Search

Many medical schools have transitioned from traditional teacher-centred education to active student-centred education. The Conception of Learning and Teaching (COLT) questionnaire investigates teachers’ conceptions of learning and teaching in student-centred medical education. This observational and multicentred study aims to validate the Italian version of the Conceptions of Learning and Teaching (COLT-IT) questionnaire and assess the Italian medical educators’ learning and teaching conceptions. To develop the COLT-IT, a back-translation was performed. The COLT-IT and socio-demographic questionnaires were electronically distributed to educators across 13 Italian medical schools. Analyses included explorative factor analysis (EFA), confirmatory factor analysis (CFA), and reliability analysis. A total of 394 medical teachers completed the survey. Although the EFA suggested retaining three factors, statistical conditions led to the exclusion of eleven of the original eighteen items and one factor. The CFA confirmed the bi-dimensional structure of the COLT-IT. The two-factor scale retained the original naming of subscales: Teacher centredness (TC) and Appreciation of active learning (AL). Approximately 50% of participants exhibited high levels of AL, while scores in the TC subscale were more varied. No differences emerged based on gender, age, or the geographical location of the medical school. The 7-item COLT-IT is a reliable, valid, robust, and easy-to-administer tool for promoting and monitoring the implementation of a student-centred approach in medical education.

Background and objectives: Facemasks represent an essential measure of prevention against the spread of infectious diseases; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemask wearing could interfere with professionals' tasks, reduce the satisfaction of blood donors and affect their future blood donation behaviour. This preliminary cross-sectional study explored the association of mandatory facemask wearing with the quality of the blood donation process at the end of the coronavirus 2019 (COVID-19) pandemic. Materials and methods: A sample of 615 voluntary unpaid Italian blood and plasma donors completed an online survey assessing their attitude towards facemask wearing, the perceived distress due to facemasks in the different steps of the donation process, self-reported vasovagal reactions after donation and the intention to donate again. Results: Nearly 24% of donors reported a worsened quality of the donation process due to facemask wearing, and 36% reported moderate to severe distress during the donation itself. Donors with a more negative attitude towards facemasks reported a worse donation experience, mainly related to the interactions and the communication with physicians and nurses, and a higher probability of experiencing vasovagal reactions at their last donation. No significant correlations were observed between negative facemask attitudes towards facemask wearing, distress or future intention to donate blood/plasma. Conclusion: Facemasks have worsened the quality of blood and plasma donations for one fourth of donors, confirming the interference with the quality of communications and relationships with healthcare professionals.

Objectives: This study explored the trajectories of patient-centered orientation in a sample of Italian medical students throughout medical school. Methods: Four consecutive student cohorts were longitudinally assessed at the second (T0) and fifth year (T1) of medical school. Students completed a questionnaire including demographics and the Italian validated version of the Patient-Practitioner Orientation Scale. Results: 352 students completed both administrations. Students became more patient-centered in terms of Sharing along the course of their clinical curriculum, whereas there were no significant changes in Caring. Groups with distinct developmental trajectory patterns of both Caring and Sharing were identified. Students high in patient-centeredness at T0 reported significantly lower scores at T1 while students with lower scores at T0 significantly increased from the first to the last measurement. Female students significantly outscored their male colleagues on Caring and Sharing in both administrations. Conclusions: Findings call for innovative education strategies to sustain patient-centeredness attitudes in medical students entering hospital-based clinical medicine. Further research is needed to identify characteristics of the medical curriculum that are primarily involved in fostering students’ patient-centeredness. Practice Implications: Including the assessment and monitoring of patient-centeredness throughout the medical school can inform tailored education aiming to foster this dimension.

