Articles de revues sur le sujet « Women employees – Italy »

This work aims to estimate the probability of bankruptcy of female entrepreneurs in Italy, particularly in the Campania region. Women who run businesses always continue to be disregarded by banks when applying for a loan due to several problems including: the small size of their companies and the low number of employees. The companies were selected by Aida. Through the T-test the probability of bankruptcy of male and female companies was compared, however, the variables that have the greatest impact on gender were examined with the regression model. It was found that, albeit slightly, female entrepreneurs have a lower probability of failure than their male counterparts.

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers. This study aims to describe a psychological screening program developed at a large University Hospital in Milan, Italy, and assess the psychological outcomes of employees and associated factors. A survey was electronically conducted among hospital employees between July and October 2020. Sociodemographic data, information about COVID-19 experience and three scales assessing anxiety (STAI-Y1), depression (HAM-D) and post-traumatic stress disorder (PCL-5) were collected. A total of 308 employees (80% women; mean age 45.1 years) responded: 16% physicians, 68% other healthcare professionals, and 16% administrative staff. Employees reported moderate/severe symptoms of anxiety (23%), depression (53%), and post-traumatic stress disorder (40%). At multivariate logistic regression analysis, having suffered a loss for COVID-19 in the personal context was independently associated with higher risk of moderate/severe anxiety (OR = 2.40; 95% CI 1.16–4.98), being female was associated with higher risk of moderate/severe depression (OR = 2.82; 95% CI 1.43–5.59), and having had a family member affected by COVID-19 was associated with higher risk of moderate/severe post-traumatic stress disorder (OR = 2.75; 95% CI 1.01–7.48). COVID-19 personal experience may have a profound impact on hospital workers’ mental health and should be considered in supportive interventions.

Purpose Female entrepreneurship has been part of the political agenda internationally. Public entities should promote entrepreneurship in general, and female entrepreneurship in particular, with dedicated resources and programs. Female entrepreneurs are considered a key asset for developing economic growth. However, women experience much more difficulties than men in opening their own ventures. Relational capital is particularly relevant when it comes to female entrepreneurship. The purpose of this study is to analyze the factors that affect the opening of new ventures and the role of relational capital in female entrepreneurship, taking into consideration the Italian context during the financial crisis. Design/methodology/approach This study uses a mixed-method approach analyzing data from a regional program to enhance the creation of new companies, trying to understand the issues of potential entrepreneurs in general and women in particular. A single case is then investigated using the characteristics – ambience – organization – sustainability model of micro-entrepreneurship and the network relationship model by Paoloni (2011). Findings The analysis highlights how women face much more difficulties in starting new ventures concerning their previous experience if their employment condition finds an extended period of inactivity. Additionally, potential female entrepreneurs are more sensitive to the complexity of the initiative, concerning the required investment and the number of employees, compared to male entrepreneurs. Relational capital is a crucial asset in fostering the success of the venture, especially in the start-up phase. Originality/value The purpose of the study is to contribute to the debate regarding the issues affecting the opening of new companies, as well as the link between relational capital and female enterprises. The paper offers some insights about a program covering a well-sized population during the financial crisis.

Young workers are in particular need of occupational safety and health (OSH) services, but it is unclear whether they have the necessary access to such services. We compared young with older workers in terms of the access to and awareness of OSH services, and examined if differences in employment conditions accounted for age-differences. We used survey data from Italy (INSuLA 1, 2014), with a sample of 8000 employed men and women aged 19 to 65 years, including 732 young workers aged under 30 years. Six questions measured access to services, and five questions assessed awareness of different OSH issues. Several employment conditions were included. Analyses revealed that young workers had less access and a lower awareness of OSH issues compared with older workers. For instance, odds ratios (OR) suggest that young workers had a 1.44 times higher likelihood [95%—confidence interval 1.21–1.70] of having no access to an occupational physician, and were more likely (2.22 [1.39–3.38]) to be unaware of legal OSH frameworks. Adjustment for selected employment conditions (company size, temporary contract) substantially reduced OR’s, indicating that these conditions contribute to differences between older and younger workers. We conclude that OSH management should pay particular attention to young workers in general and, to young workers in precarious employment, and working in small companies in particular.

ObjectivesTo assess the seroprevalence of anti-SARS-CoV-2 IgG among health careworkers (HCWs) in our university hospital and verify the risk of acquiring the infection according to work area.DesignCross-sectional study.SettingMonocentric, Italian, third-level university hospital.ParticipantsAll the employees of the hospital on a voluntary base, for a total of 4055 participants among 4572 HCWs (88.7%).Primary and secondary outcome measuresNumber of anti-SARS-CoV-2 positive serology according to working area. Association of anti-SARS-CoV-2 positive serology to selected variables (age, gender, country of origin, body mass index, smoking, symptoms and contact with confirmed cases).ResultsFrom 27 April 2020 to 12 June 2020, 4055 HCWs were tested and 309 (7.6%) had a serological positive test. No relevant difference was found between men and women (8.3% vs 7.3%, p=0.3), whereas a higher prevalence was observed among foreign-born workers (27/186, 14.5%, p<0.001), employees younger than 30 (64/668, 9.6%, p=0.02) or older than 60 years (38/383, 9.9%, p=0.02) and among healthcare assistants (40/320, 12.5%, p=0.06). Working as frontline HCWs was not associated with an increased frequency of positive serology (p=0.42). A positive association was found with presence and number of symptoms (p<0.001). The symptoms most frequently associated with a positive serology were taste and smell alterations (OR 4.62, 95% CI: 2.99 to 7.15) and fever (OR 4.37, 95% CI: 3.11 to 6.13). No symptoms were reported in 84/309 (27.2%) HCWs with positive IgG levels. Declared exposure to a suspected/confirmed case was more frequently associated (p<0.001) with positive serology when the contact was a family member (19/94, 20.2%) than a patient or colleague (78/888, 8.8%).ConclusionsSARS-CoV-2 infection occurred undetected in a large fraction of HCWs and it was not associated with working in COVID-19 frontline areas. Beyond the hospital setting, exposure within the community represents an additional source of infection for HCWs.

Despite the numerous advances made in Italy over the years in the study of sexual harassment in the workplace (SHW), research has focused exclusively on victims, perpetrators, and their relationships, and not on the consequences that the experience of sexual harassment can produce in witnesses. The present study aims to address this gap by examining how the indirect experience of SHW, in conjunction with variables such as gender, age, self-efficacy, and coping strategies, affects the mental health status of witnesses of SHW. A sample of 724 employees completed a questionnaire that included a modified version of the Sexual Experience Questionnaire (SEQ), the Oldenburg Burnout Inventory (OLBI), the General Health Questionnaire (GHQ), the Satisfaction With Life Scale (SWLS), and the Emotional Self-Efficacy Scale (RESE). Of the group, 321 participants reported witnessing sexual harassment in the workplace (28.2% of women and 16.2% of men). Results show that witnesses were younger than participants who described themselves as non-witnesses. Results also show that women and men who were witnesses were more likely to suffer the emotional and psychological consequences of the experience than non-witnesses. In addition, female witnesses expressed more positive emotions than men, which enabled them to manage their anxiety and emotional states when triggered in response to sexual harassment in the workplace. Finally, a significant association was found between perceptions of mental health and age, gender, experience with SHW, and self-efficacy strategies. The findings underscore the importance of sexual harassment intervention in the workplace, women and men who witness sexual harassment suffer vicarious experiences, psychological impact, exhaustion, disengagement, and negative feelings.

This study contributes to the validation of the Bergen Work Addiction Scale (BWAS) in the Italian context, with a focus on measurement invariance across gender and managerial status. The BWAS is a consolidated measure of work addiction (WA) anchored in general addiction theory that comprises seven items representing the core addiction components. Participants were 8419 bank workers (37.7% women, 12.9% managers) who completed a self-report questionnaire including the Italian version of the BWAS (BWAS-I) and the Dutch Work Addiction Scale, as well as measures of work engagement, perfectionism, workload, psycho-physical symptoms, work–family conflict, and job satisfaction. Results confirmed the single-factor structure of the BWAS-I. Partial scalar invariance held across gender and managerial status, meaning that most—but not all—item intercepts were equivalent across different populations. Furthermore, the BWAS-I showed adequate convergent, discriminant, criterion-related, and incremental validity. This study showed that the BWAS-I is a valuable instrument that can be used by researchers and practitioners to assess WA in the Italian context.

