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Objectives Neuropsychiatric symptoms develop in up to 20% of the patients with Systemic Lupus Erythematosus (SLE). Growing evidence is accruing on the association of SLE with Post-traumatic Stress Disorder (PTSD), but little is known about its contribution on patient-reported outcomes. This study focuses on PTSD prevalence in our SLE cohort and on its impact on quality of life. Methods Trauma and Loss Spectrum – Self Reported (TALS-SR) and Lupus Quality of Life (Lupus QoL) questionnaires were administered via web to the patients with SLE in our cohort, along with questions on demographical and disease-related aspects. Results Among 99 patients who completed the questionnaire, fatigue prevalence was 75% and 31% scored TALS-SR test consistently with PTSD. Patients with PTSD achieved lower scores compared to those without PTSD in three Lupus QoL domains: planning (83.3 vs. 100, p = .035), body image (85.0 vs. 95.0, p = .031) and fatigue (66.7 vs. 91.7, p = .001). An inverse correlation was found between TALS-SR domains and Lupus QoL scores, particularly regarding fatigue with reaction to losses or upsetting events (ρ -0.458, p < .001). Conclusions PTSD is possibly far more frequent in patients with SLE than in general population and exerts a detrimental influence on quality of life.

Purpose This research aimed to investigate the socio-demographic, clinical, and psychological variables predictive of a greater functioning and quality of life in patients with gynecological cancer after their first cycle of carboplatin and taxol-based chemotherapy. Methods The sample of the present research consisted of 104 patients. The European Organization on Research and Treatment of Cancer QLQ-C30, the State-Trait Anxiety Inventory-Form Y, and the Multidimensional Scale of Perceived Social Support were administered to each participant. Results The analyses showed that higher state anxiety levels predicted a lower role, emotional, and social functioning and a lower general quality of life. Higher trait anxiety levels and social support perceived from one’s friends predicted a greater role functioning. Similarly, having a relationship predicted a greater physical, cognitive, and social functioning. On the contrary, the presence of relapsed cancer was negatively associated with these patients’ quality of life. Conclusions The present study highlighted the importance of identifying patients at higher risk of experiencing lower levels of functioning and worse general quality of life to implement tailored interventions from the beginning of treatment, thus improving the quality of life of these patients throughout the chemotherapy treatment.

Cancer patients are at an increased risk of developing severe consequences due to the COVID-19 infection. However, psychological outcomes in this population have been overlooked in the literature. The present study aims to identify significant psychological differences between gynecological cancer patients undergoing chemotherapy before and during the pandemic. Additionally, we explore the correlations between COVID-19-related concerns and anxiety, depression, distress, and quality of life levels. Forty-two patients completed the STAI-Y, the EORTC QLQ-C30, the BDI II, the DT, and an ad-hoc questionnaire that investigated COVID-19-related concerns. The analyses did not show significant differences in the psychometric scales between the two groups, highlighting a considerable resilience against mental health and quality of life deterioration during the COVID-19 pandemic in gynecologic cancer patients. However, COVID-19-related concerns were positively associated with anxiety and inversely related to emotional functioning levels. These results emphasize the importance of a comprehensive patient care and the need to implement a multidisciplinary approach that includes psychological support in the treatment plan. Moreover, it is essential to encourage clear communication to convey comprehensive information about the impact of the pandemic on physical and psychological levels, as well as to offer psychoeducational tools to face the pandemic.

The “Healthcare workers’ wellbeing [Benessere Operatori]” project is an exploratory longitudinal study assessing healthcare workers’ mental health at three different time points over a 14-month period during the COVID-19 pandemic. We collected socio-demographic and work-related information and assessed the perceived social support, coping strategies, and levels of depression, anxiety, insomnia, anger, burnout, and PTSD symptoms. In total, 325 Italian healthcare workers (i.e. physicians, nurses, other healthcare workers, and clerks) participated in the first initial survey and either the second or third subsequent survey. Participants reported subclinical levels of psychiatric symptoms that remained mostly unchanged across time, except for an increase in stress, depression, state anger, and emotional exhaustion symptoms. Despite subclinical levels, healthcare workers’ distress can adversely affect the quality of care, patient satisfaction, and medical error rates. Therefore, implementing interventions to improve healthcare workers’ wellbeing is required.