Background: Caring in nursing is a fundamental aspect, yet teaching and fostering caring behaviours in nursing students remain challenging. Clinical instructors play a crucial role in this process. Objectives: The aims of this study were a) to describe nursing students' caring behaviours and perceptions of instructor caring, b) to assess sex-related and year of course differences in students' caring behaviours and perceptions of nursing caring, and c) to investigate the association between nursing students' caring and their perception of instructors' caring. Design: A multi-centre, cross-sectional observational study was conducted. Setting: The study involved undergraduate nursing students from four teaching hospitals of a university in Northern Italy. Participants: A total of 316 nursing undergraduate students participated in the study (83.9 % female, 16.1 % male, 23.1 % 1st year, 48.1 % 2nd year, 28.8 % 3rd year). Methods: Participants completed online self-reported surveys assessing caring behaviours, empathy, burnout, and perceptions of instructor caring. Caring behaviours, expressive and instrumental caring, were measured using the Caring Behaviour Inventory (CBI), and perceptions of instructor caring were assessed using the Nursing Students' Perceptions of Instructor Caring (NSPIC) questionnaire. Results: Students' caring behaviours were positively associated with their perceptions of instructor caring, particularly in relation to a supportive learning climate and instructor flexibility. Female students displayed higher scores in expressive caring, while students in their second and third years demonstrated increased instrumental caring behaviours. Responding to Individual Needs was significantly lower in third-years students, compared to first- and second-year ones. Conclusions: This study emphasizes the crucial role of clinical instructors in shaping nursing students' caring attributes. However, the influence of sex on caring behaviours remains unclear, nece

Global climate change has local ramifications. This is particularly so in the case of The Netherlands: a considerable coastline, the presence of the Rhine-Meuse-Scheldt river delta, and 59 percent of the land area prone to flooding, all make the country highly exposed to floods from the sea and rivers. The Netherlands also faces other physical climate risks, including waterlogging, heatwaves, and prolonged drought which can cause damage to buildings and other assets. Finally, the Netherlands faces transition risks due to both climate mitigation and adaptation policies, which can shift the value of assets affected by these policies. Climate risks bear implications for the housing market. Some of these implications are hurdles that stand in the way for the housing market to become low-carbon and climate-resilient. And from an economic perspective, these implications are of great importance when designing policies that help the shift towards a low-carbon and climate-resilient housing stock. In this report we provide insight into the impact of climate risks on the Dutch housing market. We focus on the owner-occupied sector, because – in contrast to tenants – homeowners have to act upon climate policies themselves and are also more directly impacted by price effects of climate risks and climate policies. Based on a systematic literature review, we investigated how climate change affects the housing market through three channels of impact: physical climate risks, climate adaptation, and climate mitigation.

Introduction: University psychological counselling services represent a frontline defence to detect, treat or refer students with a wide range of (clinical and non-clinical) difficulties. Nevertheless, only few studies describe their impact on academic self-efficacy and report follow-up data. Evidence on students' actual access to further psychological support in times of hardship is also scant and most needed. This study aimed to fill these gaps, exploring the stability of improvement in clinical conditions in a wide sample of university students and reporting post-intervention referrals to mental health services. Methods: In a longitudinal study, 218 students who accessed a psychological counselling service at the University of Milano-Bicocca between 2015 and 2019 completed an assessment at the beginning (T0), conclusion (T1) and 6 months after (T2) a brief cognitive behavioural intervention. The assessment included psychological symptoms, general distress, emotion dysregulation and academic self-efficacy. Information about students' choices to continue a psychological intervention in other services was also collected and contrasted with the counsellor's indication. Results: At follow-up, the improvement in academic self-efficacy remained stable, with more than 60% of the students maintaining a reliable clinical change, and nearly half of them reporting having accessed (or being willing to contact) a mental health service outside the university services. Conclusion: These findings highlight the key role of counselling services in addressing students' distress and academic performances in the long term and in building bridges with mental health services outside the university system for students who need longer and specialised treatment.

Empathy in medical students is receiving increasing attention as it is fundamental to build and develop a functional patient-physician relationship. When looking at its determinants, demographic and academic factors seem to concur in shaping empathy in this population. Although data show strong gender differences and changes in empathy throughout medical school, it is not clear the direction of these changes and whether gender and curriculum features modulate them. This longitudinal study examined changes in empathy and explored gender differences throughout the medical school. Four consecutive cohorts of Italian medical students (N = 336) completed the Jefferson Scale of Empathy – Student (JSE-S) and the Interpersonal Reactivity Index (IRI) in their second year of study (before any clinical clerkship and communication skills courses) and fifth year of study (after a 2-year clinical clerkship and communication skills courses). Analysis of variance for repeated-measures revealed that, beyond the effect of gender, JSE-S total score and IRI Perspective Taking increased, whereas IRI Personal Distress and IRI Fantasy significantly decreased throughout medical school. No significant change in IRI Empathic Concern emerged over time. Student’s t-tests showed that female students displayed significantly higher mean scores than their male counterparts for all empathy measures in both their second and fifth years of medical training. The findings suggest that the medical curriculum affects self-reported empathy dimensions among undergraduate medical students. Further research is needed to deepen the understanding of the educational factors that promote the changes in empathy levels during medical training.