Purpose – The purpose of this paper is to examine the dynamics of labour market flows over the business cycle through a vacancy chain model. It provides a direct computation of vacancy chains using micro data, empirically investigates the relationship between chain length and the characteristics of jobs and workers initiating the chain, and finally assesses the wage progression of workers moving along the chain. Design/methodology/approach – The paper draws on a longitudinal matched employer-employee database covering all employees in manufacturing in a large region of Italy. A transparent algorithm for vacancy chain computation is developed and standard econometric techniques are employed to analyze job-to-job transitions within identified chains. Findings – Vacancy chains account on average for more than one-third of total hires, and both the number and the length of chains are clearly pro-cyclical. Chains set in motion by women workers, young, old, blue collars, or employed by small firms tend to be shorter. There is a well-defined wage progression from the tail to the head of the chain, revealing that workers are sorted along chains according to skill and/or bargaining power. Research limitations/implications – There is a limited possibility of identifying separately individual ability and bargaining power. Practical implications – The vacancy chain methodology can increase the ability of policy makers to produce detailed maps of the labour market and identify worker profiles associated with poor outcomes and hence deserving special attention. Originality/value – For the first time, this paper operationalizes the vacancy chain approach on a large scale, at a very high level of detail, and over a long-time span.

The article analyzes the legal regulation for the denunciation of the conventions of the International Labour Organization. Both automatic and "pure" denunciations of conventions are examined. Ratified ILO conventions have traditionally been one of the key sources of national labour law. However, over time, some of them have lost their relevance and practical importance. The most common way to waive obligations under ratified conventions is to denounce them. Denunciation is provided for in every ILO convention, with the exception of Conventions Nos. 80 and 116, which contain rules relating to the partial revision of previous conventions. In addition, a mechanism for partial denunciation is provided for certain conventions. Such a mechanism is expressed in the possibility of denunciation of: a) certain sections of the Convention, e.g. Invalidity, Old-Age and Survivors' Benefits Convention, 1967 (No. 128); b) certain categories covered by the scope of the convention, e.g. Working Environment (Air Pollution, Noise and Vibration) Convention, 1977 (No. 148). It is determined that most denunciations of ILO conventions occur automatically, due to the country's ratification of more recent conventions. In Ukraine, all denunciation of ILO conventions took place automatically. The "pure" denunciations are more relevant to outdated conventions or conventions that no longer correspond to existing fundamental principles in the world of work. An example is Night Work (Women) Convention (Revised), 1948 (No. 89), which was denounced by Austria, Greece, Italy, Ireland, France, the Czech Republic, etc. The provisions of this Convention are no longer in line with the ILO's existing policy of equal rights and opportunities for men and women in world of work. The practice of denouncing up-to-date ILO conventions should not be called widespread, primarily due to the need for mandatory prior tripartite consultations on this issue, which involves comprehensive consideration of the interests of government, employees and employers. Ratification by the country of the ILO conventions puts national labour legislation in a fairly clear framework, which in some cases may serve as a reason for slowing down specific areas of its further development. After all, certain conventions were adopted at a time when completely different regulatory approaches in the world of work were applied than those that exist today. Resolving this issue is possible through the timely and balanced application of the denunciation procedure. This procedure, provided for in almost all ILO conventions, should be considered as a clear example of the harmonious evolution of international labour standards. Keywords: International Labour Organization, conventions, automatic denunciation, "pure" denunciation, ratification, national legislation.

Background: This study monitored total anti-SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) RBD (receptor-binding domain) antibodies levels in a large population of healthcare workers undergoing mRNA COVID-19 vaccination. Methods. The study population consisted of employees of Pederzoli Hospital of Peschiera del Garda (Verona, Italy), who underwent voluntary vaccination with two doses of COVID-19 mRNA BNT162b2 (Comirnaty; Pfizer Inc). Venous blood was drawn immediately before the first vaccine dose, as well as 21 days (immediately before second vaccine dose) and 50 days afterwards. Humoral response was assessed with Roche Elecsys Anti-SARS-CoV-2 S total antibodies, on Roche Cobas 6000 (Roche Diagnostics). Results: The final study population consisted of 925 subjects (mean age, 44 ± 13 years; 457 women), 206 (22.3%) anti-SARS-CoV-2 baseline seropositive. The increase of total anti-SARS-CoV-2 RBD antibodies levels 21 days after the first vaccine dose was ~3 orders of magnitude higher in seropositive than in seronegative individuals (11782 vs. 42 U/mL; p < 0.001). Total anti-SARS-CoV-2 RBD antibodies levels further increased by over 30-fold after the second vaccine dose in baseline seronegative subjects, while such increase was only ~1.3-fold in baseline seropositive subjects. In multivariate analysis, total anti-SARS-CoV-2 RBD antibodies level was inversely associated with age after both vaccine doses and male sex after the second vaccine dose in baseline seronegative subjects, while baseline antibodies value significantly predicted immune response after both vaccine doses in baseline seropositive recipients. Conclusion: Significant difference exists in post-mRNA COVID-19 vaccine immune response in baseline seronegative and seropositive subjects, which seems dependent on age and sex in seronegative subjects, as well as on baseline anti-SARS-CoV-2 antibodies level in seropositive patients.

This paper explores how im/migrant women coming to Italy from all corners of the world and from very different backgrounds in terms of class, education and work experience are transformed into home eldercare assistants. The paper explores how these workers are created through discourses and every day practices enforced at different levels: from the state to the employers, from the mediators to the workers themselves. The creation of these workers has a double function: one is to fill the needs of a welfare state that otherwise would have to radically transform itself in order to provide effective services to the elders and, the other, is to alleviate the pressures of those of the family caregivers, mostly women, who otherwise would collapse under the burden of extended care.

The aims of this qualitative study were to describe sexual harassment (SH) as experienced by young Italian women in the workplace and to analyse their reactions and forms of resistance. A sample of 20 university students who mostly held casual jobs was recruited at one university and interviewed in 2017‐18; the transcriptions were analysed using a thematic method.Respondents experienced multiple forms of SH, from sexual comments and requests to physical contacts, carried out by male employers, co-workers and customers. Often SH had a pronounced pornographic nature, and occasionally women were treated as ‘prostitutes’; dress-code implied ‘dressing sexily’, and becomes a form of SH.All women evaluated these behaviours as inappropriate, but no one considered making a formal complaint. They reported confusion, attempts to minimise, going along with a smile, asking the help of colleagues, and using the boyfriend as a protector. Few took direct actions such as confronting the harassers, retaliating or complaining to the employer. Notwithstanding the hostility and humiliation experienced, the young women interviewed retained a strong sense of their dignity as workers, which can count as another form of resistance to a system that consistently tries to objectify them and disqualify them as workers.

Purpose The purpose of this paper is to highlight the pivotal role of overeducation in explaining the unexplained part of the gender pay gap (GPG), i.e. the component usually attributed to gender discrimination in the Oaxaca-Blinder decomposition. Design/methodology/approach The study uses a large Italian data set (ISFOL PLUS 2005–2014) to estimate the GPG among properly educated and overeducated workers. The model simultaneously accounts for both participation bias and endogeneity bias by applying an extension of the Heckman’s two-stage procedure. Findings Estimates show that the GPG is significantly higher among overeducated than among properly educated workers because women’s unobservable characteristics driving female employment into overeducation also drag down female wages more than men’s unobservable characteristics drag down male wages. Correcting for the participation and overeducation decisions, the unexplained portion of the GPG disappears among overeducated workers, while it remains significant among properly educated individuals. Originality/value The authors draw the conclusion that overeducation is, first, a first-best matching for individuals (both men and women) compensating with more education for their lower productive characteristics. Second, it may be a signaling device for women spending their useless-for-the-job diploma to inform employers on their valuable though unobservable productive characteristics and fight gender wage discrimination. The results favor education as a tool of counteracting gender discrimination. Hence, as females are less overeducated than males despite their larger representation in higher education, there should not be concern that expanding higher education will disadvantage females.