Gestational trophoblastic disease (GTD) represents a spectrum of rare pregnancy-related disorders, including both premalignant and malignant entities. Although GTD's medical outcomes have been widely explored, limited data are available regarding the related psychological, sexual, and fertility issues. The present chapter aims to enhance comprehension of the psychosocial impact of GTD by discussing the main quantitative and qualitative evidence available in this field. Although patients globally report a good quality of life, clinically significant levels of anxiety and depression have been consistently found across studies. Similarly, despite the quality of couple relationships being generally satisfactory, they often complain of a lack of sexual desire. Moreover, pregnancy loss may raise significant and long-term fertility-related concerns. Specific socio-demographic and clinical factors have been identified as predictors of psychosocial outcomes. At the clinical level, research suggests that there is a need to provide multidisciplinary care to patients.

Purpose: Chemotherapy-induced nausea (CIN) is a relevant problem for gynaecological cancer patients. The evaluation of CIN is a key aspect in its management, along with the identification of associated risk factors. The objective of the study was to compare different measurements of nausea and to investigate personal risk factors in CIN development. Method: Eighty-one women treated for gynaecological cancers took part. The presence of CIN was evaluated using the MASCC Antiemesis Tool (MAT) and a patient’s report to clinicians at the subsequent chemotherapy cycle. Personal risk factors were assessed using the State-Trait Anxiety Inventory and a self-report questionnaire. Results: The study shows that the agreement between patients’ assessment of CIN with MAT and what they referred to clinicians was only moderate for acute nausea (Cohen’s Kappa = 0.55; p < 0.001), while good for delayed nausea (Cohen’s Kappa = 0.68; p < 0.001). At multiple logistic regression analysis, younger age, anticipatory nausea, patient medium-high expectations of CIN, and parity emerged as risk factors for the development of acute nausea (p = 0.0087, 0.0080, 0.0122 and 0.0021, respectively). Patient medium-high expectations of CIN and being single resulted to be risk factors for delayed nausea (p = 0.0397 and 0.0024, respectively). Conclusions: Our findings confirm that personal factors contribute to individual differences in the development of CIN; moreover, we highlight the importance of CIN evaluation by clinicians, underlining the need to usereliable instruments.

To deepen the comprehension of the role of specific psychological conditions in the pathogenesis and in the treatment of systemic lupus erythematosus (SLE). Specifically, the present comprehensive review aims at examining the association between SLE, alexithymia (AT)—a personality construct referring to the inability to identify, describe, and express sensations, emotions, and physical state—and post-traumatic stress disorder (PTSD), to infer potential biological relationships between these psychopathological issues and disease course, and to draw up a research agenda on gray areas of these topics. Whereas several studies document the presence of neuropsychiatric symptoms in patients with SLE, psychological distress, alexithymia, and post-traumatic manifestations are usually neglected by healthcare professionals and poorly investigated in research contexts. However, the interplay of these aspects, which affect physiologic stress coping mechanisms, potentially plays an important role in SLE pathogenesis. In particular, research documents that cytokine repertoire pattern alteration and hypothalamic–pituitary–adrenal axis impairment leading to inflammation and pain represent the main links between emotional health and immunity. AT and PTSD seem to be common in patients with SLE and account for multiple aspects of SLE-related morbidity. Furthermore, abnormal processing of stressful stimuli as hallmarks of PTSD and AT might promote neuroendocrine dysfunction and dysregulated immunity, thus contributing to the pathogenesis of SLE. A comprehensive, multidisciplinary clinical approach, based on a cooperation between immunologists, rheumatologists, neurologists, and mental health professionals, is crucial to promote patients’ global health.

COVID-19 pandemic involved several psychosocial consequences. We aimed at monitoring the mental health of Italian adults during the lockdown imposed by the government. We present here results from the baseline assessment of the "EmotionalThermometer [TermometroEmotivo] project on a sample of 1548 Italian adults. We assessed the socio-demographic conditions of participants, individuals' perception of the COVID-19-situation, psychological distress, emotion regulation strategies, and perceived social support. Having a worse representation of COVID-19 and consulting news more frequently, with higher anxiety and less credibility of different sources of information, were positively associated with psychological distress and post-traumatic responses. Being female, younger age, living in high-risk regions, having symptoms of COVID-19, and having relatives/friends with such symptoms represented risk factors for a worse perception of COVID-19 and distress. Social support and cognitive reappraisal represented protective factors for mental health.

