Impact of asymptomatic genital tract infections on in vitro Fertilization (IVF) outcome

Background

Infertility is estimated to affect approximately 9–30% of reproductive-aged couples. Several conditions involving one or both partners may contribute to infertility. The aim of this study is to evaluate the role of asymptomatic genital tract infections in the outcome of In Vitro Fertilization (IVF) in couples with infertility.

Methods

A total of 285 infertile couples were enrolled in the study. Vaginal/endocervical swabs and semen samples were collected and subjected to microbiological analysis. Spermiograms were carried out on semen specimens, and lactobacilli were quantified in vaginal swabs. Data were associated with IVF results and analysed by using non parametric tests and multivariate analysis.

Results

Microbiological analysis showed that 46.3% of couples presented with an asymptomatic genital tract infection. Spermiogram results showed a significantly diminished motility of sperm cells in samples positive to microbiological testing compared to negative specimens. Enterococcus faecalis was the most prevalent species (11.6%) in positive semen samples and was found to negatively affect both sperm morphology (p = 0.026) and motility (p = 0.003). Analysis of genital swabs from females showed that the presence of E. faecalis (p<0.0001), Escherichia coli (p = 0.0123), Streptococcus agalactiae (p<0.0001), and Gardnerella vaginalis (p = 0.0003) was significantly associated to reduced levels of vaginal lactobacilli. Association of microbiological data with IVF outcome showed that 85.7% of IVF+ couples was microbiologically negative, while IVF was successful in just 7.5% of couples infected with E. faecalis and/or U. urealyticum and/or M. hominis (p = 0.02).

Conclusions

The results show the negative impact of E. faecalis on sperm quality and the association of definite bacterial pathogens with reduced levels of vaginal lactobacilli. The presence of E. faecalis and/or U. urealyticum and/or M. hominis in genital samples of infertile couples is predictive for a negative outcome of IVF.

Type M Resistance to Macrolides Is Due to a Two-Gene Efflux Transport System of the ATP-Binding Cassette (ABC) Superfamily

The mef(A) gene was originally identified as the resistance determinant responsible for type M resistance to macrolides, a phenotype frequently found in clinical isolates of Streptococcus pneumoniae and Streptococcus pyogenes. MefA was defined as a secondary transporter of the major facilitator superfamily driven by proton-motive force. However, when characterizing the mef(A)-carrying elements Tn1207.1 and Φ1207.3, another macrolide resistance gene, msr(D), was found adjacent to mef(A). To define the respective contribution of mef(A) and msr(D) to macrolide resistance, three isogenic deletion mutants were constructed by transformation of a S. pneumoniae strain carrying Φ1207.3: (i) Δmef(A)–Δmsr(D); (ii) Δmef(A)–msr(D); and (iii) mef(A)–Δmsr(D). Susceptibility testing of mutants clearly showed that msr(D) is required for macrolide resistance, while deletion of mef(A) produced only a twofold reduction in the minimal inhibitory concentration (MIC) for erythromycin. The contribution of msr(D) to macrolide resistance was also studied in S. pyogenes, which is the original host of Φ1207.3. Two isogenic strains of S. pyogenes were constructed: (i) FR156, carrying Φ1207.3, and (ii) FR155, carrying Φ1207.3/Δmsr(D). FR155 was susceptible to erythromycin, whereas FR156 was resistant, with an MIC value of 8 μg/ml. Complementation experiments showed that reintroduction of the msr(D) gene could restore macrolide resistance in Δmsr(D) mutants. Radiolabeled erythromycin was retained by strains lacking msr(D), while msr(D)-carrying strains showed erythromycin efflux. Deletion of mef(A) did not affect erythromycin efflux. This data suggest that type M resistance to macrolides in streptococci is due to an efflux transport system of the ATP-binding cassette (ABC) superfamily, in which mef(A) encodes the transmembrane channel, and msr(D) the two ATP-binding domains.