Receiving information in the case of a positive or false-positive expanded newborn screening (ENBS) result for metabolic diseases is a stressful event. The availability of psychological support to families is crucial across the different communication steps and is recommended by different guidelines and position papers. However, more information is needed about the availability of psychological resources in the ENBS process. This national survey aimed to provide an overview of the availability of psychological resources for parents who received communication of positivity at the ENBS in the 23 Italian centers and how the support is provided to parents. An online survey was sent to the Heads of the ENBS centers asking about the availability of a clinical psychologist, their involvement in the ENBS process, and an estimation of parents receiving psychological support. More than 60% of the centers report having a clinical psychologist in the ENBS team; however, in more than 50% of cases, the psychologist does not participate in the consultation with parents (nor for the first consultation post-positivity or at confirmation of diagnosis). Furthermore, nearly 60% of the centers reported the experience of parental rejection of psychological sessions. Conclusion: There is a need for harmonization among the Italian ENBS centers concerning the availability of psychological resources and how these resources are provided to families. Parents’ needs remained only partially fulfilled. What is Known: • Receiving communication of positivity at the ENBS can be highly stressful for parents and requires adequate psychological support. • The guidelines recommend psychological support for parents during the ENBS process. What is New: • Only 14/23 (60.9%) of Italian ENBS centers have a clinical psychologist within the team. • In half of the consultations with parents receiving communication of positivity, the clinical psychologist is never involved.

PARP inhibitors (PARPi) have changed the management of patients with ovarian cancer and their effectiveness has been demonstrated especially in homologous recombination repair-deficient tumors. These first-generation drugs target PARP1, but also PARP2 and other family members potentially responsible for adverse effects that limit their therapeutic potential and restrict their use in combination with chemotherapeutic agents.We investigated ovarian cancer patient-derived xenografts (OC-PDXs) to assess whether malignant progression could be impaired by a novel inhibitor selective for PARP1 (AZD5305) and to assess the potential of its combination with carboplatin (CPT), the standard-of-care for patients with ovarian cancer.In BRCA-mutated OC-PDXs, AZD5305 achieved greater tumor regressions and longer duration of response as well as a superior impairment of visceral metastasis and improved survival benefit compared with the first-generation dual PARP1/2 inhibitors.The combination of AZD5305 plus CPT was more efficacious than single agents. Subcutaneously growing tumors experienced regression that persisted after therapy stopped. Combination efficacy was greater against tumors that did not respond well to platinum, even at a dose at which AZD5305 monotherapy was ineffective. The combination therapy impaired metastatic dissemination and significantly prolonged the lifespan of mice bearing OC-PDXs in their abdomen. This combination benefit was evident even when CPT was used at suboptimal doses, and was superior to full-dose platinum treatment.These preclinical studies demonstrate that the PARP1-selective inhibitor AZD5305 retains and improves the therapeutic benefit of the first generation PARPi, providing an opportunity to maximize benefits for this class of anticancer agents.Significance: Selective PARP1i AZD5305 can exceed the efficacy of first generation PARPi, which target both PARP1 and PARP2, and potentiates the efficacy of CPT when given in combination. AZD5305 alon

Background: The process of receiving a communication of positivity for metabolic diseases at expanded newborn screening (ENBS) is extremely articulated, involves a variety of actors (parents, maternal and child departments, clinical centres and laboratories) and is open to a variety of outcomes from false positive to true positive cases. Receiving communication of positivity can be highly stressful for parents and requires an adequate communication process to give clear and reliable information without causing excessive worry. This qualitative study describes the parents' experience of receiving a communication of positivity to metabolic diseases at ENBS, and their assessment of the quality of the communication process and steps, with the main aim to identify the process' strengths and weaknesses and to advance tailored recommendations to improve the communication process. Method: Fourteen in-depth, semi-structured phone interviews were conducted with parents whose children resulted positive to the ENBS. As part of the ENBS communication process, parents received a first phone call communication of positivity and a second in-person communication at metabolic clinical centres (MCC). The framework analysis method was used to organize the data and identify emerging themes. Results: Parents were largely dissatisfied with the quality and depth of the information received and with the way the healthcare staff delivered the first communication phone call, which failed to create a caring, empathic and safe setting. Many parents tried to reduce the uncertainty by searching online information or consulting with other providers. Nevertheless, the majority of parents described the in-person visit at MCC as clear, welcoming and reassuring. Conclusion: More efforts are needed to improve the quality of the communication process of the ENBS. Guidelines, recommendations and standard scripts to communicate positivity are needed along with programmes and educational resources to train