Background:Exposure to severe or chronic life stressors may alter immune function and high levels of subsequent distress have been implicated in autoimmune disease pathogenesis. Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition affecting 1-12% of the general population1, occurring in response to traumatic events. Growing evidence supports an association between trauma exposure and PTSD with systemic lupus erythematosus (SLE) onset2.Objectives:To cross-sectionally assess PTSD prevalence in a cohort of patients with SLE and to examine its correlation with quality of life.Methods:A 189-item anonymous questionnaire including demographics, disease features, the 9-domain Trauma and Loss Spectrum – Self Report (TALS-SR) and the 8-domain Lupus Quality of Life (Lupus QoL) was administered via web to a cohort of patients with SLE. Patients were classified as PTSD cases based on TALS-SR items corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for PTSD.Results:Ninety-nine (95% female and 5% male) patients with a median follow-up of 16.5 years completed the questionnaire. Self-reported fatigue prevalence was 75%. Fifteen patients (15%) reportedly were on psychological and/or psychiatric support. Thirty-one patients (31%) met the DSM-5 criteria for PTSD. The average LupusQoL interdomain score was 80/100. PTSD cases reported significantly lower scores compared to non-cases in three LupusQoL domains: planning (83 vs. 100, p=0.035), body image (85 vs. 95, p=0.031), and fatigue (67 vs. 92, p=0.001). An inverse correlation between TALS-SR scores and Lupus QoL subscales was found (Table1). In particular, the degree of stress secondary to losses or upsetting events was strongly correlated to fatigue intensity (rho= -0.458, pConclusion:PTSD prevalence might be higher in SLE than in the general population and have a detrimental influence on quality of life. Fatigue perception might be more significantly affected by PTSD. Intervention studies are needed to assess the therapeutical effects of psychological support in patients with SLE.References:[1]Shalev A et al. Post-Traumatic Stress Disorder. New England Journal of Medicine, June 2017.[2]Roberts AL et al. Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women. Arthritis & Rheumatology, November 2017.Table 1.Spearman rho coefficients outlining correlation across Lupus QoL and TALS-SR domains. The highest negative correlation has been found between fatigue and reaction to traumatic events. Significant correlations boxes are coloured in yellow (weak, rho 0.20-0.39) and red (moderate, rho 0.40-0.59). * pLupusQoL DomainsLupus QoL Total ScorePhysical healthPainPlanningIntimate relationshipsBurden to othersEmotional healthBody imageFatigueTALS-SR DomainsLoss events-.217-.217-.096-.031.047-.022.076-.009-.061Grief reactions-.145-.104-.041-.018-.124-.172-.192-.149-.107Potentially traumatic events.039-.082-.169-.167-.207-.185-.046-.229-.096Reaction to losses or upsetting events-.221-.256*-.289*-.218-.290*-.369**-.371**-.458**-.341**Re-experiencing-.139-.215-.245*-.228-.320**-.275*-.287*-.342**-.274*Avoidance and numbing-.176-.246*-.279*-.257*-.337**-.405**-.413**-.406**-.338**Maladaptive coping-.190-.238-.294*-.282*-.324**-.340**-.358**-.405**-.327**Arousal-.134-.177-.263*-.320**-.283*-.279*-.321**-.397**-.282*Personal characteristics / risk factors-.044-.115-.266*-.189-.409**-.231-.197-.253*-.199Disclosure of Interests:Luca Moroni: None declared, Martina Mazzetti: None declared, Giuseppe Alvise Ramirez: None declared, Simone Zuffada: None declared, Nicola Farina: None declared, Enrica Bozzolo: None declared, Valentina Di Mattei: None declared, Lorenzo Dagna Consultant of: Abbvie, Amgen, Biogen, BristolMyers Squibb, Celltrion, Galapagos, GlaxoSmithKline, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI, Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, GlaxoSmithKline,Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi Genzyme, and SOBI

Purpose of Review We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs). Recent Findings Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1–3 years in 10–40%. Depressive symptoms are reported in 27.5–50.7%, insomnia symptoms in 34–36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Summary Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs’ mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services. Electronic supplementary material The online version of this article (10.1007/s11920-020-01166-z) contains supplementary material, which is available to authorized users.

This paper is the outcome of the 1st Summer School on Geomorphology, Ecology, and Marine Biology in insular environments, focused on the advanced and multidisciplinary methods for the scientific investigation of marine coastal areas. It was held at Tremiti Islands, a significant laboratory for geomorphological, biological, and ecological studies because of its dynamic interaction between geodiversity and biodiversity, which makes it an ideal place for scientific research and geotourism. Landscape information was collected during field trips, while practical activities were finalized to sampling sediments and data collection of hard bottom assemblages. The map is the result of a multidisciplinary analysis incorporating geomorphological field observations and advanced methods applicable for ecological and environmental research, supported by scientific diving. This work represents a useful tool for the dissemination of environmental knowledge of the area and for understanding the relationships between landscape and natural heritage through modern and environmentally aware tourism.