Excision and Circularization of Integrative Conjugative Element Tn5253 of Streptococcus pneumoniae

The integrative conjugative element (ICE) Tn5253 of Streptococcus pneumoniae, conferring resistance to tetracycline and chloramphenicol, was found integrated at a 83-bp specific target site (attB) located in the rbgA gene of the pneumococcal chromosome. PCR analysis of Tn5253-carrying strains showed evidence of precise excision of Tn5253 from the pneumococcal chromosome with production of (i) circular forms of the ICE in which the ends were joined by a 84-bp sequence (attTn), and (ii) reconstituted chromosomal attB. When integrated into the chromosome, Tn5253 was flanked by attL, identical to attB, and attR, identical to attTn. Circular forms of Tn5253 were present at a concentration of 3.8 × 10^-4 copies per chromosome, whereas reconstituted attB sites were at 3.0 × 10^-4 copies per chromosome. Deletion of int-xis of Tn5253 abolished production of circular forms (<7.1 × 10^-6 copies per chromosome) and was associated to the lack of Tn5253 conjugal transfer suggesting, as expected, that Tn5253 circular form acts as a conjugation intermediate.

Transcriptomics of the Vaccine Immune Response: Priming With Adjuvant Modulates Recall Innate Responses After Boosting

Transcriptomic profiling of the immune response induced by vaccine adjuvants is of critical importance for the rational design of vaccination strategies. In this study, transcriptomics was employed to profile the effect of the vaccine adjuvant used for priming on the immune response following re-exposure to the vaccine antigen alone. Mice were primed with the chimeric vaccine antigen H56 of Mycobacterium tuberculosis administered alone or with the CAF01 adjuvant and boosted with the antigen alone. mRNA sequencing was performed on blood samples collected 1, 2, and 7 days after priming and after boosting. Gene expression analysis at day 2 after priming showed that the CAF01 adjuvanted vaccine induced a stronger upregulation of the innate immunity modules compared with the unadjuvanted formulation. The immunostimulant effect of the CAF01 adjuvant, used in the primary immunization, was clearly seen after a booster immunization with a low dose of antigen alone. One day after boost, we observed a strong upregulation of multiple genes in blood of mice primed with H56 + CAF01 compared with mice primed with the H56 alone. In particular, blood transcription modules related to innate immune response, such as monocyte and neutrophil recruitment, activation of antigen-presenting cells, and interferon response were activated. Seven days after boost, differential expression of innate response genes faded while a moderate differential expression of T cell activation modules was appreciable. Indeed, immunological analysis showed a higher frequency of H56-specific CD4+ T cells and germinal center B cells in draining lymph nodes, a strong H56-specific humoral response and a higher frequency of antibody-secreting cells in spleen of mice primed with H56 + CAF01. Taken together, these data indicate that the adjuvant used for priming strongly reprograms the immune response that, upon boosting, results in a stronger recall innate response essential for shaping the downstream adaptive response.

Researches about Knowledge of Self-Examination and some Problems about Breast Cancer

A research on the degree of knowledge about the problem of breast self-examination was carried out in a group of 500 women in the Out-patients Department of the Cancer Institute in Milan.

The women were given a questionnaire to fill up at home and to return at the moment of the medical examination.

The analysis of data showed that, though the level of education of the subjects was fairly good, the knowledge and the practise of the periodical self-examination as a method for an early diagnosis was very low. 70% of the women declared to have some knowledge about the method, but only 9% declared to practise it regularly.

