"A Feeling of Safeness and Freedom": The Promotion of Mental Health Recovery Through Co-Production in an Italian Community Organization.

In mental health promotion, recovery is a process that leads to personal strengthening, control over crucial life decisions, and participation in communities through relevant professional, educational, or family social roles. Co-production, a key aspect of the recovery-oriented approach, emphasizes collaboration and active participation of people with mental health first-hand experience, family members, and citizens. Even though studies on co-production are limited and fragmented, there is evidence that co-production leads to positive outcomes, including improved well-being, empowerment, social connectedness, inclusion, and personal competencies. This study aimed to contribute to the limited literature on co-production in mental health by evaluating the co-production process in a non-profit mental health organization and its impact on empowerment processes and personal recovery outcomes. The research team adopted a collaborative approach and conducted qualitative research, including 13 individual semi-structured interviews and four focus groups. Results showed how the different dimensions of empowerment are promoted in and by the organization: (a) co-production processes supported empowered outcomes on an individual level, such as self-awareness; (b) the organization was perceived to promote empowering processes, such as a sense of safeness and protection; (c) co-production was a mean to build and maintain a network with mental health services that acknowledges the dignity and value of each subjectivity and promotes participation and recovery. Peer support workers were seen as facilitators of mental illness management, and the organization as a place for sharing mental health experiences and fostering individual recovery journeys.

Oocyte Quality Assessment in Breast Cancer: Implications for Fertility Preservation.

BACKGROUND: The aim of this study was to evaluate the effects of breast cancer on the ovarian response and on oocyte quality following controlled ovarian hyperstimulation (COH). METHODS: This retrospective case-control study evaluated the effects of breast cancer on the ovarian response and on the oocyte quality. Oncological patients with breast cancer undergoing controlled ovarian stimulation cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization (IVF) for male or tubal factor infertility were included in the study. Two hundred and ninety-four women were enrolled: 105 affected by breast cancer and 189 healthy women in the control group. Both groups were comparable in terms of age, BMI, and AMH value. Maximal estradiol levels on the triggering day, duration of stimulation, total amount of gonadotropins administered, number of oocytes retrieved, rate of metaphase 2 oocyte production, and numbers of immature and dysmorphic oocytes were analyzed. RESULTS: Considering factors influencing the oocyte quality, such as age, BMI, AMH, duration of stimulation, E2 level on the triggering day, total FSH cumulative dose, stage, histotype, BRCA status, and hormone receptors, the univariate and multivariate analyses identified breast cancer as a risk factor for the presence of dysmorphic oocytes. CONCLUSIONS: The diagnosis of breast cancer does not seem to be associated with the impairment of the ovarian reserve, but is linked to a worsening oocyte quality.

The selective effect of lockdown experience on citizens' perspectives: A multilevel, multiple informant approach to personal and community resilience during COVID-19 pandemic.

In the face of the first wave of COVID-19 contagion, citizens all over the world experienced concerns for their safety and health, as well as prolonged lockdowns - which brought about limitations but also unforeseen opportunities for personal growth. Broad variability in these psychological responses to such unprecedented experiences emerged. This study addresses this variability by investigating the role of personal and community resilience. Personal resilience, collective resilience, community disaster management ability, provided information by local authorities, and citizens' focus on COVID-19-related personal concerns and lockdown-related opportunities for personal growth were detected through an online questionnaire. Multilevel modelling was run with data from 3,745 Italian citizens. The potential of personal resilience as a driver for individuals to overcome adverse situations with positive outcomes was confirmed. Differently, the components of community resilience showed more complex paths, highlighting the need to pay more attention to its role in the face of far-reaching adverse events which hardly test individuals' as well as communities' adaptability and agency skills. The complexities linked to the multi-component and system-specific nature of resilience, as well as potential paths towards making the most out of citizens' and communities' ones, emerge. The theoretical and practical implications are discussed.

Emergency online school learning during COVID-19 lockdown: A qualitative study of adolescents' experiences in Italy.

The COVID-19 pandemic caused abrupt and profound changes to teaching and learning. The present study seeks to understand adolescents' experiences of the emergency adoption of online school learning (OSL) during the first national lockdown in Italy. Sixty-four students in their final two years of high school were interviewed and content analysis was performed. The findings describe students' views of the changes related to OSL according to structural, individual and relational dimensions. Schools' lack of organization, overwhelming demands, as well as experience of difficulties in concentration, stress and inhibited relationships with teachers and classmates were among the challenges evidenced in the transition. OSL, however, has also made it possible to experience a new flexibility and autonomy in the organization of learning. The study stresses the importance of fostering adaptation of teacher-student relationships and collaborative learning in order to improve schools' preparedness for digital transitions in and out of emergencies.