Abstract Background An increased appreciation for vaccines could be expected due to COVID-19. However, surveys show a polarization in opinions with about 20% of Americans preemptively rejecting any COVID-19 vaccine, partly due to inconsistent risk communication. While Health Care Professionals (HCPs) will be heavily relied upon to encourage uptake of a COVID-19 vaccine and 70% of Americans receive their vaccine information from HCPs, 84% also rely on peer networks. Understanding that HCPs have an important, but not exclusive, influence on health decision making can signal a new approach. This study provides data on where women, the main decision-makers regarding immunization in most families access information about vaccination. Methods Through an online survey conducted in UK, Brazil, Germany, Italy and Canada from 10 to 19-March 2020, we collected data on where, and from whom, women aged 25–54 years access information about vaccination. We set 1000 respondents/country quotas to reflect regional differences with data weighted as necessary. Results 5,036 women who met inclusion criteria responded: from the UK (1,003), Brazil (1,002), Germany (1,008), Italy (1,007), and Canada (1,016). Though most likely to receive vaccination info via their HCP: in Germany, women are least likely to be influenced by HCPs, with those aged 25–34 years more likely to turn to family members or online sources; in the UK, they are more likely to find info via a health authority’s website; and in Brazil, they are more likely to see info in traditional media and on Facebook. Only 50% ranked vaccine efficacy and disease risk in the Top 5 factors influencing their vaccine decisions, alongside the opinion of an HCP, recommendation of a Public Health Authority and impact of the disease. Conclusion HCPs, families and peers are important sources of info regarding vaccination. COVID-19 is unlikely to improve vaccine confidence as the issue becomes increasingly polarized and communications more inconsistent. We can respond by investing in health promotion and harmonized communications through peer networks. Since caregivers, their families and peers have increased weight in vaccination decisions, then they should have increased weight in preventive health strategies. Disclosures Ivo Vojtek, PharmD, PhD, MSc, FRSM, RPh, GSK Vaccines (Employee, Shareholder) Vanessa Palsenbarg, MA, GSK Vaccines (Employee, Shareholder) Joe Smyser, PhD, Public Good Project (Board Member, Employee)

In Italy, as in other countries, a significant number of migrants are employed as domestic workers, baby-sitters or carers of elderly people in Italian families (Parreñas 2001). Many of them begin as irregular migrants, but they manage to accede to a regular status: Italy is the EU country that has granted the highest number of regularizations, through six amnesties in 22 years, and other forms of hidden regularization. As employers, the families are the main actors in the regularization process. In many other situations, they are involved in hiring unregistered migrants and in managing the migrants’ underground work, especially that of women, as they welcome and accommodate them in their homes. This paper aims to explore the hidden world of the survival practices and social integration of undocumented migrants employed in Italian families, showing how most of them can obtain a regular status, after a period of hard work and a difficult life, turning it into a transient stage in the migrant’s career.

This article explores the success of the “migrant in the family” model of care for the elderly in southeast Italy and the mechanisms that bond the caregivers and their patients in a mutual dependency. I describe this model as a meeting place between endurance and vulnerability, and between the fragility of the elderly and the fragility of most of the women who work as migrant care workers. I argue that migrant live-in care work for the elderly is a combination of attentive practice and detachment in completion to the current description of care work as ritual and as tinkering and adaptation. In a broader perspective, the article shows that the economic needs in poorer regions of the world manifest in the commitment and determination to keep the elderly alive in Italy. This article reports findings from long-term ethnographic research among 34 migrant domestic care workers and 24 Italian employers in a medium-sized town in Italy. The article illustrates the findings by means of three case studies and engages with the existing literature on person-centered care in patients with dementia, biopolitics, and the global political economy of migration for work in the field of care. Migrant work for the elderly is crucial for a general understanding of social reproduction in Italy and in many other global contexts.

In 2004 the French National Assembly and Senate passed legislation which makes it illegal for Muslim women to wear headscarves (the hijab) within French public schools. To be precise the legislation refers to the banning of ostentatious religious symbols within the secular domain of the public school system, but is clearly aimed primarily at Muslim women, following a long-running dispute over this issue. Similar debates are taking place in other European countries such as Germany, Italy, Belgium, the Netherlands and Spain. A bill modelled on the recent French legislation has been tabled in the Belgian senate, whilst various court cases have been brought in other European countries by Muslim women who have been banned from wearing headscarves by employers or schools. Following a ruling of the German Supreme Court that a Muslim teacher should be allowed to wear a headscarf, as this did not contravene current legislation, the state of Baden-Wuerttenberg acted to introduce legislation to ban headscarves, and this legislation is likely to be copied by six other German states.

ABSTRACTIn recent years in Italy, population ageing, rising female labour-market participation, and the restructuring of the welfare state have combined to create increased demand for long-term care services for frail and dependent older people. The rising demand has increasingly been met by immigrant women of different nationalities, and to a lesser extent immigrant men, who are hired to provide individualised care in people's own homes and other private settings. While there have been many studies of this growing phenomenon, very little attention has been paid to the reasons that bring family care-givers to choose this care-support option. To begin to fill the gap, this paper reports the finding of a qualitative study of 26 family members who were caring for a disabled elder. Semi-structured interviews lasting between 60 and 100 minutes and that covered various aspects of long-term care in family households were conducted. The participants' responses indicate that they did not choose immigrant home eldercare assistants solely for economic reasons but also to be consistent with cultural, moral and traditional understandings of family responsibilities and care. They also provide valuable findings and insights into Italian attitudes towards the welfare state and the care-labour market. While the wealthiest respondent declared a clear predilection for the free-market and a desire to bypass the state, the majority of the respondents advocated a stronger role of the welfare state in helping people cope with the increased burden of long-term care.

Migrant household work is a global phenomenon present across geographical contexts. Employing a household worker, especially a worker coming from another country, is a symbolically complex situation that requires interpretive work and negotiations of role-identities from interactional partners. There has been much debate about how to define the relationship between a domestic and/or care worker and her/his employer. It has been argued that the preferred definition by workers themselves is one that centers on work (Anderson 2000). In contrast, “fictive kinship” appears to be the employers’ almost universal strategy, which is usually portrayed in the literature as an exploitative practice (Romero 1992; Anderson 2000; Parreñas 2001; Constable 2003; Lan 2006; McDowell 2006). In this paper, I offer a conceptual grid that consists of hierarchy/equality and distance/intimacy dimensions to examine complex relationships between domestic workers and employers, elaborated during the case study of Polish migrant domestic workers in Naples in 2004. Within the investigated site some elements of the traditional model of service culture have persisted. Migrant workers who come from a post-communist country, and who have rather egalitarian attitudes, have been confronted with these elements. The result has been a clash of definitions over the household worker’s role. Polish women developed two contrasting ways of experiencing and coping with it. The strategies identified in the workers’ narratives are professionalization and personalization, and they refer respectively to emphasizing the professional and the personal dimensions in relations with the employer. They manifest themselves on the levels of action (as narrated by the workers) and narrative construction. The strategies on the level of action aim to shift the situation in a desired direction; the narrative strategies aim at framing the situation in a desired way within a narrative. The text underlines the diversity of migrant response and tentatively assesses the output of different strategies.