Heterologous Prime-Boost Combinations Highlight the Crucial Role of Adjuvant in Priming the Immune System

The induction and modulation of the immune response to vaccination can be rationally designed by combining different vaccine formulations for priming and boosting. Here, we investigated the impact of heterologous prime-boost approaches on the vaccine-specific cellular and humoral responses specific for a mycobacterial vaccine antigen. C57BL/6 mice were primed with the chimeric vaccine antigen H56 administered alone or with the CAF01 adjuvant, and boosted with H56 alone, or combined with CAF01 or with the squalene-based oil-in-water emulsion adjuvant (o/w squalene). A strong secondary H56-specific CD4⁺ T cell response was recalled by all the booster vaccine formulations when mice had been primed with H56 and CAF01, but not with H56 alone. The polyfunctional nature of T helper cells was analyzed and visualized with the multidimensional flow cytometry FlowSOM software, implemented as a package of the R environment. A similar cytokine profile was detected in groups primed with H56 + CAF01 and boosted with or without adjuvant, except for some clusters of cells expressing high level of IL-17 together with TNF-α, IL-2, and IFN-γ, that were significantly upregulated only in groups boosted with the adjuvants. On the contrary, the comparison between groups primed with or without the adjuvant showed a completely different clusterization of cells, strengthening the impact of the formulation used for primary immunization on the profiling of responding cells. The presence of the CAF01 adjuvant in the priming formulation deeply affected also the secondary humoral response, especially in groups boosted with H56 alone or o/w squalene. In conclusion, the presence of CAF01 adjuvant in the primary immunization is crucial for promoting primary T and B cell responses that can be efficiently reactivated by booster immunization also performed with antigen alone.

Managing Different Time Granularities of Clinical Information by an Interval-based Temporal Data Model

In the field of databases, time management at different levels of granularity has been an issue for several years, for instance when dealing with clinical information from different databases using different time units, dealing with natural language expressions, or when dealing with temporal uncertainty. A temporal data model is proposed to manage the temporal aspect of data, presented at various and mixed levels of granularity. The concept of temporal assertions shapes the entire temporal information. The model provides a temporal dimension to the data by using intervals that can be specified at different granularities. The model supports a three-valued logic, where True, False and Undefined are the truth values. The temporal data model allows to manage some degrees of uncertainty when establishing temporal relationships between intervals or between temporal assertions, expressed at different granularities. The logical connectives and quantifiers can manage each of the three truth-values.

We applied the temporal data model by implementing an object-oriented database system for managing follow-up clinical data from patients who underwent percutaneous transluminal coronary angioplasty.

MS2/Cardio: Towards a Multi-Service Medical Software for Cardiology

Many clinics are interested to use software packages in daily practice, but lack of integration of such packages seriously limits their scope. In practice this often entails switching between programs and interrupting the run of an individual program. A multi-task approach would not solve this problem as it would not eliminate the need to input the same data many times, as often occurs when using separate packages. The construction of a Multi-Service Medical Software package (MSx2) is described, which was also developed as an example of practical integration of some clinically relevant functions. The package runs on a personal computer in an MS-DOS environment and integrates a time-oriented medical record management unit (TOMRU) for data of ambulatory patients, and a drug information management unit (DIMU) concerning posology, content, effects, and possible interactions. Of the possible database configurations allowed by MSx2, the cardiology patient database (MSx2/C) and hypertensive patient database (MSx2/H) were developed and described here. Clinical information to be included in the configurations was obtained after discussion and consensus of clinical practitioners. MSx2/C was distributed to several hundred clinical centers during computerized courses to train future users. MSx2 can easily transfer patient data to statistical processing packages.

Identification of the chain-dispersing peptidoglycan hydrolase LytB of Streptococcus gordonii

Bacterial cell division ends with the separation of the daughter cells, a process that requires peptidoglycan hydrolases (PGHs). Bacteria lacking cell separating PGHs are impaired in cell separation with the formation of long chains or clusters. We identified a gene in Streptococcus gordonii encoding for a putative glucosaminidase (lytB). The lytB isogenic mutant grew in long bacterial chains and resulted in impaired biofilm formation. Purified recombinant LytB showed a murolytic activity on Micrococcus lysodeikticus cell suspension and was able to disperse the long chains of the mutant, restoring the wild type diplococci/short chain phenotype. LytB protein was localized only in culture supernatant cell fraction of S. gordonii, and co-cultures of wild type and lytB mutant showed a significant reduction of bacterial chain length, indicating that LytB is a secreted enzyme. Our results demonstrate that LytB is a secreted peptidoglycan hydrolase required for S. gordonii cell separation.