An Integrated Model of Compliance with COVID-19 Prescriptions: Instrumental, Normative, and Affective Factors Associated with Health-Protective Behaviors.

BACKGROUND: The efficacy of public measures for reducing the transmission of the COVID-19 infection relies on citizens' voluntary adherence with prescribed actions. Drawing on prior literature about compliant behavior, this study aimed to identify factors associated with people engagement in health-protective behaviors by including a conjoint complement of instrumental/self-oriented, normative/community-based, and affective variables. METHOD: A cross-sectional study involving a non-representative sample of 4045 Italian citizens was carried out during the first stage of the pandemic (April-May 2020). Variables associated with health-protective behaviors were perceived personal and societal concerns and perceived effectiveness of the institutional response to the outbreak (instrumental dimensions), and family and friends perceived norms and sense of community responsibility (normative dimensions). Two negative emotions (anxiety and fear) were included as mediators between personal and societal concerns and outcome behaviors. RESULTS: Results showed the importance of both self-interest and community-based factors. Indeed, self-interest concerns, family perceived norms, and sense of community responsibility were significant predictors of people's decisions to engage in health-protective behaviors. CONCLUSIONS: The research findings show that compliance with public health prescriptions is a multimodal phenomenon and integrating self-interest and community-based factors can offer a better understanding of people's decision to engage in health-protective behaviors. Further, this study unveils that a shared sense of community is effective in encouraging adherence to recommended behaviors so as behavioral changes can be sustained by targeting the recommendations not only on risk minimization for oneself but also on the allocation of personal responsibility toward the belonging community.

Female fertility preservation: Impact of cancer on ovarian function and oocyte quality.

OBJECTIVE: To evaluate the influence of cancer on ovarian response and oocyte quality in controlled ovarian hyperstimulation (COH). METHODS: This prospective study conducted at the Physiopathology of Reproduction and Andrology Unit of Sandro Pertini Hospital enrolled 82 cancer patients undergoing controlled ovarian stimulation (COH) cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization for male-factor infertility from June 2016 to November 2019. The interventions performed were COH, oocyte retrieval, and quality evaluation. Main outcome measures were maximal estradiol levels on the day of human chorionic gonadotropin administration, duration of stimulation, total amount of gonadotropins administered, number of oocytes retrieved, and rates of metaphase 2 oocytes and abnormal oocytes. All data were analyzed using the Statistical Package for the Social Sciences (IBM Corp., Armonk, NY, USA) 22.0. RESULTS: Intergroup comparisons (82 cancer patients and 180 patients in control group) showed a significant difference in ovarian response, especially for a significant higher number of abnormal oocytes in cancer patients (P < 0.0001). Regression analysis to assess the influence of the neoplastic process, regardless of the type, on ovarian response showed an effect on the main outcome measured due to cancer itself. CONCLUSION: Cancer influences the ovarian response, particularly the oocyte quality, during COH performed for fertility preservation.

Prosocial behaviours under collective quarantine conditions. A latent class analysis study during the 2020 COVID-19 lockdown in Italy.

We aimed to identify the patterns of prosocial behaviours under collective quarantine conditions. Survey data were collected from a sample of Italian adults during the March May 2020 COVID-19 lockdown in Italy. Participants reported on offline and online prosocial behaviours, sense of community responsibility (SoC-R) and perceptions of community resilience. Latent class analysis (LCA) was used for data analysis. A total of 4,045 participants completed the survey, and 2,562 were eligible (72% female; mean age 38.7 years). LCA revealed four classes of prosocial behaviours: Money donors (7%), Online and offline helpers (59%), Online health information sharers (21%) and Neighbour helpers (13%). The classes were partially invariant across age groups (18-35 and 35-65 years). Being a man, having achieved a higher educational level and higher SoC-R scores were associated with belonging to the Online and offline helper class. The members of this class also reported the greatest perceptions of community resilience. The results provide insight on the multidimensionality of prosociality under collective quarantine conditions. Online and offline helpers could be targeted for promoting sustained altruism and involvement in community organisations. For the other groups, programmes should aim at eliminating barriers to help others in multiple ways. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

COVID-19 in our lives: Sense of community, sense of community responsibility, and reflexivity in present concerns and perception of the future.