In Clara Sereni's (1946–2018) semi-autobiographical (cook)book, non-chronological recollections are evoked by a variety of recipes that mark crucial moments in the narrator's life. At first glance, Sereni portrays herself as a patient and perceptive housewife who learns how to read a room and cook accordingly. She describes her individuality and imagination in the kitchen as an adolescent, and later she depicts the pride and power she derives from her duties as a housewife. However, if we peer between the cracks, what emerges is a depiction of a woman who struggles to convince herself of her worth. Undoubtedly, cooking is one of Sereni's chosen means of communication and self-starvation is another. Food speaks volumes about the challenges she faces as a woman navigating the private, patriarchal sphere as well as the public, capitalist one at a crucial time when the Women's Movement was gaining momentum in Italy. In this article, I focus on Sereni's complex relationship to food, family, and freedom as she transitions from childhood, in the wake of the Second World War, to parenthood, on the heels of the Vietnam War. First, I illustrate how Sereni's account of adolescent bulimarexia in relationship to her father problematizes the mainstream eating disorder theory of the 1980s, which vilifies the role of the mother and largely overlooks the role of the father. Thereafter, I suggest that as an adult Sereni is spread thin in her conflicting roles as housewife and employee, and thus she struggles to negotiate the opposing demands imposed upon her. Consequently, Sereni experiences an eating disorder relapse. However, as an adult her anorexia is of a highly different nature, triggered by the larger social and cultural context of the 1970s, a time when the Italian feminist movement was arguably at its peak. In essence, I show how Sereni's eating disorder is shaped and reshaped over time, namely in line with a shifting patriarchal system.

Background:Symptomatic osteoarthritis (OA) leads to functional limitations and loss of independence. OA management focuses on pain relief and preserving physical function using non-pharmacologic and pharmacologic therapy. Additionally, patients commonly manage OA pain by avoiding activities that exacerbate their pain. Informal care, i.e. assistance from an unpaid caregiver, plays a major role in the total care provided to patients with chronic diseases like OA.Objectives:To evaluate how OA pain severity affects physical functioning and the subsequent need for assistance with mobility and daily activities in 5 EU countries: France, Germany, Italy, Spain and UK.Methods:Data were drawn from the Adelphi OA Disease Specific Programme (2017-18), a point-in-time study of physicians and their OA patients. Patients rated their average pain intensity over the last week on a 0-10 scale (0 = no pain; 10 = worst possible pain) and were then categorised into mild (0-3), moderate (4-6) and severe (7-10) pain groups. Patients also provided an assessment of their physical function (0-10 WOMAC scale where higher scores indicated greater functional impairment), impact on mobility, whether caregiver assistance was required, daily activities requiring caregiver assistance and home modifications made due to their OA. Physicians also rated patients’ functioning on a 0 to 10 scale (0 = fully functional; 10 = completely impaired). Comparisons among pain severity groups were made using chi-squared tests and analysis of variance.Results:The analysis included 1750 OA patients: 24% mild pain (n=413); 47% moderate pain (n=822); 29% severe pain (n=515). The patients were predominantly women (58%) and had a mean (SD) age of 65.6 (11.5).Increased pain severity was associated with greater functional impairment scores as reported by patients (WOMAC scores: mild pain=2.1; moderate pain=4.1; severe pain=5.9) and physician-rated functional impairment (mild pain=3.5; moderate pain=4.3; severe pain=5.6). Mobility was impacted for 78% of patients with severe pain (vs. 41% mild; 63% moderate) and the need for a walking aid such as a walking stick or walking frame increased with worsening severity; wheelchair assistance was needed for 7% of severe patients (compared with <1% of mild or moderate patients). Furthermore, 31% of patients with severe pain reported having to modify their home due to their OA (vs. 11% mild; 18% moderate [p<0.001]), typically adapting their bathroom (23%) or fitting a stairlift (6%).The need for assistance from a caregiver to help with daily activities was associated with an increase in patients’ pain (9% mild; 20% moderate; 42% severe [p<0.001]). For most patients this was an immediate family member, however, the proportion of patients paying for professional care also increased with severity (1% mild; 2% moderate; 7% severe). Taking the patient to work or doctor’s appointments; help with shopping; preparing/cooking meals and help with travelling out of the home were most frequently reported activities needing caregiver assistance.Conclusion:In this study of European patients, increased pain severity was associated with greater functional impairment and impact on mobility as expected; however, this study highlights the substantial need for assistance with daily activities as well as modifications to the home. The unseen costs to the patient with moderate to severe OA pain are significant.Disclosure of Interests:Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer, Lucy Abraham Shareholder of: Pfizer, Employee of: Pfizer, Peita Graham-Clarke Shareholder of: Eli Lilly and Co, Employee of: Eli Lilly and Co, Lars Viktrup Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Joseph C Cappelleri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Craig Beck Shareholder of: Pfizer, Employee of: Pfizer, Andrew G Bushmakin Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Niall Hatchell: None declared, Emily Clayton: None declared, James Jackson: None declared

Background:Behçet’s syndrome, a chronic, multi-system variable vessel vasculitis, is often characterized by painful oral ulcers (OU) affecting quality of life (QoL). Apremilast (APR), an oral PDE4 inhibitor, demonstrated efficacy in OU treatment in the phase 3 multinational RELIEF study.Objectives:To evaluate APR efficacy in OU treatment in patients with active Behçet’s syndrome in a prespecified subgroup of patients enrolled in 13 European RELIEF sites (France, Germany, Greece, and Italy).Methods:patients were adults with active Behçet’s syndrome and ≥3 OU at randomization or ≥2 OU at screening and randomization, without active major organ involvement. Patients were randomized (1:1) to APR 30 mg BID or PBO during a 12-week double-blind phase. The primary endpoint was area under the curve for the number of OU through Week 12 (AUCWk0-12). Other outcomes were OU pain visual analog scale (VAS); achievement of OU complete response (ie, OU-free) and maintenance of OU complete response (ie, complete response at Week 6 and remaining OU-free for ≥6 additional weeks); OU partial response (ie, OU reduction ≥50%); disease activity (Behçet’s Syndrome Activity Score [BSAS]; Behçet’s Disease Current Activity Form [BDCAF], including Behçet’s Disease Current Activity Index [BDCAI], and Patient’s and Clinician’s Perception of Disease Activity); and QoL (BDQoL; Short Form Health Survey version 2 [SF-36v2], including Physical Functioning [PF] scale and Physical and Mental Component Summary [PCS, MCS]).Results:Of 207 patients randomized and treated in RELIEF, 52 were in the European subgroup. Mean (±SD) age in the subgroup was 39 (±12) years; 54% were women. Baseline disease characteristics were similar between treatment groups (Table 1). Patients receiving APR achieved lower AUCWk0-12 for OU vs PBO (Figure 1) and greater reduction in pain. A greater proportion of patients receiving APR achieved complete, maintained, or partial OU responses at Week 12 vs those receiving PBO (Table 1). Consistent treatment effects favoring APR vs PBO were observed in disease activity, as shown by BSAS and BDCAF component scores at Week 12 (Table 1). Greater improvement in SF-36v2 MCS was observed favoring APR vs PBO at Week 12, and moderate treatment differences were seen for other QoL measures (BDQoL, SF-36v2 PF, and SF-36v2 PCS).Conclusion:In the European subgroup of patients with Behçet’s syndrome and OU in RELIEF, APR resulted in greater reduction in OU count, OU pain, and disease activity as well as favorable treatment effect on QoL measures than PBO. These results are consistent with the efficacy of APR treatment in the overall RELIEF population.Baseline Disease Characteristics, Mean*PBO (n = 27)APR (n = 25)Duration of BD, years9.08.2OU count3.84.0OU pain (VAS 0-100)60.664.2BSAS (0-100)38.741.4BDCAI (0-12)3.53.6BDQoL (0-30)10.59.0Efficacy Outcomes at 12 Weeks*PBO (n = 27)APR (n = 25)Treatment Difference [95% CI]OU pain (VAS 0-100), mean†–17.7–48.7–31.0 [–44.7, –17.3]OU complete response, n (%)‡4 (14.8)16 (64.0)51.5 [29.8, 73.3]OU maintained response, n (%)‡1 (3.7)8 (32.0)26.7 [7.4, 46.0]OU partial response, n (%)‡11 (40.7)21 (84.0)46.0 [23.9, 68.0]BSAS (0-100)†,§–5.23–20.68–15.5 [–22.6, –8.3]BDCAI (0-12)†,§–0.0–1.4–1.4 [–2.2, –0.6]Patient’s Perception of Disease Activity†,§–0.4–1.6–1.2 [–2.1, –0.4]Clinician’s Overall Perception of Disease Activity†,§−0.6−1.7–1.0 [–1.7, –0.4]BDQoL (0-30)†,§–1.25–2.37–1.12 [–3.8, 1.5]SF-36v2 MCS (0-100)†,§–2.14.26.3 [2.2, 10.4]*ITT population.†LS mean of the change from baseline at Week 12.‡Non-responder imputation for missing data.§LOCF approach. All efficacy endpoints (except BDQoL) were significant at the level of P<0.05.Acknowledgements :This study was funded by Celgene. Additional analyses were funded by Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.Disclosure of Interests:Alfred Mahr Speakers bureau: Chugai; Roche, Consultant of: Celgene; Chugai, Gulen Hatemi Speakers bureau: AbbVie, Novartis, and UCB, Grant/research support from: Celgene, Mitsuhiro Takeno Speakers bureau: AbbVie, Esai, and Mitsubishi-Tanabe, Consultant of: Celgene, Grant/research support from: Novartis, Doyoung Kim: None declared, Melike Melikoglu: None declared, david Saadoun Consultant of: AbbVie, Celgene, Janssen, and Roche, Grant/research support from: AbbVie and Roche, Christos C. Zouboulis Speakers bureau: Amgen, Galderma, Pierre Fabre, PPM and Sobi, Consultant of: AbbVie, AccureAcne, Almirall, Bayer Healthcare, GSK/Stiefel, Incyte, Inflarx, Janssen, Novartis, PPM, Regeneron, and UCB, Grant/research support from: Celgene, NAOS-BIODERMA, and Relaxera, Sue Cheng Employee of: Amgen Inc, Sven Richter Employee of: Amgen Inc, Shauna Jardon Employee of: Amgen Inc, Maria Paris Employee of: Amgen Inc, Mindy Chen Employee of: Amgen Inc, Yusuf Yazici Consultant of: Bristol-Myers Squibb, Celgene, Genentech, and Sanofi

