Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study.

AIMS AND OBJECTIVES: To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic. BACKGROUND: The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences. DESIGN: A qualitative design based on phenomenological approach. METHODS: A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines. RESULTS: One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. CONCLUSIONS: Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis. RELEVANCE TO CLINICAL PRACTICE: Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial.

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Public views on the Covid-19 immunity certificate: A scoping review.

INTRODUCTION: Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance. METHODS: We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions. RESULTS: We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure. CONCLUSION: The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure. PATIENT OR PUBLIC CONTRIBUTION: This does not apply to our work as it was a review paper.

Public Perceptions of Harms and Benefit of COVID-19 Immunity Certificate: A Cross-Sectional Study in the Italian Setting.

A cross-sectional survey between 29 January 2022 and 3 February 2022 was conducted to understand the public rationale for accepting or rejecting the use of COVID-19 immunity certificates and to identify the psychosocial factors that mostly predict the positive/negative individuals' perceptions of this measure. One thousand twenty-two Italian adults were recruited by a professional panel provider by employing a stratified sampling strategy controlled for gender, age, geographical area of residence, size of the urban centre of residence, employment, and wage. Eight Welch's ANOVAs were then carried out to compare the perception of benefits and the perception of harms among different population groups. Multiple linear regression was carried out to measure the explained variance of benefits perception and harms perception by age, trust in institutions, and concern for health emergencies. The results shows that age, trust in institution, and concern for the COVID-19 emergency explain more variance of perceived benefits than of perceived harms of COVID-19 immunity certificates but the opposite regarding political orientation which explains perceived harms better than perceived benefits. The need for policy improvements is pressing because a large share of the world's population remains unvaccinated. Moreover, our results can serve as vital information for similar health crises that may occur in the future. In addition, our results are expected to offer useful insights into public feelings around the use of digital health information tools.

Caring for Health Professionals in the COVID-19 Pandemic Emergency: Toward an "Epidemic of Empathy" in Healthcare.

Psychological research into healthcare opened the door to understanding people's emotional reactions when experiencing events perceived as life-threatening. This is the case of the current outbreak of the novel Coronavirus disease (COVID-19) that has recently been declared "a public health emergency of international concern (PHEIC)" by the World Health Organization (WHO). The response to an influenza pandemic might generate remarkable stress and emotional turmoil to healthcare providers who work during the outbreak. Prior experience with disasters, pandemics, and major traumatic events indicates that enhanced support to healthcare professionals enabling them to become aware of their own emotions and effectively share their perspective and lived experience with patients can help them in remaining efficient and focused during these stressful events. This outbreak marks a vital moment where healthcare systems can endorse an "epidemic of empathy" aimed at bringing science and humanism together to benefit patients and consolidate citizens' trust in healthcare providers during this and future healthcare crisis. Perhaps, the greatest opportunity for managing people fears during health emergencies-like the COVID-19 one-lies, in the short term, in restoring our connections with each other. Today, we are all called to rebuild a sense of community and the ties that bind us together as human beings.

Prevalence and health correlates of online fatigue: A cross-sectional study on the Italian academic community during the COVID-19 pandemic

Background: During the COVID-19 pandemic, many people had to shift their social and work life online. A few researchers and journalists described a new form of fatigue associated with a massive use of technology, including videoconferencing platforms. In this study, this type of fatigue was referred to as Online Fatigue. A new tool (the Online Fatigue Scale) was developed, and its psychometric properties were evaluated. This tool was used to assess Online Fatigue among Italian academics and to examine its associations with psychological and physical health. Methods: An online survey was conducted in December 2020 on a sample of Italian academics. Besides the Online Fatigue Scale (11 items) used to assess Online Fatigue, the survey was composed of questionnaires (including validated measures) focused on sociodemographic and job-related information, technostress creators, health status, psychological well-being, and COVID-related perceived distress. The psychometric properties of the Online Fatigue Scale were evaluated, and statistical analyses were conducted to examine the associations between Online Fatigue and all the other variables. Results: Participants were 307 academics aged 24-70 years old (mean age = 40.7;SD = 10.1). The Online Fatigue Scale showed good psychometric properties. Two subscales were identified: Off-Balance Fatigue and Virtual Relations Fatigue. High levels of Off-Balance Fatigue were associated with a greater use of technology, female gender, and presence of minor children. Participants with high scores on both subscales reported a greater frequency of psychosomatic symptoms, unhealthy habits, poorer psychological well-being, and greater Covid-related perceived distress. Conclusions: The Online Fatigue Scale can be considered a reliable tool to assess Online Fatigue, which was significantly detected in our sample of Italian academics, along with its negative effects on physical and psychological health. Being a woman and having young children represent important risk factors. Universities should promote the separation between work and private life by encouraging self-care activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The impact of COVID-19 pandemic on family caregivers' mental health: a rapid systematic review of the current evidence.