Correlations between medical students’ specialty choice and different attitudes towards mental illness

Introduction

Discrimination and stigmatization cause an important burden for people suffering from psychiatric disorders. The medical doctors, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.

Objectives

It is extremely important to study and to know the attitudes of undergraduate medical students towards psychiatric disorders, since these individuals will be involved in the care of these patients throughout their careers.

Aims

The present study analyzes the attitudes of a group of Italian medical students towards mental illness, highlighting the differences between the students who would choose surgical specialties from those who prefer medical ones.

Methods

A total of 339 medical students of different medical schools, in Rome and Foggia (Italy), completed a cross-sectional survey. The Italian version of community attitude towards the mentally Ill test (CAMI) was used to evaluate the students’ attitudes.

Results

The students that would choose medical specialties reported less stigmatizing responses in 11 CAMI items (including five items with P < 0.01), in benevolence and community mental health ideology subscales (P = 0.003) and in the total score (P = 0.003).

Conclusions

It is evident that the students that prefer the surgical specialties have more stigmatizing attitudes towards psychiatric patients. Negative feedbacks on Psychiatry from non-psychiatrist colleagues may have a fundamental role in stigmatizing mental disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Differences in empathy in Italian university students: Are medical students more or less empathetic?

Introduction

Empathy is the capacity to understand or feel what another person is experiencing. It is an important quality in the medical profession, since it is fundamental in interpersonal relationships with patients. Nevertheless, many studies have found that over time medical students (MS) become less empathic and more detached from patients.

Objectives and aims

To determine MS loss of empathy and to study the differences in empathy between MS and other university students who are not involved in healthcare.

Methods

We enrolled 244 MS (120 of the 1st year and 124 of the last year) and 125 other university students not involved in healthcare, in different universities in Rome and Foggia (Italy). They anonymously and voluntarily completed a socio-demographic questionnaire and Baron Cohen's empathy quotient test (EQ).

Results

We found no differences regarding EQ total score between MS and other students, however there are few differences considering individual EQ items. In particular, MS really like taking care of others (P = 0.005) and they are sometimes considered to be rude, even if only they are only blunt (P = 0.006). We found no differences in empathy between first year and last year MS.

Conclusions

In our sample of Italian students, we have not found MS to be more or less empathetic than other university students, but there are some peculiar differences in empathy that make them better suited to the chosen course of study. Moreover, we found no differences between the different years of medical school.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Genomic polymorphisms in a Laboratory Isolate of Mycobacterium tuberculosis Reference Strain H37Rv (ATCC27294)

The complete genome sequence of Mycobacterium tuberculosis reference strain H37Rv (ATCC27294) was determined on an isolate carried in our laboratory collection for almost 20 years and named H37RvSiena. DNA sequence analysis showed that the genome of H37RvSiena was 4,410,911 bp in size and contained 101 genetic polymorphisms compared to H37Rv: 83 single nucleotide polymorphisms, 10 insertions, and 8 deletions of which one was 617-bp long and seven ranged from 1 to 7 bp. Comparison with the genomes of two other H37Rv derivatives allowed identification of 28 polymorphisms specific for H37RvSiena.

Experimental Evolution of Mycobacterium tuberculosis in Human Macrophages Results in Low-Frequency Mutations Not Associated with Selective Advantage