Background:Previous studies have compared Patient-Reported Outcomes (PROs) in Spondyloarthritis (SpA); a recent one has found similarity in Psoriatic Arthritis (PsA) and axial patients1.Objectives:To describe PROs at SpA diagnosis (new or confirmed), by type of SpA and by gender.Methods:SIRENA is an Italian, prospective Registry of SpA patients diagnosed according to ASAS criteria and naïve to any DMARDs. At inclusion, patients were classified as predominant axial (AxSpA) or mainly peripheral (pSpA). PROs showed in the Table 1 were collected and analysed descriptively.Table 1.PhGA and PROs at diagnosis*AxSpA*pSpAAll(n=123)Women(n=64)Men(n=58)All(n=227)Women(n=109)Men(n=118)PhGA, n1156054222105117mean (SD)50.2 (28.6)54.8 (26.7)45.0 (30.1)45.4 (25.9)49.9 (25.6)41.3 (25.6)median (min, max)52.0 (0-100)62.0 (0-100)43.5 (0-100)48.5 (0-100)50.0 (1.0-100)40.0 (0-95.0)PtGA, n1125952209102107mean (SD)56.4 (27.8)61.5 (25.8)50.3 (29.2)50.3 (26.2)56.4 (23.1)44.5 (27.7)median (min, max)63.0 (0-100)70.0 (2.0-100)50.0 (0-100)50.0 (0-100)58.5 (7.0-100)47.0 (0-100)Pain VAS score, n1136052207101106mean (SD)56.7 (28.3)61.1 (26.6)50.6 (29.1)51.9 (26.8)57.4 (25.3)46.8 (27.3)median (min, max)60.0 (0-100)69.5 (2.0-100)50.0 (0-100)53.0 (0-100)61.0 (0-100)48.5 (0-100)Sleep VAS score, n1136052211103108mean (SD)55.3 (29.3)57.4 (29.5)52.3 (29.2)44.0 (30.1)50.4 (29.8)37.9 (29.2)median (min, max)59.0 (0-100)61.5 (0-100)53.0 (0-100)44.0 (0-100)53.0 (0-100)34.0 (0-100)BASFI, n11058511336568mean (SD)4.6 (2.8)5.2 (2.6)3.9 (2.8)3.5 (2.6)4.0 (2.6)3.1 (2.4)median (min, max)5.1 (0-9.7)5.8 (0-9.4)3.6 (0-9.6)2.9 (0-10.0)3.9 (0-10.0)2.45 (0-8.9)BASDAI, n11259521397069mean (SD)5.2 (2.4)5.8 (2.3)4.5 (2.3)5.2 (2.3)5.8 (2.1)4.6 (2.3)median (min, max)5.5 (0-9.3)6.2 (0-9.3)4.5 (0.3-9.2)5.5 (0.2-10.0)6.1 (1.0-10.0)4.8 (0.2-9.2)HAQ-DI score, n109585020399104mean (SD)0.9 (0.7)1.1 (0.7)0.6 (0.6)0.7 (0.7)0.9 (0.7)0.6 (0.6)median (min, max)0.8 (0.0-2.5)1.1 (0-2.5)0.5 (0-2.3)0.6 (0.0-2.8)0.8 (0-2.8)0.4 (0-2.6)WPAI% work time missed, n4919301074562mean (SD)7.3 (21.4)4.2 (9.5)9.2 (26.3)8.8 (24.7)8.6 (25.6)8.9 (24.3)median (min, max)0 (0-100)0 (0-35.1)0 (0-100)0 (0-100)0 (0-100)0 (0-100)% impairment at work, n6733341346173mean (SD)48.2 (31.9)58.5 (26.6)38.2 (33.7)39.7 (31.4)45.4 (30.9)34.9 (31.2)median (min, max)50.0 (0-100)60.0 (0-100)25.0 (0-100)40.0 (0-100)50.0 (0-100)30.0 (0-100)% overall work impairment, n4819291064561mean (SD)44.1 (33.0)52.4 (27.9)38.7 (35.3)40.1 (33.0)45.1 (33.1)36.4 (32.7)median (min, max)45.0 (0-100)60.0 (0-100)20.0 (0-100)40.0 (0-100)50.0 (0-100)30.0 (0-100)% activity impairment, n10053461839390mean (SD)56.7 (28.6)63.4 (23.9)48.0 (31.0)48.5 (30.3)55.3 (28.7)41.4 (30.4)median (min, max)60.0 (0-100)70.0 (0-100)50.0 (0-100)50.0 (0-100)60.0 (0-100)40.0 (0-100)* The sum does not add up to the total because of some missing values.Results:From 23 sites, 123 AxSpA and 227 pSpA patients were analysed. Diagnosis was new in 58% of AxSpA and 77% of pSpA. 85.5% of the pSpA had PsA, while in AxSpA the most frequent type was Ankylosing Spondylitis (48.8%). Time from symptom onset to diagnosis was higher in AxSpA than in pSpA (median 36 vs 24 months, respectively). At inclusion, composite disease activity measures showed high disease activity for AxSpA (mean ASDAS-CRP 3.1) and moderate disease activity for pSpA (mean DAS28 3.6; mean DAPSA 22.5). AxSpA patients had numerically worse values than pSpA in all the PROs collected, except for BASDAI score that was similar (mean 5.2). For both AxSpA and pSpA, all PROs were worse in women than men, except for the % of work time missed. PtGA scores were higher than PhGA, in each group and gender.Conclusion:At diagnosis, SpA patients perceive a slightly higher disease burden than assessed by Physicians. For PROs other than BASDAI, AxSpA reported a worse impact than pSpA. Overall, women showed a higher disease impact than men.References:[1]Michelsen B. et al. PLoS ONE 2015; 10(4): e0123582.Disclosure of Interests:Rosario Foti Speakers bureau: Speaker bureau honoraria from Eli Lilly, Sanofi, MSD, Janssen, AbbVie, Bristol-Myers Squibb, Celgene, Roche, Consultant of: Consultancy fees from Eli Lilly, Sanofi, MSD, Janssen, AbbVie, BMS, Celgene, Roche, Gabriella Cardinale: None declared., Luisa Costa: None declared., Franco Franceschini: None declared., Francesco Ciccia Speakers bureau: Speaker bureau honoraria from AbbVie, Abiogen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Pfizer, Novartis, Roche, Consultant of: Consultancy fees from Novartis, Pfizer, Janssen, Eli Lilly, Roche, Celgene, Grant/research support from: Grant/research support from Pfizer, Novartis, Celgene, Janssen, Roche, Antonio Marchesoni: None declared., Giuliana Guggino Speakers bureau: Speaker bureau honoraria from Celgene, Sandoz, Pfizer, Grant/research support from: Grant/research support from Pfizer, Celgene, Maurizio Rossini: None declared., Ennio Lubrano Di Scorpaniello: None declared., Bruno Frediani: None declared., Maria Sole Chimenti: None declared., Gerolamo Bianchi: None declared., Giuseppe Galfo: None declared., Silvia Marelli Employee of: Employee of Janssen-Cilag SpA Italy, Ennio Favalli Speakers bureau: Consulting fees and/or speaking engagements from AbbVie, Bristol-Myers Squibb, Lilly, Merck Sharp & Dohme, Pfizer, Galapagos, Sanofi-Genzyme, and UCB.

Abstract STUDY QUESTION What is the clinical validity and utility of preconception Expanded Carrier Screening (ECS) application on the management of prospective parents? SUMMARY ANSWER The high detection rate of at-risk couples (ARCs) and the high proportion opting for IVF/preimplantation genetic testing (PGT) treatment demonstrate the clinical utility of ECS in the preconception space in IVF and general population. WHAT IS KNOWN ALREADY About 2–4% of couples are at risk of conceiving a child with an autosomal recessive or X-linked genetic disorder. In recent years, the increasing cost-effectiveness of genetic diagnostic techniques has allowed the creation of ECS panels for the simultaneous detection of multiple recessive disorders. Comprehensive preconception genetic screening holds the potential to significantly improve couple’s genetic risk assessment and reproductive planning to avoid detectable inheritable genetic offspring. STUDY DESIGN, SIZE, DURATION A total of 3877 individuals without a family history of genetic conditions were analyzed between January 2017 and January 2020. Of the enrolled individuals, 1212 were gamete donors and 2665 were patients planning on conceiving from both the IVF and the natural conception group. From the non-donor cohort, 1133 were analyzed as individual patients, while the remaining ones were analyzed as couples, for a total of 766 couples. PARTICIPANTS/MATERIALS, SETTING, METHODS A focused ECS panel was developed following American College of Obstetrics and Gynecology ACOG-recommended criteria (prevalence, carrier rate, severity), including highly penetrant severe childhood conditions. Couples were defined at-risk when both partners carried an autosomal recessive pathogenic/likely pathogenic variant (PLP) on the same gene or when the woman was a carrier of an X-linked PLP variant. ARC detection rate defined the clinical validity of the ECS approach. Clinical utility was evaluated by monitoring ARCs reproductive decision making. MAIN RESULTS AND THE ROLE OF CHANCE A total of 402 individuals (10.4%) showed PLP for at least one of the genes tested. Among the 766 couples tested, 173 showed one carrier partner (22.6%), whereas 20 couples (2.6%) were found to be at increased risk. Interestingly, one ARC was identified as a result of cascade testing in the extended family of an individual carrying a pathogenic variant on the Survival Of Motor Neuron 1SMN1 gene. Of the identified ARCs, 5 (0.7%) were at risk for cystic fibrosis, 5 (0.7%) for fragile X syndrome, 4 (0.5%) for spinal muscular atrophy, 4 (0.5%) for Beta-Thalassemia/Sickle Cell Anemia, 1 (0.1%) for Smith-Lemli-Opitz Syndrome and 1 (0.1%) for Duchenne/Becker Dystrophy. Fifteen ARCs were successfully followed up from both the IVF and the natural conception groups. All of these (15/15) modified their reproductive planning by undergoing ART with Preimplantation Genetic Testing for Monogenic disease and Aneuploidies (PGT-M and PGT-A). To date, 6/15 (40%) couples completed their PGT cycle with euploid/unaffected embryos achieving a pregnancy after embryo transfer and three of them have already had an unaffected baby. LIMITATIONS, REASONS FOR CAUTION The use of a limited panel of core gene-disease pairs represents a limitation on the research perspective as it can underestimate the rate of detectable carriers and ARCs in this cohort of prospective parents. Expanding the scope of ECS to a larger panel of conditions is becoming increasingly feasible, thanks to a persistent technological evolution and progressive cataloging of gene–disease associations. WIDER IMPLICATIONS OF THE FINDINGS These results highlight the potential clinical validity and utility of ECS in reducing the risk of a pregnancy affected by a detectable inheritable genetic condition. The steady reduction in the costs of genetic analyses enables the expansion of monogenic testing/screening applications at the preimplantation stage, thus, providing valid decisional support and reproductive autonomy to patients, particularly in the context of IVF. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. A.C., M.F., S.C., M.P., L.G., and C.P. are employees of Igenomix Italy. C.S. is the head of the scientific board of Igenomix. TRIAL REGISTRATION NUMBER N/A.

BackgroundPrior studies have demonstrated improved accuracy and efficacy when Intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. There is also growing evidence that many patients with knee osteoarthritis (OA) exhibit a pro-inflammatory catabolic synovial fluid (SF) profile. However, it is not known if temporary clinical improvement in pain and function after IA Hyaluronic acid (HA) injections is associated with changes in SF volumes.ObjectivesThe purpose of this study was to determine if IA HA injections delivered using US directed needle visualization with an external pneumatic compression device would result in improved clinical outcomes for knee OA at 3 and 6 months, and if this was associated with a reduction in the amount of knee synovial fluid (SF) measured on US.Methods49 eligible subjects with symptomatic Knee OA, BMI < 40 and KL radiographic rating of II or III OA were consented for this open label prospective IRB approved Investigator Initiated SF OA biomarker study (HS 3179, NCT 04093232). All standing radiographs were reviewed by a fellowship-trained MSK radiologist. 36 subjects had adequate aspirated SF volumes of > 500 mcl for biomarker analysis and therefore were eligible to receive two IA injections of HYADD4, 24 mg/3ml (Fidia Farmaceutici S.p.A. Italy) 7 days apart by a MSK US certified Rheumatologist. An external pneumatic compression device and US visualized needle insertion ensured injections were delivered into the intra-synovial space. Despite COVID-19 restrictions, 34 patients (17 women and 17 men) between 35 and 78 years of age returned for 3 month evaluations and 30 had evaluations at 6 months. The following clinical variables were measured: Western Ontario and McMaster Universities Index (WOMAC) total scores, Visual Analog Pain Scale (VAS, 0-10), PCS scores on the SF-36 health survey questionnaires (physical function/bodily pain and general health), 6-minute walking distance in meters (6 MWD), and measured SF depth before and after an external pneumatic compression device was inflated to 100 mmHg to facilitate aspiration by increasing available SF volumes under positive presure. The SF depth was measured on the recorded US image (GE logiq e) as the largest anechoic region selected for aspiration on either the lateral (n= 30) or medial (n=4) compartment. SF and simultaneous peripheral blood samples were centrifuged and cryopreserved at -80 o C within 45 minutes of aspiration for future analysis. Statistical differences between baseline values compared to those levels at 3 and 6 months were determined using a paired ANOVA test with p <0.05 significance.ResultsImprovements over baseline values were observed at 3 and 6 months respectively, after IA HA injections in WOMAC (40%, 40%), VAS (45%, 51%) and PCS (15%, 18%) all p< 0.0001. The 6 WWD improved by 7 % at 3 months (p< 0.007) but was not statistically improved at 6 months. US measured SF depth at baseline was 3.2 ± 2.2 mm before inflation and 6.4 + 3.7 mm after inflation of the pneumatic external compressioin device but statistical differences in SF depth were not observed at 3 and 6 months.ConclusionDespite improvements in WOMAC, VAS scores, and PCS scores on the SF 36 at 3 and 6 months after US guided knee injections with an HA product, a statistically significant reduction in the amount of US measured SF was not observed. The 6 MWD improved at 3 months but was not statistically different from the baseline distance by 6 months. IA injections using US needle visualization confirmed that the product was delivered into the synovial space with 100 % accuracy which might have resulted in improved efficacy results in this study compared to prior IA HA studies injected without US or using different HA products. In the future, we hope SF biomarkers may identify which individual OA patients will likely achieve the greatest benefit with IA HA injections and to determine if this is associated with a reduction in catabolic pro-inflammatory proteins.Disclosure of Interestsrichard Meehan Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. I was the PI., Mary Gill Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As the study coordinator she received salary support, Eric Hoffman Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As a biomedical engineer consultant he received some compensation for his work., Molly Wolf Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As the Immunology laboratory supervisor she received support from this grant for sample processing and analysis., Isabelle Amigues Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As a Rheumatologist who performed some of the aspirations and injections she did receive some very small salary support from this grant., Liudmila (Mila) Kastsianok Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As a Rheumatologist who performed some of the aspirations and injections she did receive some very small salary support from this grant., Elizabeth Regan Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As a orthopedic surgeon and immunologists she did receive some very small salary support from this grant., James Crooks Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As our biostatistician for this project he did receive some support from this grant for statistical analysis and consultation., Gregory Czuczman: None declared, claire Coeshott Consultant of: She was ben an employee for pharmaceutical companies in the past unrelated to this project and has no relationship in the past with Fidia who funded the study., Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As the director of the ADx immunology labs where this samples are processed her staff received some compensation for sample handling and biomarker analysis. She did not receive any salary support., Vijaya Knight Grant/research support from: This grant was funded by Fidia Pharmaceutici and Fidia Pharma USA as an Investigator Initiated grant for synovial fluid based biomarker research in osteoarthritis. As an Immunologists and prior director of the ADx immunology labs when the project started in 2019 her staff performed sample processing and testing and they received support from this grant by Dr Knight did not receive and salary support or direct compensation for her consultation expertise.

The COVID-19 evolution has forced the massive introduction of homeworking (HW) for most employees in the initial stages of the pandemic and then return to work, mainly due to the vaccination campaign. These multiple abrupt adjustment demands in work may be a source of intense stress for office workers with consequences on wellbeing and the quality of life. This long-term prospective study aimed at investigating the effect of adaptation demands on a broad population of employees of a large Italian banking group in the job-related stress framework. We administered a web-based survey to 1,264 participants in Reopening after the first lockdown, from June to October 2020, at 841 subjects in Second Wave, corresponding to the rise of contagions from November 2020 to January 2021, and to 491 individuals in Vaccination Round, which ranged from February to June 2021. We assessed workaholism by using the Dutch Work Addiction Scale (DUWAS-10), work-family conflicting overlap by using the Work and Family Conflict Scale (WAFCS), and concern for back to work (BW) and for HW by specific questions. Higher WAFCS scores characterized Reopening and Vaccination Round while Second Wave had the highest level of concern for HW. Women and younger individuals showed the highest concern for BW, WAFCS, and DUWAS-10 scores regardless of the pandemic stage. HW days per week were related to more heightened concern for BW and lower concern for HW, DUWAS, and WAFCS scores. The number of children was related to lower Concern for BW and higher WAFCS scores in Reopening and Second Wave. Our data showed that massive adjustment demands in work and family routine represented a significant source of stress for employees, regardless of the different pandemic stages. The highest level of fatigue emerged in women and younger subjects. These results shed light on the need for a road map to promote a gradual and structured adjustment for workers and encourage organizations to consider homeworking as a valid stable alternative.

Improving occupant's satisfaction represents an important target oriented both towards the increment of productivity and towards the reduction of operational costs related to health and safety of employees. These considerations are the bases of an interdisciplinary cross-country survey on the human-building interaction in office buildings. The proposed study presents findings from the survey conducted at the University of Calabria (Italy). In particular, both demographic characteristics of the sample and data regarding comfort, satisfaction, and productivity are processed and investigated. Descriptive statistical analysis is developed with the aim of highlighting the influence of indoor comfort conditions on the perceived productivity of employees. Particular attention is dedicated to the study of gender-related differences in internal environment perception. Indoor temperature, quality of indoor air, and acoustics are the most selected causes of dissatisfaction and low perceived productivity both for women and men. The responses regarding satisfaction level and perceived productivity are also combined by defining a quantitative indicator named Office Productivity and Satisfaction index (OPSi) that is the ratio between the perceived productivity and the satisfaction level of the considered comfort condition. Causes of discomfort are also analyzed and demonstrated gender-related differences in workplaces quality evaluation.

Abstract Background Pharmacists play a crucial role in the COVID-19 pandemic scenario, performing frontline roles for the community, and supporting the healthcare system. This study aimed at investigating stress and its correlates among this category of workers at a high risk of SARS-CoV-2 infection. Methods The participants for this study were employees of the “Municipal Pharmaceutical Company” of L’Aquila (Italy). Data were collected using an anonymous, web-based, self-administered questionnaire. Two independent surveys were conducted, from June to July 2020, and in January 2021. Results Two separate groups of respondents were involved: a total of 37 workers participated in the first survey (mean age 44.9 ± 10.7, 75.7% women) and 18 in the second survey (mean age 45.9 ± 9.2, 94.4% women). The average total scores of the perceived stress (GHQ-12 score) increased significantly from 15.5 to 18.2 (p = 0.0438), showing a moderate level of stress in the category investigated. Conclusions We observed a strong emotional exhaustion in the study sample of pharmacists, who reported high-risk perceptions and fear. A comprehensive assistance should be granted to support the well-being of healthcare workers who provide an essential service, despite the high risk of infection.

Abstract Background Even if the food supplement industry is one of the fastest growing worldwide, the inappropriate use of these products can potentially cause harms. Considering the key role played by pharmacists in advising citizens on the purchase of food supplements, this cross-sectional observational study evaluates pharmacists' knowledge, attitudes and practice on this topic. Methods From September 2020 to February 2021, an online questionnaire implemented through the EU-Survey tool, was administered to pharmacists of both public and private authorized pharmacies of the Friuli-Venezia Giulia (FVG) Region (Italy). The 47 multiple-choice questions about pharmacists' knowledge (20), attitudes and practice (27), were followed by a sociodemographic section (7 items) collecting data about sex, age, years of experience, degree, role within pharmacy (owner, employee). Descriptive analyses, Chi-square, Shapiro-Wilk and Mann Whitney tests were used and a p-value&lt;0.05 was considered as statistically significant. Results A sample of 232 questionnaires was collected, 70.7% of which from women. Most responders (77.2%) had a Pharmacy degree, with owners representing the 34.5%. The 61.2% of pharmacists had at least 10 years of experience. Knowledge was generally poor with just 49.2% of the sample scoring above the median value of 11 but higher among pharmacists with more than 11 years of experience. Lesser-known aspects were the possible link between cancer and multivitamin's abuse and presence of non-labeled agents in food supplements. Responders &lt; =10 years of experience felt more unprepared about vitamin's dosage and in counselling particular groups of patients (p &lt; 0.05). Employees more frequently reported the attitude to purchase food supplements under patient specifical request (p &lt; 0.05). Conclusions Pharmacists' knowledge about food supplements is scarce and young professionals in particular need further education to ensure a safe and effective purchase of these products to patients. Key messages The use of vitamin supplements is growing but their consumption needs to be evaluated by expert and qualified professionals. Pharmacists play a key role in counselling people about food supplements but need continuous professional education to give adequate advice.