Breast cancer and its pharmacological treatment often induce an impairment in women's sexual functioning and couple relationships, as a consequence of physiological changes and psychosocial issues that may arise and persist long after treatment. This study aims to evaluate the sexual functioning, the quality of the couple relationship, and the overall health status of breast cancer survivors. A further objective is to determine the predictive role of specific clinical and sociodemographic variables for sexual functioning and the couple relationship. Sixty-four breast cancer survivors completed the following questionnaires: the Female Sexual Function Index (FSFI), the Dyadic Adjustment Scale (DAS), the Short Form Health Survey-12 (SF-12), and a self-report questionnaire to collect sociodemographic characteristics. Clinical information was retrieved from medical records. Compared to normative data, our sample reported significantly (p .01) lower mean scores in the FSFI, DAS, and Physical Component (PCS) and Mental Component Summary (MCS) of the SF-12. Multiple regression analyses show a significant effect of age, hormonal therapy, and psychological well-being on sexual functioning and a significant effect of physical and mental well-being on the quality of the couple relationship. Additionally, 75% of patients qualified for sexual dysfunction as measured by the FSFI global scale, and 71.9% declared they were not adequately informed about the side effects of treatments on sexuality. The high prevalence of sexual dysfunction in breast cancer survivors underlines the need for specific attention to this problem, starting from a complete and targeted communication between patients and health providers regarding these side effects.El cáncer de mama y su tratamiento farmacológico frecuentemente producen un deterioro del funcionamiento sexual de las mujeres y de las relaciones de pareja como consecuencia de los cambios fisiológicos y los problemas psicosociales que pueden surgir y continuar mucho después del tratamiento. Este estudio tiene como finalidad evaluar el funcionamiento sexual, la calidad de la relación de pareja y el estado de salud general de las sobrevivientes de cáncer de mama. Otro objetivo es determinar el papel predictivo que desempeñan las variables clínicas y sociodemográficas específicas para el funcionamiento sexual y la relación de pareja. Sesenta y cuatro sobrevivientes de cáncer de mama contestaron los siguientes cuestionarios: el Índice de la Función Sexual Femenina (Female Sexual Function Index, FSFI), la Escala de Ajuste Diádico (Dyadic Adjustment Scale, DAS), la Encuesta Breve sobre la Salud-12 (Short Form Health Survey-12, SF-12) y un cuestionario de autoinforme para recopilar características sociodemográficas. Se obtuvo información clínica de expedientes médicos. En comparación con los datos normativos, nuestra muestra informó puntajes de la media significativamente más bajos (p0.01) en el FSFI, en la DAS y en el Resumen del Componente Físico (PCS) y del Componente Mental (MCS) de la SF-12. Los análisis de regresión múltiple indican un efecto significativo de la edad, la terapia hormonal y el bienestar psicológico en el funcionamiento sexual, y un efecto significativo del bienestar físico y mental en la calidad de la relación de pareja. Además, el 75 % de las pacientes reunió los requisitos de disfunción sexual según la medición de la escala global del FSFI, y el 71.9 % declaró que no estaba adecuadamente informado acerca de los efectos secundarios de los tratamientos en la sexualidad. La alta prevalencia de disfunción sexual en las sobrevivientes de cáncer de mama subraya la necesidad de atender este problema de manera específica, partiendo de una comunicación completa y dirigida entre pacientes y profesionales de la salud con respecto a estos efectos secundarios.乳腺癌及其药物治疗往往会对妇女的性功能和夫妻关系造成损害，这是由生理变化和社会心理问题引起的，并在治疗后长期存在。本研究旨在评估乳腺癌幸存者的性功能、夫妻关系的质量和整体健康状况。另一个目标是确定特定临床和社会人口学变量对性功能和夫妻关系的预测作用。 对64名乳腺癌幸存者进行调查。他们完成了以下问卷：女性性功能指数(FSFI)、二元调整量表(DAS)、健康调查简表-12(SF-12)，以及一份收集社会人口特征的自我报告问卷。临床资料则从病历中提取。 与常模数据相比，我们的样本报告的FSFI、DAS、SF-12的生理成分（PCS）和心理成分总结（MCS）的平均得分显著降低（P0.01）。多元回归分析显示，年龄、激素治疗和心理健康对性功能有显著影响，身心健康对夫妻关系质量有显著影响。此外，75%的患者符合FSFI全局量表测量的性功能障碍，71.9%的患者宣称没有充分了解乳腺癌治疗对性欲方面的副作用。性功能障碍的发病率高。乳腺癌幸存者中性功能障碍的高发率凸显了对这一问题给予特别关注的必要性，从患者和医疗服务提供者之间就这些副作用进行全面和有针对性的沟通开始。.