Isolates of the human pathogen Mycobacterium tuberculosis recovered from clinical samples exhibit genetic heterogeneity. Such variation may result from the stressful environment encountered by the pathogen inside the macrophage, which is the host cell tubercle bacilli parasitize. To study the evolution of the M. tuberculosis genome during growth inside macrophages, we developed a model of intracellular culture in which bacteria were serially passaged in macrophage-like THP-1 cells for about 80 bacterial generations. Genome sequencing of single bacterial colonies isolated before and after the infection cycles revealed that M. tuberculosis developed mutations at a rate of about 5.7 × 10⁻⁹ / bp/ generation, consistent with mutation rates calculated during in vivo infection. Analysis of mutant growth in macrophages and in mice showed that the mutations identified after the cyclic infection conferred no advantage to the mutants relative to wild-type. Furthermore, activity testing of the recombinant protein harboring one of these mutations showed that the presence of the mutation did not affect the enzymatic activity. The serial infection protocol developed in this work to study M. tuberculosis genome microevolution can be applied to exposure to stressors to determine their effect on genome remodeling during intra-macrophage growth.

Modulation of Primary Immune Response by Different Vaccine Adjuvants

Adjuvants contribute to enhancing and shaping the vaccine immune response through different modes of action. Here early biomarkers of adjuvanticity after primary immunization were investigated using four different adjuvants combined with the chimeric tuberculosis vaccine antigen H56. C57BL/6 mice were immunized by the subcutaneous route with different vaccine formulations, and the modulation of primary CD4⁺ T cell and B cell responses was assessed within draining lymph nodes, blood, and spleen, 7 and 12 days after priming. Vaccine formulations containing the liposome system CAF01 or a squalene-based oil-in-water emulsion (o/w squalene), but not aluminum hydroxide (alum) or CpG ODN 1826, elicited a significant primary antigen-specific CD4⁺ T cell response compared to antigen alone, 7 days after immunization. The effector function of activated CD4⁺ T cells was skewed toward a Th1/Th17 response by CAF01, while a Th1/Th2 response was elicited by o/w squalene. Differentiation of B cells in short-lived plasma cells, and subsequent early H56-specific IgG secretion, was observed in mice immunized with o/w squalene or CpG adjuvants. Tested adjuvants promoted the germinal center reaction with different magnitude. These results show that the immunological activity of different adjuvants can be characterized by profiling early immunization biomarkers after primary immunization. These data and this approach could give an important contribution to the rational development of heterologous prime–boost vaccine immunization protocols.

Transporters for Antiretroviral Drugs in Colorectal CD4+ T Cells and Circulating α4β7 Integrin CD4+ T Cells: Implications for HIV Microbicides

CD4+ T lymphocytes in the colorectal mucosa are key in HIV-1 transmission and dissemination. As such they are also the primary target for antiretroviral (ARV)-based rectal microbicides for pre-exposure prophylaxis. Drug transporters expressed in mucosal CD4+ T cells determine ARV distribution across the cell membrane and, most likely, efficacy of microbicides. We describe transporters for antiretroviral drugs in colorectal mucosal CD4+ T lymphocytes and compare gene expression with circulating α4β7+CD4+ T cells, which traffic to the intestine and have been shown to be preferentially infected by HIV-1. Purified total CD4+ T cells were obtained from colorectal tissue and blood samples by magnetic separation. CD4+ T cells expressing α4β7 integrin were isolated by fluorescence-activated cell sorting from peripheral blood mononuclear cells of healthy volunteers. Expressions of 15 efflux and uptake drug transporter genes were quantified using Taqman qPCR assays. Expression of efflux transporters MRP3, MRP5, and BCRP and uptake transporter CNT2 were significantly higher in colorectal CD4+ T cells compared to circulating CD4+ T cells (p = 0.01-0.03). Conversely, circulating α4β7+CD4+ T cells demonstrated significantly higher expression of OATPD compared to colorectal CD4+ T cells (p = 0.001). To the best of our knowledge this is the first report of drug transporter gene expression in colorectal CD4+ and peripheral α4β7+CD4+ T cells. The qualitative and quantitative differences in drug transporter gene expression profiles between α4β7+CD4+ T cells and total mucosal CD4+ T cells may have significant implications for the efficacy of rectally delivered ARV-microbicides. Most notably, we have identified efflux drug transporters that could be targeted by selective inhibitors or beneficial drug-drug interactions to enhance intracellular accumulation of antiretroviral drugs.

