Sexuality education in Italy 2016-2020: a national survey investigating coverage, content and evaluation of school-based educational activities

Comprehensive sexuality education is an important means of promoting sexual well-being amongst young people and is key to preventing sexually transmitted infections (STIs). However, sexuality education is not currently included in the formal curriculum in Italian schools. The aim of this study was to develop an inventory of schoolbased sexuality education (SBSE) activities carried out by external providers and implemented in Italy from 2016 to 2020. A desk review and survey were carried out. In the desk review online documents on STI prevention were analysed. The survey investigated the providers, objectives, content and methods used to implement SBSE activities in secondary schools. Findings revealed a highly heterogeneous situation in terms of geographical coverage, service providers, objectives and evaluation. Some SBSE activities were classified as adopting a comprehensive approach to sexuality education, while the majority focused on STI prevention, and many were single-session activities. Although most activities were said to have been evaluated no results were available. The data showed that SBSE is not systematically and equally delivered across Italy. Action is needed to provide young people with evidence-based, age-appropriate and accurate education about sexual and reproductive health and wellbeing

Combined pharmacological and psychosocial interventions for alcohol use disorder

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of combined pharmacological and psychosocial interventions for the treatment of alcohol use disorder

Co-creazione, implementazione e valutazione degli interventi pilota EduForIST nelle scuole.

Il saggio presenta il progetto educativo EduForIST nelle sue fasi di ideazione, costruzione della rete, progettazione, implementazione e valutazione. Il contributo del sottoscritto è relativo alla formalizzazione delle scelte pedagogiche

HIV rapid testing in community and outreach sites: results of a nationwide demonstration project in Italy

Abstract Background Globally the access to HIV testing has greatly increased over the past 30 years. Nonetheless, a high proportion of people living with HIV remains undiagnosed, even in resource rich countries. To increase the proportion of people aware of their HIV serostatus and their access to medical care, several strategies have been proposed including HIV rapid test programs offered outside health facilities. The aim of this project was to evaluate the feasibility and efficacy of the HIV rapid testing offered in community and outreach settings in Italy. Methods We conducted a national demonstration project on HIV rapid tests offered in community and outreach settings, including nongovernmental organization (NGO) facilities, primary care services for migrants and low-threshold services or mobile units for drug users (DU services). HIV rapid test on oral fluid (OraQuick®; Orasure Technologies) was anonymously offered to eligible people who presented themselves at the selected sites. Those with reactive results were referred to a specialized outpatient unit for confirmatory testing and medical care. Results Over a period of six months a total of 2949 tests were performed and 45.2% of individuals tested had not been previously tested. Overall 0.9% (27/2949) of tested people had a preliminary positive test. In NGO facilities the positivity rate was 1%. All subjects who performed their confirmatory test were confirmed as positive. In services for migrants the positivity rate was 0.5 and 80% were referred to care (with 1 false positive test). In DU services we observed the highest positivity rate (1.4%) but the lowest linkage to care (67%), with 1 false positive test. Conclusion Our project showed that the offering of an HIV rapid testing program in community and outreach settings in Italy is feasible and that it may reach people who have never been tested before, while having a significant yield in terms of new HIV diagnoses as well

Bringing comprehensive sexuality education into Italian lower secondary schools’ practice: A pilot study

Background: Theoretical and research evidence indicates that comprehensive sexuality education (cse) positively impacts on behaviour and attitudes of young people, by improving sexual and reproductive health outcomes and empowering them to make free and informed choices. This study aims to describe the creation and development of a pilot cse activity in lower secondary schools (lss) within the context of eduforist project. Eduforist is funded by the italian ministry of health and involves academics, the italian national institute of health and hiv/aids civilsociety organisations (csos). Methods: Evidence was collected through a desk review on regional and national normative documents, international literature and guidelines regarding sexually transmitted infections (stis), relationships and sexuality education (se). An online survey was developed to collect information on duration, content and methods used to implement school-based se (sbse) in italian secondary schools from 2016 to 2020. The results of the survey and desk review, along with focus groups and open discussions involving all partners were used to define objectives, contents, methods of delivery and evaluation of the pilot activity. Additional information was added after feedback from an expert advisory board. Results: A pilot activity was designed targeting lss students, in 4 different geographical regions, for a total of 11 schools involved. The activity consisted of 5 interactive interventions per class: 4 theoretical and practical modules (each consisting of a syllabus, a theoretical slides deck and a list of activating tools) and 1 intervention focusing on evaluation and deepening topics requested by the students. The evaluation have been carried out on educators’ (swot analysis, diary of the field) and students’ level (pre/post-tests and satisfaction questionnaires). Conclusions: This pilot activity represents a first step towards the implementation of an evidence-based and integrated approach to sbse, to be promoted and implemented equally across the country

Pilot experience of comprehensive sexuality education among italian adolescents: Results from the eduforist project

Background and Objective: Comprehensive sexuality education (CSE) is an integrated approach to sexual health and wellbeing promotion, internationally recognised to be highly effective in preventing HIV and sexually transmitted infections (STIs), especially when experienced in school contexts. CSE, however, is not included in Italian school curricula. This study describes the results of a pilot CSE experience among Italian adolescents attending lower secondary schools of 4 Regions within the EduForIST project, funded by the Italian Ministry of Health. Methods: The pilot experience consists of 5 modules of 2 hours conducted per classroom. Modules have been developed by a research team of pedagogists, academics, HIV/AIDS civil-society organisations (CSOs), experts and educators from CSOs that lead the activities in the schools. The modules address the domains: A) changes in adolescence, B) emotions and relationships, C) sexual identities and diversity, D) consent, STIs/pregnancy prevention, sexual health services. The last module is dedicated to evaluation of activities, by using standardised pre/post tests and satisfaction questionnaires. Results: The pre/post-test results referred to 35 classrooms of 11 schools (566 students). Pre/post analysis showed a significance increase of correct answers for 11/15 items investigated. Domain C and D reported the major positive increase, while a higher level of uncertainty regarded domain A and B. The students reported to be overall satisfied by the activity, especially when talking about psychological changes in adolescence and STIs’ symptoms and prevention. They reported higher neutrality regarding the methods, i.e. use of innovative technological tools, and group-work. Conclusions: Pre/post-tests analysis suggested that the pilot activity was effective in providing students with correct information, enhancing knowledge and decreasing uncertainty. Evidence collected through this study and its advancements (increasing the geographical area of implementation and school grades) will foster awareness among policy makers on the value and urgency of introducing CSE in Italian school curricula

Psychic Structure of Opioid Addiction: Impact of Lifetime Psychiatric Problems on SCL-90-based Psychopathologic Dimensions in Heroin-dependent Patients

Background: By applying a Principal Component Analysis (PCA) to the items of the SCL-90 checklist, we previously investigated the psychopathologic structure of individuals with heroin addiction, finding a 5-factor aggregation of psychological/psychiatric symptoms: "Worthlessness and Being trapped," "Somatic Symptoms," "Sensitivity-Psychoticism," "Panic-Anxiety," and "Violence-Suicide." Our studies on this subject did not, however, explore the possible impact of comorbid psychiatric conditions on 5 psychopathologic dimensions listed above. The aim of the present study is to verify whether there is any difference in these 5 dimensions between heroin-addicted patients with (PC-HA) or without (NPC-HA) known lifetime psychiatric problems. Methods: A total of 1195 patients with heroin dependence entering a residential therapeutic community treatment were assigned to one of the 5-factor solutions yielded by Principal Component Analysis on the basis of the highest z score obtained. Differences between NPC-HA and PC-HA patients in the frequency of the 5 psychopathologic dimensions and in their severity were then analyzed by means of univariate and multivariate analyses. Results: All the SCL-90 factor scores were, from a statistical viewpoint, significantly higher in PC-HA than in NPC-HA patients, but the only statistically significant differences in the frequency of the 5 psychopathological dimensions were those observed in the case of "Panic-Anxiety," which turned out to be higher in the PC-HA group. Stepwise discriminant analysis showed that the severity of "Somatic Symptoms" and "Panic-Anxiety" made these 2 factors the only ones that successfully discriminated between NPC-HA and PC-HA patients. The other SCL-90-based psychopathologic dimensions were unable to improve the value of the discrimination. Conclusions: On the basis of our results, the SCL-90-defined structure of opioid addiction may be considered to be only partly dependent on the presence of a "psychiatric" condition. This observation adds to the previous ones that go to show the stability of the above aggregations of symptoms, irrespectively of other demographic and clinical characteristics, as well as active involvement with heroin abuse or the kind of treatment chosen. When the available evidence is considered as a whole, it seems to support the trait-dependent, rather than state-dependent, nature of the proposed factorial dimensions of the psychopathology of opioid addiction

Psychopathological symptoms in detoxified and non-detoxified heroindependent patients entering residential treatment

Background: In a previous study, by evaluating patients entering an Outpatient Agonist Treatment, or a residential Therapeutic Community, through the use of SCL-90, a 5-factor solution was identified: a depressive 'worthlessness and being trapped' dimension, a 'somatization' dimension, a 'sensitivity-psychoticism' dimension, a 'panic anxiety' dimension, and a 'violence-suicide' dimension. Aim of the present study is to compare these dimensions between heroin-addicted patients that have already been detoxified (DTX) and those not yet detoxified (NDTX) from heroin at the time of entering a Therapeutic Community Treatment. Methods: The demographic and clinical variables of NDTX patients and DTX patients were first compared; all patients were then assigned to the appropriate SCL-90-based dimension among the five just identified ones. Differences in psychopathological dimensions were analysed at univariate and multivariate level. Results: Out of 1,015 subjects included in the study, 374 (36.8%) were DTX patients, while 641 (63.2%) were NDTX patients. Distribution of demographic and heroin addiction history variables between NDTX and DTX heroin-addicted patients at residential treatment entry were very similar. In the univariate analysis, the SCL-90 total score and all the SCL-90 factors showed higher statistical significance in NDTX than in DTX patients. In the discriminant analysis, severity of ‘somatic symptoms’ was the factor differentiating NDTX from DTX-patients, with 64.4% of the originally grouped cases shown to be correctly classified. Differences in qualities of psychopathological symptoms between NDTX and DTX patients were found regarding ‘somatic symptoms’ ‘sensitivity psychoticism’ and ‘panic anxiety’, the last two features being better represented in DTX patients. Conclusions: All the five aggregations of symptoms resulting from the application of Principal Component Analysis to the SCL-90 of opioid addicts were present in subjects actively involved with opioids as well as already detoxified ones. Although the severity of psychiatric damage was lower in the DTX than in the NDTX patients, the only dimension that successfully discriminated between the two groups of patients was that of ‘somatic symptoms’

The impact of psychopathological subtypes on retention rate of patients with substance use disorder entering residential therapeutic community treatment

A specific psychopathology of addiction has been proposed and described using the self-report symptom inventory (SCL-90), leading to a 5-factor aggregation of psychological/psychiatric symptoms: 'worthlessness and being trapped', 'somatic symptoms', 'sensitivity-psychoticism', 'panic-anxiety' and 'violence-suicide' in various populations of patients with heroin use disorder (HUD) and other substance use disorders (SUDs). These clusters of symptoms, according to studies that have highlighted the role of possible confounding factors (such as demographic and clinical characteristics, active heroin use, lifetime psychiatric problems and kind of treatment received by the patients), seem to constitute a trait rather than a state of the psychological structure of addiction. These five psychopathological dimensions defined on the basis of SCL-90 categories have also been shown to be correlated with the outcomes of a variety of agonist opioid treatments. The present study aims to test whether the 5-factor psychopathological model of addiction correlates with the outcome (retention rate) of patients with SUDs entering a therapeutic community (TC) treatment