The aim of this study is to examine the association between citizens' perceptions of the effectiveness of the institutional response, their connection and responsibility to their community (Sense of Community-SoC; Sense of Community Responsibility-SoC-R), and their personal and social concerns about the current emergency and their perceptions of a postpandemic future during the first COVID-19 pandemic lockdown. Another variable considered was the personal reflexivity about the COVID-19 pandemic. 3925 Italian adults completed an online questionnaire during the first COVID-19 lockdown. A structural equation model with mediation was tested. Institutional effectiveness was associated with SoC, SoC-R, current social concerns, and perceptions of a postpandemic future. SoC and SoC-R were associated with current personal and social concerns, and perceptions of a postpandemic future. Reflexivity was negatively associated with SoC and positively associated with SoC-R, mediating the relationships between SoC, SoC-R and current personal and social concerns and perceptions of a postpandemic future. Findings indicate the need to adopt a perspective that considers individual and socio-political levels and their interaction to better understand the impact of the pandemic during a national lockdown.

Evaluation of an Active Citizenship Intervention Based on Youth-Led Participatory Action Research.

Youth-led participatory action research (YPAR) is a theoretical-methodological approach that has been designed to promote positive development (e.g., well-being and health, social-emotional and cognitive development, academic or career advancement) and civic engagement among young people. Although YPAR holds particular promise, there has been little systematic assessment of its effects. Moreover, no study has investigated the role of YPAR in the promotion of active citizenship. We report on an effectiveness evaluation of a YPAR project designed to promote European active citizenship (i.e., identification and attitudes toward a political entity, institutional trust, participation, and political alienation) and social well-being among adolescents. Our sample included 69 Italian high school students (35 in the intervention group; 34 in the control group). We evaluated the impact of YPAR using a pretest-posttest control group design and fitting the generalized estimating equations procedure. The results showed that participants in the intervention group reported increased scores on social well-being, institutional trust, and participation and decreased scores on political alienation compared with the control group. We found no significant effects for identification as European and attitudes toward a political entity. Findings support the benefits of YPAR in terms of social well-being and active citizenship.

Hyperandrogenism in a postmenopausal woman: a rare case of ectopic adrenal cortical gland.

Most frequent causes of androgenic manifestation are Cushing's syndrome, PCO, benign and malignant androgen-secreting non adrenal tumors and iatrogenic hirsutism. Hyperplasia or neoplasms of ectopic adrenocortical gland are rare. We report a case of a 63-year old female with hirsutism and alopecia. Laboratory data highlighted increased levels of androgens. Diagnostic imaging revealed normal morphology of adrenocortical gland and ovaries. In view of the clinical picture and suspected diagnosis of extra-adrenal cause, she underwent bilateral salpingo-oophorectomy. Histologic examination showed an ectopic adrenal gland with adenoma in the ovarian and peri-ovarian tissue. At six months of follow up, the patients has no sign of hyperandrogenism. In case of hyperandrogenism in postmenopausal women and in the absence of the adrenocortical gland abnormality, ovarian origin should be considered in the differential diagnosis.

Conservative and timely treatment in retained products of conception: a case report of placenta accreta ritention.

The term retained products of conception (RPOC) refers to intrauterine tissue that develops after conception and persists after medical and surgical pregnancy termination, miscarriage, and vaginal or cesarean delivery. One of the most important factor risk for RPOC is placenta accreta, defined as "the abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall". We report a case of a 37 years old woman referred to our gynecologic department with irregular vaginal bleeding. On her medical history, she had a cesarean occurred 3 months before. Ultrasonography revealed in the uterine cavity hyperechoic mass, treated with curettage. Two weeks later the curettage, patient complained still vaginal bleeding. On the transvaginal ultrasound, the uterine cavity was occupied again by a hyperechoic mass. She underwent to hysteroscopic resection and histological diagnosis was compatible with placenta accreta residual. In the follow up she had not complications. Early diagnosis, prompt evaluation of bleeding is important for timely treatment and for preventing immediate complications and demolitive approach. A careful follow up is necessary to prevent late consequences. The purpose of this study is to report our experience in timely diagnosis and conservative management.