Using IFN-gamma release assay to confirm tuberculin skin test improves the screening of latent tuberculosis infection in Italian healthcare workers

Background

Healthcare workers (HCWs) represent a tuberculosis (TB) risk group for a wide range of tasks in healthcare, even in countries with low TB incidence, like Italy. Latent Tuberculosis Infection (LTBI) screening programs are an important tool for TB prevention in these setting.

Methods

A retrospective study under a LTBI screening program among HCWs at the Siena University Hospital (Italy), was conducted between September 2011 and July 2015. Tuberculin Skin Test (TST) was used as a first level examination; all TST-positive cases were tested with QuantiFERON-TB Gold In-Tube (QFT-GIT) test, together with a group of TST-negative subjects.

Results

Among the 2136 HCWs screened, 144 (6.7 %) were TST-positive and therefore tested with QFT-GIT, confirming a positive result in 36 cases (25 %). Agreement between two tests was poor (k = 0.092; 95 %, Confidence Interval [CI]- 0.048–0.136, p = 0.002). Among TST-positive cases, discordant results occurred more frequently in BCG vaccinated than unvaccinated HCWs (86.3 %, p < 0.001). The probability of a QFT-GIT-positive result increased according to the TST diameter (p = 0.001). No putative risk factor was associated with LTBI occurrence.

Conclusions

The use of QFT-GIT test as a second step in TST-positive cases offers an appropriate tool for LTBI detection, especially among BCG-vaccinated HCWs.

Differences in attitudes towards mental illness and psychiatry among medical students, before and after the academic course of psychiatry

Background

Stigma towards mental illness and psychiatry have a major impact on psychiatric patients’ quality of life; in particular, prejudicial beliefs make it more difficult for future doctors to send patients to mental health services, leading to a delay of necessary care.

Aims

Our aim is to evaluate the stigma towards mental illness and psychiatry, in a sample of Italian medical students. We studied the differences between the first-year students who have not attended the academic course in psychiatry, compared to the senior students who have attended the psychiatric lectures.

Methods

We tested 113 medical students, using the following questionnaires:

– Attitudes Towards Psychiatry (ATP 30);

– Community Attitudes Towards Mental Ill (CAMI);

– Perceived Discrimination Devaluation Scale (PDD), to assess the discrimination towards mental illness perceived in society;

– Baron-Cohen's Empathy Quotient (EQ), to measure empathy.

Results

Among the 113 students, 46 have already attended the academic course of psychiatry and CAMI scores were less stigmatizing as total score (P = 0.014) and in authoritarianism subscale (P = 0.049), social restriction (P = 0.022) and ideology of mental health in the community (P = 0.017). However, there were no statistically significant differences in empathy, perceived discrimination in the society and stigmatization of psychiatry.

Conclusions

The 67 students who have not attended the academic course of psychiatry are more stigmatizing, considering psychiatric patients as inferior people that require coercive attitudes, socially dangerous and that should be treated faraway from the community. Studying psychiatry is therefore useful to reduce, in the future doctors, these prejudices toward mentally ill patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mental Health and Empathy: Do Nursing Students Have Better Attitudes to Psychiatric Patients?

Background

Stigma towards mental illness has a major impact on the quality of life and the health care of psychiatric patients. Several studies have reported that health professionals have more negative attitudes than general population.

Aims

To explore empathy and attitudes towards mental illness in nursing students (NS) and non-health university students. Our purpose is to see how NS have more empathic and less stigmatizing attitudes towards psychiatric patients, compared to other university students.

Methods

We tested 96 university students (50 NS and 46 non-health university students), with the following questionnaires anonymously filled out:

– Community attitudes towards mental ill (CAMI), to evaluate the different students’ attitudes towards mental illness;

– Empathy quotient (EQ), to assess empathy.