BACKGROUND AND AIM OF THE WORK: Older adults, especially in isolation and with cognitive decline/dementia, can become more anxious and stressed during the quarantine. All these symptoms negatively affect the psycho-physical health of their caregivers. This study aimed to synthesize the current evidence on the impact of the COVID-19 pandemic on caregivers' mental health. METHODS: A rapid systematic review was conducted using the following databases: Pubmed/Medline, CINAHL, Scopus, and PsycInfo (PROSPERO registration number: CRD42020215485). The 'PRISMA' flow chart guided the selection of articles. The search was entirely performed up to September 15th, 2021. RESULTS: The narrative synthesis has brought out two main themes that represent the current debate in literature: "Family caregivers COVID-19 related stress", and "(Mal)adaptive strategies to the "new" normality". CONCLUSIONS: This study provides an evidence synthesis of the negative mental health impact experienced by caregivers of older adults during the COVID-19 pandemic.

Exploring the Motivational Roots of Getting Vaccinated against COVID-19 in a Population of Vaccinated Pediatric Healthcare Professionals: Evidence from an Italian Cross-Sectional Study.

Health care professionals (HCPs) working in pediatric and perinatal settings have a strong influence on parental vaccine decision making. Furthermore, HCPs' motivations behind vaccine acceptance are associated with their likelihood of recommending vaccines to their patients. Understanding these motivations in the context of the COVID-19 vaccination campaign may aid in the development of interventions that improve pediatric practitioners' vaccine confidence and prescription. We aimed at studying the motivations affecting COVID-19 vaccination behavior among a sample of vaccinated Italian HCPs working in pediatric settings. A sample (n = 162) of HCPs completed an online self-reported survey exploring motivations behind getting vaccinated against COVID-19. Emotions of HCPs at the moment of COVID-19 vaccination injection were also recorded to collect data about the main feelings connected to the vaccination decision-making process. Data were collected between 19 March 2021 and 21 April 2021. The most effective motivational incentives were the beliefs that vaccination helped protect vulnerable members of the community (97.5% agreement), could protect one's own health (93.7%), health authorities could be trusted (58.7%), and the vaccine had been rigorously tested (53.8%). Actual personal exposure to COVID was less important (reported importance agreement 16-24%), and the influence of news and social media was still lower (4-6%). Differences between physicians' and other HCPs' ratings were also found. Finally, emotional status at vaccination showed high ratings for positive emotions surrounding the vaccination act. This study provided additional evidence about the multifaceted motivations behind COVID-19 vaccine acceptance and showed the potential of understanding the psychosocial roots of vaccine behaviors for shaping public communication campaigns. The highly emotionally charged response obtained underscores the importance of strengthening the community feeling among HCPs.

The State of the Evidence about the Family and Community Nurse: A Systematic Review.

INTRODUCTION: The increase in chronic degenerative diseases poses many challenges to the efficacy and sustainability of healthcare systems, establishing the family and community nurse (FCN) who delivers primary care as a strategic role. FCNs, indeed, can embrace the complexity of the current healthcare demand, sustain the ageing of the population, and focus on illness prevention and health promotion, ensuring a continuous and coordinated integration between hospitals and primary care ser. The literature on FCNs is rich but diverse. This study aimed to critically summarise the literature about the FCN, providing an overall view of the recent evidence. METHODS: A state-of-art systematic review was performed on PubMed, CINAHL, and Scopus, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist to guide the search and reporting. RESULTS: Five interpretative themes emerged from the 90 included articles: clinical practice, core competencies, outcomes, Organisational and educational models, and advanced training program. CONCLUSIONS: FCNs can make a major contribution to a population's health, playing a key role in understanding and responding to patients' needs. Even if the investment in prevention does not guarantee immediate required strategies and foresight on the part of decisionmakers, it is imperative to invest more political, institutional, and economic resources to support and ensure the FCNs' competencies and their professional autonomy.