Objectives: Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions. Methods: In this cross-sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self-perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2-Adult Faces including 24 faces representing anger, fear, sadness, and happiness. Results: Facemasks impaired the self-perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation. Conclusion: Facemasks reduced clinicians' self-confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.

To advance our knowledge of vaccine intention mechanisms, plan effective vaccination strategies, and better direct communication efforts, this study explored whether and to what extent the perception of severity and susceptibility to the infection, trust in authorities, and demographics shaped people’s COVID-19 vaccine intention during the first COVID-19 wave. In a cross-sectional study, 1373 Italian participants completed an online survey measuring demographic features, perception of the disease severity, disease risk perception, COVID19-related worry, vaccination intention, and level of trust in authorities and news media. Higher COVID-19 vaccination intention was associated with having a regular history of seasonal flu vaccine, a greater COVID-related worry, a higher perception of disease severity, and a higher trust in the Government. These findings further our understanding of vaccine intention in a pandemic scenario where a vaccine is still hypothetical and provide valuable information on the public’s representation of the infection and precious insight into people’s future acceptance of a vaccine to inform the development of communication interven- tions aiming to maximize adherence to vaccination programmes and to modify disease-related dysfunctional representations.

Facemasks represent an essential measure of prevention against the spread of COVID-19; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemasks may interfere with professionals' tasks. This qualitative study aims to describe healthcare staff's experiences, beliefs, and attitudes toward facemask wearing and strategies used to overcome communication and relational barriers along the blood donation process. Semistructured qualitative interviews were conducted with 25 healthcare professionals (14 physicians and 11 nurses) working in Italian blood donation centers. The framework analysis method was used to organize the data and identify emerging themes. More than 70% of participants reported discomfort and a negative impact on communicating effectively with donors and building empathic relationships. The difficulty to detect early signs of adverse reactions was reported by almost all nurses, and physicians were concerned that facemasks limited the identification of donors and the detection of deferral criteria. Facemasks have changed the blood donation process, reducing the healthcare professionals' ability to build empathic relationships and communicate with donors effectively. New strategies should be developed to overcome these limitations.

Background: Assessing medically-related fears is of paramount importance to foster medical positive experiences and outcomes and requires an easy-to-administer tool. The Medical Fear Survey-Short Version (MFS-SV) is a 25-item questionnaire assessing 5 medically related fears (Injections and Blood Draws, Sharp Objects, Blood, Mutilation, and Examinations and Symptoms). Methods: To examine the psychometric properties of the Italian version of the MFS-SV, exploratory and confirmatory factor analysis were performed on data from 1010 young adults (68.8% female, mean age= 23.9±5.05) who provided demographic information and completed the MFS-SV, the Padua Inventory-Contamination Fear Subscale, the Disgust Propensity and Sensitivity Scale revised (DPSS-R) and the Injection Phobia Scale-Anxiety (IPS-Anx). Convergent validity, reliability, test-retest stability, and multigroup invariance were assessed. Discriminant analysis explored the potential screening function of the MFS-SV. Results: The 5-factor structure of the questionnaire was confirmed, explaining the 68.8% of variance. Raykov’s composite reliability coefficients ranged between.84 and.95. Test-retest stability, convergent validity, and the consistency of the scores across gender were confirmed. The MFS-SV could discriminate subjects with a history of blood donations (Wilk’s Lambda = 0.915; p < 0.001). Conclusion: The overall results supported the psychometric properties of the MFS-SV and its suitability for both research and clinical uses to assess different medical fears

Background: The search for biomarkers to evaluate ovarian cancer (OC) homologous recombination (HR) function and predict the response to therapy is an urgent clinical need to improve the selection of patients who could benefit from platinum- and olaparib (poly-ADP ribose polymerase inhibitors, PARPi)-based therapies. Methods: We used a large collection of OC patient-derived xenografts (PDXs) (n = 47) and evaluated their HR status based on BRCA1/2 mutations, BRCA1 promoter methylation and the HRDetect score. RAD51 foci were quantified in formalin-fixed, paraffin-embedded untreated tumour specimens by immunofluorescence and the messenger RNA expression of 21 DNA repair genes by real-time PCR. Results: Tumour HR deficiency predicted both platinum and olaparib responses. The basal level of RAD51 foci evaluated in geminin-positive/replicating cells strongly inversely correlated with olaparib response (p = 0.011); in particular, the lower the foci score, the greater the sensitivity to olaparib, while low RAD51 foci score seems to associate with platinum activity. Conclusions: The basal RAD51 foci score is a candidate predictive biomarker of olaparib response in OC patients as it can be easily translatable in a clinical setting. Moreover, the findings corroborate the importance of OC-PDXs as a reliable tool to identify and validate biomarkers of response to therapy. [Figure not available: see fulltext.].

Chemotherapy is the standard of care for most malignancies. Its tumor debulking effect in adjuvant or neoadjuvant settings is unquestionable, although secondary effects have been reported that paradoxically promote metastasis. Chemotherapy affects the hematopoietic precursors leading to myelosuppression, with neutropenia being the main hematological toxicity induced by cytotoxic therapy. We used renal and lung murine tumor models metastatic to the lung to study chemotherapy-induced neutropenia (CIN) in the metastatic process. Cyclophosphamide and doxorubicin, two myelosuppressive drugs, but not cisplatin, increased the burden of artificial metastases to the lung, by reducing neutrophils. This effect was recapitulated by treatment with anti-Ly6G, the selective antibody-mediated neutrophil depletion that unleashed the formation of lung metastases in both artificial and spontaneous metastasis settings. The increased cancer dissemination was reversed by granulocyte-colony stimulating factor-mediated boosting of neutrophils in combination with chemotherapy. CIN affected the early metastatic colonization of the lung, quite likely promoting the proliferation of tumor cells extravasated into the lung at 24–72 hours. CIN did not affect the late events of the metastatic process, with established metastasis to the lung, nor was there any effect on the release of cancer cells from the primary, whose growth was, in fact, somewhat inhibited. This work suggests a role of neutrophils associated to a common cancer treatment side effect and claims a deep dive into the relationship between chemotherapy-induced neutropenia and metastasis.

Wearing a facemask remains a pivotal strategy to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection even after vaccination, but one of the possible costs of this protection is that it may interfere with the ability to read emotion in facial expressions. We explored the extent to which it may be more difficult for participants to read emotions in faces when faces are covered with masks than when they are not, and whether participants’ empathy, attachment style, and patient-centred orientation would affect their performance. Medical and nursing students (N = 429) were administered either a masked or unmasked set of 24 adult faces depicting anger, sadness, fear, or happiness. Participants also completed self-report measures of empathy, patient-centredness, and attachment style. As predicted, participants made more errors to the masked than the unmasked faces with the exception of the identification of fear. Of note, when participants missed happiness, they were most likely to see it as sadness, and when they missed anger, they were most likely to see it as happiness. A multiple linear regression analysis showed that more errors identifying emotions in faces was associated with faces being masked as opposed to unmasked, lower scores on the empathy fantasy scale, and higher scores on the fearful attachment style. The findings suggest that wearing facemasks is associated with a variety of negative outcomes that might interfere with the building of positive relationships between health care workers and patients. Those who teach student health care workers would benefit from bringing this finding into their curriculum and training.

Psychological counselling represents sensitive frontline services for the detection and treatment of early signs of distress in students. This study aims to assess psychological distress in medical students at the beginning of their academic career and the access rate to a counselling service during medical school. Predictors of access to the service and the effectiveness of the service were also explored. Distress and emotional dysregulation were measured in three consecutive cohorts of first-year students (n = 385, 53% female). Students accessing the counselling service at any time during the 6 years of medical school all completed the same baseline measurements and a pre/post assessment of the intervention. Nearly one-third of first-year students reported levels of distress above the clinical cutoff. The access rate to the counselling service was 13.9%. Only 21% of the students with clinical levels of distress contacted the counselling service. Living alone and having high distress at the beginning of the medical course were the main predictors of access to the service. Students reported a significant reduction of distress and dysregulation after counselling interventions. More efforts are needed to develop effective tools for identifying and tracking medical students in psychological hardship and to increase their willingness to attend the counselling services.