Introduction/Background Chemotherapy-Induced Nausea (CIN) is a distressing side effect for patients undergoing chemotherapy, which deeply affects their quality of life and everyday activities. Several treatment-related and patient-related factors may be involved in the expression of CIN. This study aims to identify predictive factors for nausea after the first chemotherapy infusion in a sample of women with gynecological cancer. Methodology One hundred and sixty-five patients (mean age=58.23, SD=13.19) treated for gynecological cancer at the San Raffaele Hospital completed the MASCC Antiemesis Tool (MAT) in order to register the presence of acute (within 24 hours) and delayed (24–72 hours) nausea after the first chemotherapy infusion. Socio-demographic and clinical characteristics that could represent risk factors for nausea were collected with an ad hoc questionnaire designed by the research team. Logistic regression analyses were performed for predicting acute or delayed CIN; significance level was set at 0.05. Results Sixty-three (38.7%) patients experienced acute nausea after their first chemotherapy infusion; 46% (n=75) of the sample experienced delayed nausea. Neoadjuvant (vs. adjuvant) chemotherapy represents a protective factor for delayed CIN (OR=0.350; p=0.033). Hyperemesis gravidarum and anticipatory nausea both represent risk factors for delayed nausea (OR=2.307, p=0.026; OR=4.316; p=0.004, respectively). No significant association was found with acute nausea. Conclusion Despite advancements in antiemetic therapy, results show that CIN still represents a common chemotherapy side-effect for women with gynecological cancer. Specific patient-related and treatment-related characteristics seem to influence the onset of delayed nausea after the first chemotherapy infusion. The knowledge of risk factors for CIN could help identify patients who are more vulnerable to this symptom and implement specific psychological and medical interventions in order to promote a better adjustment to the disease and its treatment. Disclosure Nothing to disclose.

Gestational Trophoblastic Disease encompasses a group of pregnancy-related disorders that derive from the placenta. Taking Leventhal’s Common Sense Model as a starting point, this study aims to investigate how illness perception could influence patients’ psychological adaptation to these rare diseases. Thirty-seven women completed: the Illness Perception Questionnaire-Revised, the Beck Depression Inventory Short Form, the State-Trait Anxiety Inventory, and the Fertility Problem Inventory. Results show that the perception of severe illness consequences significantly predicts the level of anxiety patients reported at the time of questionnaire completion. Furthermore, mental representations of illness present a significant association with infertility-related stress. Specifically, the belief in the efficacy of the treatment results in fewer feelings of discomfort and isolation from family and social context due to infertility-related problems. Since patients’ illness perception was found to have a specific impact on both anxiety and infertility-related stress, this variable should be considered in the planning of a clinical intervention.

e21557 Background: Advances in cancer treatment have resulted in an increase in survival rates. Thus, quality of life after disease is being addressed more often; loss of fertility is a crucial aspect, especially in young women. This study aims to investigate the psychological profile of women who access the Oncofertility Unit at the San Raffaele Hospital before gonadotoxic treatment. Psychological consultation is undertaken prior to the medical evaluation as an integrative part of fertility preservation counselling. Our hypothesis is that women who access the Unit present psychologically adaptive characteristics, which facilitate a better adjustment to diagnosis and disease; this involves the decision to cryopreserve their oocytes to avoid possible future infertility. Methods: Seventy-six women were counselled between January 2014-2017; 96% of these (N = 73) decided to undergo cryopreservation. Only these women returned the administered questionnaires and took part in the study. A self-report measure and three validated questionnaires were used: the Beck Depression Inventory (BDI-II), the State Trait Anxiety Inventory Form-Y (STAI-Y), and the Temperament and Character Inventory – Revised (TCI-R). Results: The age range of the sample was 19-42 years (mean = 30.49; SD = 5.42); 21% (N = 15) of patients were older than 35 years. Seventeen women (23%) were single and 12% (N = 9) had children prior to the cancer diagnosis. Regarding the BDI, 89% (N = 65) of patients obtained minimal depression scores [0-13]. On the STAI-Y trait subscale, 70% (N = 51) of patients’ scores fell within the low anxiety range [20-40]; state anxiety scores were higher, but only 18% (N = 13) of women reported high levels [60-80]. The TCI-R highlighted that 95% (N = 69) of patients had medium or high levels of Persistence (perseverance despite fatigue Conclusions: Women who access the Unit report low levels of psychological distress (depression and anxiety) and show adaptive personality traits. This supports our hypothesis. The main study limitation of the study is the lack of data regarding women who decided not to undergo cryopreservation.

Background Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal’s Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this disease. Methods Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. Results High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between “time since diagnosis” and the Treatment control subscale. Discussion This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception.