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COVID-19 epidemic has been spreading in the world causing strong psychological pressure for the global population. Quarantine has huge impact and can cause considerable psychological stress. The study aims to identify psychological stress, emotional changes, approach to studies, resilience skills related to the experience of the COVID-19 pandemic in a sample of university students. A sample of university students from the Campus Bio Medico University of Rome was studied. The participants responded to an online questionnaire packet that included socio-demographic information, COVID-19 impact on emotions and on university life, perceived stress (PSS-10) and resilience skills (RS-14). We received 955 responses. The respondents experienced an increase in perceived stress in 89.4% of cases (66% stress moderate and 23.4% high). Moreover, 54.4% of students reported decrease in attention span and difficulty in studying with consequent concern about the exam outcomes (55%). Resilience skills positively affect stressful events and in particular the COVID-19 impact on study and interpersonal relationships. The study shows a psychological impact of the Covid-19 emergency on college students. Stress significantly decreases learning and negatively affects psychological well-being of students. Resilience skills were a protective factor to overcome difficulties learning.

The strict lockdowns imposed to contain the COVID-19 pandemic brought an increase in levels of stress, anxiety, and depression in the general population. However, in a previous study, our group found that individuals with High-Functioning Autism Spectrum Disorders (HF-ASD) reported an increase in their psychological wellbeing and a decrease in their daily tiredness, in relation to the social distancing measures imposed during the first Italian lockdown (between March and May 2020). In this follow-up study, conducted during the "second wave" of COVID-19, we included the same group of individuals with HF-ASD and evaluated their levels of stress, anxiety, depression, PTSD-related symptoms, tiredness, and perceived wellbeing; moreover, we compared our results to the ones we obtained during the first lockdown on the same population. We found that individuals with HF-ASD experienced higher levels of the aforementioned psychiatric symptoms during the second lockdown, with respect to the first one. These levels positively correlated with their scores at the Autism Quotient subscale Attention Switching: hence, we speculated that these symptoms might be due not only to the prolonging of the social distancing measures, but also to the uncertainty that HF-ASD participants started experiencing at the end of the first lockdown.

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The aim of this study was to assess HPV genotype distribution among men with and without clinical manifestations, and to evaluate the potential impact of the nonavalent HPV vaccine on HPV infection compared with the previously utilized quadrivalent HPV vaccine, in a male population living in Sicily, Southern Italy.

About vaccine impact, we used similar parameters adopted by Riethmuller et al.24, particularly, we considered the empirical probability evaluated on positive cases only. In this way, we define low impact, as the empirical probability of HPV genotypes (HPV6,11,16 and 18 for the quadrivalent, and HPV6,11,16,18,31,33,45,52 and 58 for the nonavalent vaccine), alone or in association, by excluding the presence of any other HPV type; while with high impact, the empirical probability of HPV genotypes (HPV6,11,16 and 18 for the quadrivalent, and HPV6,11,16,18,31,33,45,52 and 58 for the nonavalent vaccine) alone or in association, also in the presence of any other HPV type. These parameters have been defined in order to be able to optimally compare the effectiveness of the two vaccines.. Furthermore, sample size estimation was performed to ensure an adequate group size to obtain a statistically significant and robust study.

The current study provides an important overview on HPV-DNA prevalence in men with and without clinical manifestations and on the evaluation of the potential impact that nonavalent HPV vaccine has on HPV infection compared to the previously used quadrivalent HPV vaccine. The 58.7% of the samples tested were positive for HPV, with significant differences depending by considered group. In fact, 69% of men with clinical symptoms, 44.3% of those with a risky sexual contact (STD), and 63.7% of men with positive partners, were positive results to the HPV infection. HPV infection is very common in men, with variations reflecting the selection criteria of the studied populations and sampling methods used14,32.

From the statistical analysis of the data it is highlighted that in group II, of subjects with sexual contacts at risk, a higher age was observed, suggesting once again to extend the vaccination also to adult men. This vaccination policy, in Sicily, is also applied to women. The vaccine is free for women up to 45 years of age.

Oncogenic genotypes have been found in almost 80% of the men included in our study. The prevalence of hrHPV in the three different groups was statistically significant. In 84.5% of partner men of HPV-positive women, hrHPV was shown, suggesting a possible role of man in the transmission of the infection. Furthermore, high and significant prevalence was observed also in men with risky intercourse, again suggesting the need to make vaccination offerings as gender-neutral as possible.

We should also note that no screening tests are currently available for men, and that persistent penile HPV infections have been shown to be associated with penile intraepithelial neoplasia (PIN) development in younger men. These generally resolve within 2 years; however, a small minority of cases can progress and cause invasive cancer. Penile cancer in the United States has an incidence rate of around 1/100,000, while the incidence in some developing countries, such as Uganda, can be much higher (4.4/100,000)40. This occurs in these countries due to the immunocompromised caused by HIV infection41. In contrast, in women a decrease in dysplasia has been observed thanks to screening programs but overall thanks to vaccination40.

Impact of the vaccine was measured according to low and high impact parameters and defined in statistical analysis section. These parameters were similar to parameters adopted by Riethmuller et al.24, but we consider positive HPV patients only, to evaluate the effectiveness of the two vaccine.

In this study, the effectiveness of the vaccine was calculated with low and high impact parameters. In particular, low impact was calculated considering HPV genotypes alone or in association, by excluding the presence of any other HPV type; while high impact was calculated considering the vaccine genotypes associated with other genotypes. This configures the risk of an overestimation of the vaccine's degree of effectiveness. Therefore, it can be reasonably assumed that the potential real impact of the vaccine is in the middle between high and low impact24.

Several countries recommend gender-neutral vaccination indeed. The infection supported by HPV has a great impact also on men. In Europe, 14,700 annual cases of anogenital tumours are attributable to HPV, with 5400 cases diagnosed in men (about half in the anus and half in the penis). With regard to precancerous lesions, it is estimated that over 1000 cases of AIN2/3 are diagnosed in men each year43.

There is evidence to suggest that where there is a high level of vaccination coverage in women, males are indirectly protected from infection. In Australian heterosexual men under the age of 25, the prevalence of HPV16,18, 6,11 decreased by 78% from the pre-vaccination period45.

Here, we briefly summarize the major mechanisms linking education to health and mortality (an extensive compilation of recent studies can be found in Montez and Friedman (2015)). Schooling develops basic cognitive functioning, such as reading, writing, and communicating, and teaches individuals how to think logically, critically analyze data, solve problems, and implement plans (Kingston et al. 2003). Higher education is the key to stable and well-paid jobs, and increased income helps to pay for nutritious food, better-quality housing, and high-quality medical care (Mirowsky and Ross 2003). In addition, education promotes healthy lifestyles through the development of effective human agency. Highly educated people use their knowledge, information, and past experiences to avoid health-related risk factors and engage in health-enhancing behaviors, such as smoking cessation, alcohol abstinence, and frequent physical exercise (Denney et al. 2010; Laaksonen et al. 2008). Moreover, education provides socio-psychological resources that can contribute to health and longevity through emotional and instrumental support (House et al. 1988). That well-educated people are more likely to be and remain married also contributes to the relationship between education and health (Qian and Preston 1993).

Information about the population by age, sex, and education level stems from the data collection IPUMS-USA (Ruggles et al. 2015).Footnote 3 Age-, sex-, and education-specific numbers of death stem from the Division of Vital Statistics of the National Center for Health Statistics and are based on death certificates. The data were downloaded from the website of the Centers for Disease Control and Prevention (CDC).Footnote 4 Both datasets are available in micro-data form, and we merged them into 5-year age groups from age 30 to 90+. In the data for the population at risk, education refers to the highest educational attainment, which enabled us to translate the numbers directly into the ISCED-97 classification. In the mortality data for 1990, education is classified by the number of actual years of schooling. In the mortality data for 2010, education refers to the highest educational attainment as defined in the Revision of the Standard Certificate of Death of the year 2003.Footnote 5 Given that not all states have adopted the new classification, the mortality data for 2010 includes both classifications: number of years in school and the highest educational attainment. For the states which used the new regulation, we were able to translate the numbers directly into the ISCED-97 classification. To obtain corresponding education classifications for the deaths of 1990 and for those of 2010 which were still classified by the number of school years, we performed an approximate reclassification into the ISCED-97 system on the basis of the EDATTAIN International Recode of Educational Attainment.Footnote 6 Cases with unknown education levels (23.6% of deaths in 1990 and 2.2% of deaths in 2010) were distributed according to the education-specific proportions for valid cases for each age and sex group. be457b7860