.

Methods

In 2020, an online cross-sectional survey was conducted on 430 medical students of the University of Turin, Italy. Participants filled out a questionnaire consisting of 29 items concerning the areas of knowledge and attitudes regarding gender medicine. Multivariable logistic regression model was performed to explore potential predictors of knowledge among students.

Results

More than 60% of the students knew the correct definition of gender medicine and around 90% of them knew the difference between sex and gender. In total, 58.16% of female students had a good level of knowledge, significantly more than male students (37,5%; p < 0.001); female students also showed a higher mean score compared to male students (respectively 17.96±2.75 vs 16.59±3.20, p < 0.001). Using a multivariate linear regression model, with level of knowledge about gender medicine used as a continuous variable, we found that being female was the only potential predictor of high consideration of gender medicine in patient management.

Conclusions

The results indicate that students have a good knowledge and high regard for gender medicine. Female students seem more aware of the importance of gender medicine and areas of improvement can be identified. Future European physicians must consider gender medicine in order to encourage a patient-tailored approach and to reduce gender gap still existent in current practice.

Key messages

Gender medicine is a fundamental approach to improve quality of care and to reduce gender gap among European patients. Medical students should be more aware and trained about gender and sex differences during clinical practice in order to encourage a patient-tailored medicine.

Is the hospital Safety Walkround effective to control the risk of contagion during COVID-19 pandemic?

Background

The Safety Walk Round (SWR) is a risk assessment technique designed to decrease adverse events and improve workers attitudes about safety culture through visits and interviews about safety of care. A new field of application could be the safety requirements that hospitals have to guarantee during the Covid-19 pandemic. Our study aimed to investigate the efficacy of SWR on identifying and solving the critical issues that can increase the risk of SARS-CoV-2 infection in three Italian hospitals.

Materials and Methods

The project was developed during the first wave of SARS-Cov-2 pandemic, from May to July 2020, it involved 3 hospitals in Turin: Traumatology and Orthopaedic Centre, Paediatric Hospital Regina Margherita and Sant'Anna Hospital (obstetric and gynaecological hospital). Pre-triage services and outpatient waiting rooms were identified as areas at higher risk of crowding and potential non-compliance with anti-contagion rules. The first round consisted of observations focused on hands sanitation, safety social distance, PPE correct use. Than the workers of the observed areas were interviewed. Thanks their participation, the critical issues about patient safety and the potential resolutions were identified. A second round was realized to verify the implementation of the planned actions and their effectiveness in solving the issues.

Results

A total of 4907 moments were observed and the 9,1% of them was at risk of contagion. During the interviews 23 critical issues and their possible resolutions were identified. A total of 14 critical issues were solved, 4 partially solved and 5 were build environmental problems and cannot be solved. The 77% of total were completely solved, excluding built environment issues.

Conclusions

SWR project was effective in involving health workers in safety promotion activities, sharing informations and improving trust between hospital managers and operators and spreading new skills about safety culture in Covid-19 pandemic contest.

Key messages

SWR was effective in a pandemic context. During the emergency, the front line staff were enthusiastic about the method and felt listened and guided.This has contributed to achieving the aim of safety.

The study showed that SWR is a useful tool for hospital infection control. It also showed that the SWR method can be used in a time of constant change that requires adaptability like a pandemic.

COVID-19 Lockdown and Self-Perceived Changes of Food Choice, Waste, Impulse Buying and Their Determinants in Italy: QuarantEat, a Cross-Sectional Study

Data about self-perceived food choice (FC) changes and their determinants during COVID-19 lockdowns are limited. This study investigated how the Italian lockdown affected self-perceived food purchases (FP), occurrence of impulse buying (IB), household food waste production (HFWP) and their determinants. A web-based cross-sectional survey was distributed in May 2020, collecting an opportunistic sample of the Italian population. A total of 1865 (70% females) people were enrolled, the median age was 29 (IQR 16.0). Most of the sample increased overall FP (53.4%), food consumption (43.4%), reduced HFWP (53.7%) and halved the prevalence of IB (20.9%) compared to the period before the lockdown (42.5%). Baking ingredients, fresh vegetables, fresh fruit and chocolate had the largest sales increase by individuals, while bakery products, fresh fish and salted snacks purchases highly decreased. Increased FP was associated with the occurrence of IB (adjOR 2.48, p < 0.001) and inversely associated with not having worked during lockdown (adjOR 0.71, p = 0.003). Multivariable logistic regressions revealed occurrence of IB was associated with low perceived dietary quality (adjOR 2.22, p < 0.001), resulting at risk, according to the Emotional Overeating Questionnaire (EOQ, adjOR 1.68, p < 0.001), and inversely associated with decreased HFWP (adjOR 0.73, p < 0.012). Reduced HFWP was associated with higher perceived dietary quality (adjOR 2.27, p < 0.001) and negatively associated with low score at WHO-5 Well-Being Index (adjOR 0.72, p = 0.002). The Italian lockdown highly affected FC behaviours, leading to positive and sustainable habits towards food purchase and consumption. Public health interventions are needed to keep these new positive effects and avoid negative consequences in case of future lockdowns.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