The Effect of Message Framing on COVID-19 Vaccination Intentions among the Younger Age Population Groups: Results from an Experimental Study in the Italian Context.

The coronavirus pandemic has been recognized as a major threat to public health. Widespread acceptance of COVID-19 vaccines is crucial for achieving adequate immunization coverage to end the global pandemic. However, to date, there are still hesitant people, especially among the younger population groups. For this reason, it is essential to identify the psychological variables that may affect vaccination intention among these "at risk groups" and to select possible successful communication frames in order to increase vaccination rates. An online cross-sectional survey was carried out on 208 Italian citizens younger than 50 years old, to explore message framing effects on their intention to receive the vaccination and to understand the psychological factors influencing it. Results showed that depending on the goal (stimulate vaccination intention, vaccination trust, or vaccine attitude), not all the communication stimuli are equally effective on this target population. Furthermore, the study showed that sociodemographic variables do not help to explain the vaccination intention of the younger population groups, while the psychological variables have been found to have a stronger impact on such attitude. Trust and attitudes towards vaccines, concern about the pandemic and concern about infecting others have been found to be the most effective predictive variables of people vaccination intention. The study results underline the importance of understanding the psychological roots behind vaccine hesitancy to shape sensitization actions and vaccination campaigns targeting this population group.

Public Reaction towards the Potential Side Effects of a COVID-19 Vaccine: An Italian Cross-Sectional Study.

In March 2021, the possible link between the Oxford-AstraZeneca vaccine and some cases of blood clots lead several governments to suspend the administration of said vaccine, or to adjust their administration strategies, regardless of the fact that both EMA and WHO claimed the benefits of the vaccine to far outweigh its risks. The lack of a coordinated decision-making process between different health authorities possibly had an impact on people's trust in the health authorities themselves, and on their willingness to vaccinate against COVID-19. In this study, we assessed the impact of the Astrazeneca case on a sample of 1000 Italian participants. The results demonstrate that a large part of the population is willing to delay the vaccination to be granted a vaccine perceived as "better". We also assessed the importance of several socio-demographic and psychological factors in predicting hesitancy and discuss the implications for public communication strategies.

Measuring citizens' engagement during emergencies: Psychometric validation of the Public Health Engagement Scale for Emergency Settings (PHEs-E).

The Covid-19 pandemic has highlighted the importance of citizens' behaviors in the containment of the virus. Individuals might change their intention to adhere to public health prescriptions depending on various personal characteristics, including their own emotional status, which has been recognized to be a crucial psychological factor in orienting people's adherence to public health recommendation during emergency settings. In particular, it is crucial to support citizens' alliance with authorities and feeling of trust: public engagement is a concept that refers to the general involvement of citizens into public affairs which is generally considered an effective approach to enhance citizens' understanding of their crucial role in public affairs. However, so far there is no agreement on the metrics and indexes that should be used to measures public engagement during a health crisis. The aim of this paper is to validate a psychometric scale (PHEs-E), which intends to measure the readiness of individuals to adhere to the prescribed behavioral change to contain the emergency. Data were collected throughout the pandemic in Italy: in particular, five independent samples were recruited starting from March 2020 to March 2021. Results showed that the proposed measure has good psychometric characteristics. A general linear model was computed to assess the differences of public engagement across the different data points and among citizens with different sociodemographic characteristics. Correlations with other psychological constructs (i.e. Anxiety, Depression and Self-Efficacy) were also tested, showing that more engaged citizens have a lower level of anxiety and depression, and a higher self-efficacy. This study's findings indicate that individuals' characteristics may differentiate citizens' motivation to engage in public health behavioral recommendation to prevent the COVID-19 contagion. However the scale could be useful to perform a psychological monitoring of psychological readiness to engage in public health strategies to face critical events and settings.

Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards.

BACKGROUND: During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses' ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. METHODS: Design-Multicentre online survey. Setting-Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman's rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses' characteristics and outcome variables, and the Mann-Whitney/t-test to compare groups. RESULTS: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low-moderate level of ethical conflict (median = 111.5 [76-152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96-13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56-9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. CONCLUSIONS: Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.

Patient Engagement in Health Management as a Mediator Between Perceived Risk and COVID-19 Related Distress in Patients With IBD: A Structural Equation Model.

Objective: This study aimed to evaluate the impact of the COVID-19 emergency on patients with IBD's psychological distress, understanding the role of patient engagement as a mediator. Methods: An online questionnaire was created, measuring perceived risk susceptibility toward COVID-19, perceived stress, and patient engagement. The questionnaire was distributed to a purposive sample of IBD patients who belonged to the Italian Association for patients with IBD (AMICI Onlus) in April 2020. Structural equation models were implemented. Results: The effect of the perceived risk susceptibility toward COVID-19 contagion on the perceived stress is fully mediated by patient engagement (ß = 0.306, p < 0.001). Moreover, the patient engagement mitigates the perceived stress (ß = -0.748, p < 0.001) in our sample of IBD patients, and it is negatively influenced by the perceived risk susceptibility toward COVID-19 (ß = -0.410, p < 0.001). Conclusion: Patient engagement is the key factor that explains how the perceived risk susceptibility toward COVID-19 affects the perceived psychological distress in patients with IBD, underlining that the perceived risk of contagion increases their perceived level of stress through a decrease of patient engagement.

Prevalence and health correlates of Onine Fatigue: A cross-sectional study on the Italian academic community during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, many people had to shift their social and work life online. A few researchers and journalists described a new form of fatigue associated with a massive use of technology, including videoconferencing platforms. In this study, this type of fatigue was referred to as Online Fatigue. A new tool (the Online Fatigue Scale) was developed, and its psychometric properties were evaluated. This tool was used to assess Online Fatigue among Italian academics and to examine its associations with psychological and physical health. METHODS: An online survey was conducted in December 2020 on a sample of Italian academics. Besides the Online Fatigue Scale (11 items) used to assess Online Fatigue, the survey was composed of questionnaires (including validated measures) focused on sociodemographic and job-related information, technostress creators, health status, psychological well-being, and COVID-related perceived distress. The psychometric properties of the Online Fatigue Scale were evaluated, and statistical analyses were conducted to examine the associations between Online Fatigue and all the other variables. RESULTS: Participants were 307 academics aged 24-70 years old (mean age = 40.7; SD = 10.1). The Online Fatigue Scale showed good psychometric properties. Two subscales were identified: Off-Balance Fatigue and Virtual Relations Fatigue. High levels of Off-Balance Fatigue were associated with a greater use of technology, female gender, and presence of minor children. Participants with high scores on both subscales reported a greater frequency of psychosomatic symptoms, unhealthy habits, poorer psychological well-being, and greater Covid-related perceived distress. CONCLUSIONS: The Online Fatigue Scale can be considered a reliable tool to assess Online Fatigue, which was significantly detected in our sample of Italian academics, along with its negative effects on physical and psychological health. Being a woman and having young children represent important risk factors. Universities should promote the separation between work and private life by encouraging self-care activities.

The effect of health literacy on vaccine hesitancy among Italian anticoagulated population during COVID-19 pandemic: the moderating role of health engagement.

Assessing vaccine hesitancy and its determinants is pivotal to optimize vaccine acceptance in anticoagulated patients, given that this population has been described to have a higher risk of severe COVID-19-related complications. This study assessed the moderator role of patients' health engagement on the relationship between health literacy and vaccine hesitancy. A web-based survey was performed in Italy during the first wave (June-August 2020) and the second wave (October 2020-March 2021) of the COVID-19 pandemic, enrolling 288 patients. The rates of vaccine hesitancy reported during the first pandemic wave were 38.4% and 30.8% during the second wave (when a vaccine was available) (p = .164). A moderation analysis was performed to assess the role of health engagement in influencing the relationship from health literacy to vaccine hesitancy. Patients' health engagement enhanced the effects of health literacy on decreasing vaccine hesitancy (p < .001), suggesting that co-construction strategies for communicative action are pivotal.

Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences.

INTRODUCTION: Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. OBJECTIVE: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy. METHODS: A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors). RESULTS: Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males. CONCLUSIONS: This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study's cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs.

The Experience of Child Neuropsychiatry Residents who Volunteered in Italian COVID-19-Designated Hospitals.

OBJECTIVE: During the first months of 2020, the coronavirus disease of 2019 (COVID-19) spread rapidly and soon reached a pandemic level. With the increasing number of hospitalizations, medical and nursing personnel resources were soon inadequate. As a consequence, medical volunteers became a key human resource and young medical residents in any specialty were hired on a voluntary basis to contribute to take care of patients with COVID-19. This study reports on the lived experience of residents in child neuropsychiatry who volunteered in Italian hotspot COVID-19-designated hospitals during the epidemic outbreak. METHODS: A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was used to obtain in-depth narratives of the experience of residents in child neuropsychiatry volunteering in North Italy COVID-19-designated hospitals. All residents (n = 8) participated in the study. Interviews were conducted by an expert researcher trained in qualitative methods. Data analysis was performed by independent coders. RESULTS: Five core themes could be identified from the interviews: acting as mediators on two fronts, facing the shock of COVID-19 reality, capitalizing from specialty education, growing as persons and professionals, and humanizing medical care. CONCLUSIONS: This study is unique in providing an in-depth understanding of the experience of young residents in child neuropsychiatry volunteering in general hospitals during the COVID-19 pandemic in Northern Italy. The findings suggest that this experience may be highly beneficial for both the residents and the hospital quality of care. Insights for an accurate planning of residents' engagement in future healthcare emergencies are provided.

Effects of the COVID-19 Emergency and National Lockdown on Italian Citizens' Economic Concerns, Government Trust, and Health Engagement: Evidence From a Two-Wave Panel Study.

Policy Points Preventive measures such as the national lockdown in Italy have been effective in slowing the spread of COVID-19. However, they also had psychological and economic impacts on people's lives, which should not be neglected as they may reduce citizens' trust and compliance with future health mandates. Engaging citizens in their own health management and in the collaboration with health care professionals and authorities via the adoption of a collaborative approach to health policy development is fundamental to fostering such measures' effectiveness. Psychosocial analysis of citizens' concerns and emotional reactions to preventive policies is important in order to plan personalized health communication campaigns. CONTEXT: Because of the COVID-19 pandemic, between February 23 and March 8, 2020, some areas of Italy were declared "red zones," with citizens asked to stay home and avoid unnecessary interpersonal contacts. Such measures were then extended, between March 10 and May 4, 2020, to the whole country. However, compliance with such behaviors had an important impact on citizens' personal, psychological, and economic well-being. This could result in reduced trust in authorities and lowered compliance. Keeping citizens engaged in their own health and in preventive behaviors is thus a key strategy for the success of such measures. This paper presents the results from a study conducted in Italy to monitor levels of people's health engagement, sentiment, trust in authorities, and perception of risk at two different time points. METHODS: Two independent samples (n = 968 and n = 1,004), weighted to be representative of the adult Italian population, were recruited in two waves corresponding to crucial moments of the Italian COVID-19 epidemic: between February 28 and March 4 (beginning of "phase 1," after the first regional lockdowns), and between May 12 and May 18 (beginning of "phase 2," after the national lockdown was partially dismissed). Respondents were asked to complete an online survey with a series of both validated measures and ad hoc items. A series of t-tests, general linear models, and contingency tables were carried out to assess if and how our measures changed over time in different social groups. FINDINGS: Although sense of self and social responsibility increased between the two waves, and trust toward authorities remained substantially the same, trust in science, consumer sentiment, and health engagement decreased. Our results showed that while both the level of general concern for the emergency and the perceived risk of infection increased between the two waves, in the second wave our participants reported being more concerned for the economic consequences of the pandemic than the health risk. CONCLUSIONS: The potentially disruptive psychological impact of lockdown may hamper citizens' compliance with, and hence the effectiveness of, behavioral preventive measures. This suggests that preventive measures should be accompanied by collaborative educational plans aimed at promoting people's health engagement by making citizens feel they are partners in the health preventive endeavor and involved in the development of health policies.