Results

NS differs from the other group in 5 items of CAMI (P < 0.05 in 3 items and P < 0.01 in 2 items), and Authoritarianism subscale (P = 0.023). This shows that NS have a greater general awareness and less stigmatizing attitudes about the need to hospitalize the mentally ill, the difference between psychiatric patients and general population, the wrong need of segregation and the real causes of mental illness. There is also a significant difference in EQ (items 6, 21, 25, 44, 59): future nurses seem to have a slightly higher empathy, even though the EQ total score does not differ in the two groups.

Conclusions

These results suggest that there is a difference with respect to the attitudes towards psychiatric patients in NS and students who do not follow health-care courses: NS have more empathetic and less stigmatizing attitudes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Different Attitudes Toward Psychiatry and Psychiatric Patients in Nursing Students: Can Personal Experiences Reduce Stigma?

Background

Psychiatric patients often do not receive the same health treatment reserved for patients with no mental disorders. Stigma in mental-health nurses can worsen the patients’ healing time and quality of care.

Objective

To explore the different attitudes towards mental illness and psychiatry in nursing students (NS) of the first and the final year of university, and the importance of having visited a psychiatric ward and having known a psychiatric patient.

Methods

Fifty NS completed the following tests:

– Community attitudes towards mental ill (CAMI);

– Attitudes towards psychiatry (ATP-30);

– Empathy quotient (EQ).

Results

NS of the final year differ significantly from those of the first year in 4 CAMI items, in Authoritarianism subscale (P = 0.041), Social Restrictiveness (P = 0.029) and Community Mental Health Ideology (P = 0.045), indicating a more mature and responsible approach to psychiatric patients, without considering them a threat to be secluded. EQ does not show a significant difference in empathy, not even considering the individual items. Final year NS also have more positive attitudes toward Psychiatry in 3 ATP-30 items and total score (P = 0.01). Those who visited a psychiatric ward have more positive attitudes towards mental illness and Psychiatry, in 6 CAMI items and 3 ATP-30 items. Having personally known a psychiatric patient leads to positive attitudes in only a few CAMI items.

Conclusions

Last-year NS, who have had more direct relationships with patients through practical training, have more empathetic and less stigmatizing attitudes. It is also very useful to attend a psychiatric ward during the nursing training.

Normal 0 14 false false false IT X-NONE X-NONE.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Attitudes toward psychiatry and psychiatric patients in medical students: Can real-world experiences reduce stigma?

Introduction

Stigma towards psychiatry and mental illness significantly worsens the quality of life of psychiatric patients. Negative prejudices in medical students make it difficult for future doctors to send patients to mental health services and promote an increased risk of premature death.

Aims

Our aim is to assess stigma towards mental illness and psychiatry in medical students, and to study the influence of real-world experiences, such as having visited a psychiatric ward, having personally met a psychiatric patient or having friends and/or family members who suffer from a mental illness.

Methods

One hundred and thirteen Italian medical students completed the following tests:

– Attitudes Towards Psychiatry (ATP-30);

– Community Attitudes Towards Mental Ill (CAMI);

– Perceived Discrimination Devaluation Scale (PDD);

– Baron-Cohen's Empathy Quotient (EQ).

Results

Having visited a psychiatric ward correlates with a better attitude towards psychiatry (P = 0.008), rather than towards the mentally ill. Having personally known someone with mental disorders correlates with less stigmatizing scores in CAMI: total score (P = 0.002), authoritarianism (P < 0.001), benevolence (P = 0.047) and social restriction (P = 0.001). Similar results emerged in those who have close relationships with a psychiatric patient. There is no statistical significance as to empathy.

Conclusions

The students who have visited a psychiatric ward have a less stigmatizing vision of psychiatry, while having personally known psychiatric patients favors a less stigmatizing attitude towards them. Those who have not had this experience, have a more hostile and intolerant vision of mental illness, and consider psychiatric patients as inferior subjects that require coercive attitudes and that would be better to avoid because socially dangerous.

Disclosure of interest

The authors have not supplied their declaration of competing interest.