[Organization and management of clinical-care pathways at the Regina Margherita Hospital in Turin during Covid-19 emergency]

The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.

Vaccination knowledge, attitudes and practices in patients with HIV: a cross-sectional survey

Background

Infectious diseases are more common and severe in patients with HIV, which show different response to vaccines and a diminished protection. It is therefore very important to assess knowledge and attitudes towards vaccination in people with HIV, since precise vaccination coverage and vaccine hesitancy are not well established in this subgroup of patients.

Methods

A sample of 119 patients with HIV completed a cross-sectional survey. Patients were recruited during their routine medical examination at the infectious diseases clinic in Turin. The survey explored these main areas: demographics and history of HIV infection, vaccination history, attitudes towards vaccination, confidence in the public health system, contagion risk and disease seriousness perception. In this preliminary phase descriptive analysis were conducted.

Results

Preliminary data show that mean age of the participants was 49.51 years, 80% were males. The median of HIV infection duration was 10 years, while the median of the lymphocyte count was 762.50 cells/mm3. The disease with the highest vaccination coverage was tetanus (88.7%), considered a serious or very serious disease by 85.6% of the participants, despite low or very low contagion risk perception (84.1%). The disease with the lowest vaccination coverage was Herpes Zoster (7.3%), despite high or very high seriousness perception (70%). Furthermore, 99.1% of the participants showed high or very high confidence toward public health system professionals, and the majority of them (59.5%) stated that vaccines are more useful for the community than for the single person.

Conclusions

Vaccination coverage is still not fully satisfactory regarding diseases considered infrequent or mild. Considering the high level of confidence toward the public health system that has emerged, it is necessary to implement informative and operative strategies about vaccination for European HIV patients, which are particularly at risk regarding infectious diseases.

Key messages

Vaccination coverage and risk perception in HIV patients is not satisfactory for many diseases and an effort to implement informative strategies in Europe is needed. The role of vaccination in preventing infectious diseases in HIV patients should be recognized and strengthened by relying on the high level of confidence toward European public health systems.

Prevalence and predictors of stress, suicidal thoughts and depression in Italian university students

Background

Depression is a major public health issue in Europe. The prevalence of depressive symptoms (DS) in university students (US) is considerably higher than in the general population.

Since few data on DS among Italian US exist, this study aimed to estimate perceived stress (PS) and DS prevalence and assess associated factors in Italian US.

Methods

A cross-sectional study was performed in the Social Sciences and Educational Sciences degree courses at University of Cassino through self-administered questionnaires including socio-demographic items, Beck Depression Inventory-II (BDI-II) scale and Perceived Stress Scale. Primary outcomes were DS presence (BDI-II score≥14), suicidal thoughts (ST) and PS. Multivariable analysis and linear logistic regressions were performed.

Results

Globally, 203 questionnaires were collected (23 BDI-II missing). DS and ST prevalence was 30.6% and 11.3 %. PS median score was 20 (IQR=11) and 87.7% reported moderate/severe PS. Family history of psychiatric disorders and not being a freshman (attending first years of courses) were significantly (p &lt; 0.05) related to DS, while not thinking that University hinders carrying out personal activities was protective. High PS and having a chronic disease were significantly associated with ST, while family cohesion appears to be protective. High PS was significantly associated with: female gender, family history of psychiatric disorders, thinking that University hinders resting and relaxing, being under psychiatric/psychological care and having chosen university for Intellectual curiosity. Having no worries about future was linked to a lower PS.

Conclusions

This study found an alarmingly high prevalence of DS and ST in Italian US. Further longitudinal studies need to define risk factors for depression and stress in US. Public health actions such as offering preventive treatment interventions could improve health in European US.

Key messages

Depressive symptoms can be widespread up to 30% of university students and European policies should afford this issue with a strong commitment in order to reduce harmful consequences. Predictors of depressive symptoms, such as university workload and family cohesion, are recognizable and can be a target for European strategies aimed to improve university students’ mental health.