IntroductionItaly was the first Western country affected by the COVID-19 pandemic that still constitutes a severe challenge for healthcare workers (HCWs), with a deep impact on their mental health. Several studies confirmed that a considerable proportion of HCW developed adverse psychological impairment (PsI). To focus on preventive and rehabilitation measures, it is fundamental to identify individual and occupational risk factors. We systematically assessed possible PsI among all employees in a large university hospital in Italy, using validated psychometric scales in the context of occupational health surveillance.MethodsIn the period of July 2020 to July 2021, we enrolled 990 HCWs. For each subject, the psychological wellbeing was screened in two steps. The first-level questionnaire collected gender, age, occupational role, personal and occupational COVID-19 exposure, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R), and anxiety (GAD-7). Workers showing PsI (i.e., test scores above the cutoff in at least one among GHQ-12, IES-R, and GAD-7) have been further investigated by the second-level questionnaire (psycho-diagnostic) composed by PHQ-9, DES-II, and SCL-90 scales. If the second-level showed clinically relevant symptoms, then we offered individual specialist treatment (third level).ResultsThree hundred sixteen workers (32%) presented signs of PsI at the first-level screening questionnaire. Women, nurses, and subjects engaged in the COVID-19 area and with an infected family member showed significantly higher PsI risk. PsI prevalence was strongly associated with the pandemic trend in the region but sensibly decreased after January 2021, when almost all workers received the vaccination. A proportion of subjects with PsI presented clinically relevant symptoms (second-level screening) on PHQ-9 (35%), DES (20%), and SCL-90 (28%). These symptoms were associated neither to direct working experience with patients with COVID-19 nor to COVID-19 experience in the family and seemed not to be influenced by the pandemic waves or workers vaccination.ConclusionsThe evaluation of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for PsI in situations of high stress and/or disasters, as well as variables associated with symptom chronicization.

Abstract Background The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it’s fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician’s health surveillance, in collaboration with Psychiatric Unit. Methods The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions. Results Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months. Conclusions The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.

This article looks at the role(s) of girls and women as depicted in some early twentieth-century popular texts and in one more recent text set during those years: Bianca Pitzorno’s Il sogno della macchina da cucire (2018). Pitzorno’s coming-of-age novel explores the power of education, literature and work for an orphan girl, a sartina whose sewing skills allow her a degree of independence, and whose determination to learn, particularly through reading and conversations with other women, allows her to protect herself in a society in which women of her class and background are highly vulnerable. The novel’s engagement with turn-of-the-century popular culture both celebrates and critiques its importance in the lives of women, as the dramatic and melodramatic stories recounted in genre fiction, novels and opera offer the protagonist an escape but also an education. Through the tales – often tragic and cautionary – of Madama Butterfly, Jane Eyre and, above all, Carolina Invernizio’s Giselda (Storia di una sartina, 1892), Pitzorno helps a contemporary audience comprehend the strictures faced by women in earlier times, while also furnishing her young sartina with much greater agency than those antecedents. In reading about this girl’s reading, and about the lives of her friends and employers, we gain new insights into women’s work and leisure in early twentieth-century Italy, and see social expectations and class dynamics brought to life. We also encounter sobering parallels with ongoing issues in today’s society.

In the Italian social context difficulties in remaining in the labor market characterizes working mothers, leading them sometimes to resign from their jobs. The aim of this research is to explore narratives of those women dropping out of the workforce during pregnancy and soon after childbirth and their experiences in these circumstances. The study analysed 30 interviews with working mothers with an average age of 35.4 years, living in Naples, Italy, who “spontaneously” left their jobs. Grounded Theory Methodology allowed a deeper understanding of these women’s thoughts, feelings, and experiences. The content of the interviews was categorized into 4 macro-areas: (1) The role of the family and of the working contexts, (2) Mothering and caregiving (3) Identity conflicts, and (4) The consequences of resignation. A sense of helplessness towards fulfilling maternal expectations, role assignments, and employers’ requests ultimately led to the individuals’ response to the requirements of motherhood. The narratives highlighted how respondents feel powerless and oppressed by the burden of guilt and feelings of ambivalence towards both work and motherhood and how all these subjective feelings were supported and had been induced by external social factors (discriminatory business strategies, organizational time management, lack of support services, familial cultural models idealizing maternity).

The pandemic period has placed the organizations in a state of great tension. It has generated a situation of confusion, lack of rules, and production-related criticalities that have called into question the very existence of many productive realities. This article aims to highlight the dimensions of care and ethics put in place by HR managers in COVID-19. The objective that animated the authors have focused on the HRM level of medium and large companies in Italy to highlight the protective actions toward people and the organization in the period COVID 19, highlighting what were the ethical values and actions of care put in place. In this article, we wanted to give voice to managers (N = 45, including 21 women and 24 men, aged between 40 and 55 years old) who had management tasks in their organizations by asking them to tell us how they dealt with the challenges imposed by the emergency. In the research, we start from a way of understanding workplaces understood as a “process of ongoing social relationship” within which the HR function is dedicated to the care of the quality of relationships. HR managers have to manage a complex role of mediating between the interests of people and employers by trying to find good mediations.

The article applies a comprehensive approach to the research of the impact of labor migration on the implementation of Sustainable Development Goals 8 "Decent work and economic growth", which is based on the theory of labor migration and the concept of sustainable development; a system of indicators describing the problems in the labor market of the country of origin of migrant workers is proposed. As a result of the research, a system of indicators was proposed, which includes four groups that meet the current problems in the labor market of Ukraine. Using the proposed system of indicators, we investigated the impact of labor migration on the current problems of the labor market of Ukraine, which include: 1) the inconsistency of skills of job seekers to the requirements set by employers; 2) low productivity; 3) population reduction and aging; 4) low level of women's participation in the labor force. These problems were researched on the example of Ukraine and the recipient countries of Ukrainian labor migrants (in Poland, the Russian Federation and Italy). As part of the analysis of the first problem, the following indicators were researched: the level of coverage of the population with higher education, the unemployment rate, the share of those employed with higher education. To address the second problem, the labor productivity index and the competitiveness index were used, namely its sub-index "labor market efficiency". The third problem was analyzed using indicators of natural growth, population decline, 65+ age, life expectancy and Lancet aging rating. To analyze the fourth problem, the proportions of the employed female population, the level of wages and the unemployment rate of women and women were used in comparison with similar indicators of men. This system can be successfully used for comparative analysis of labor market characteristics of donor countries and recipient countries of migrant workers. We concluded that labor migration is more effective and can contribute to the implementation of Goal 8 if it is considered a temporary phenomenon and is followed by the return of migrant workers to their homeland. In this case, Ukraine will be able to take advantage of foreign experience, knowledge and skills, which will increase productivity, reduce unemployment, increase the share of the employed women.

“There is nothing more public than privacy.” (Berlant and Warner, Sex) How did it come to this? How did it happen that a one-off, two-hour event at a public swimming pool in a suburb of outer Melbourne ignited international hate mail and generated media-fanned political anguish and debate about the proper use of public spaces? In 2010, women who attend a women’s only swim session on Sunday evenings at the Dandenong Oasis public swimming pool asked the pool management and the local council for permission to celebrate the end of Ramadan at the pool during the time of their regular swim session. The request was supported by the pool managers and the council and promoted by both as an opportunity for family and friends to get together in a spirit of multicultural learning and understanding. Responding to criticisms of the event as an unreasonable claim on public facilities by one group, the Mayor of the City of Greater Dandenong, Jim Memeti, rejected claims that this event discriminates against non-Muslim residents of the suburb. But here’s the rub. The event, to be held after hours at the pool, requires all participants older than ten years of age to follow a dress code of knee-length shorts and T-shirts. This is a suburban moment that is borne of but exceeds the local. It reflects and responds to a contemporary global conundrum of great political and theoretical significance—how to negotiate and govern the relations between multiculturalism, religion, gender, sexual freedom, and democracy. Specifically this event speaks to how multicultural democracy in the public sphere negotiates the public presence and expression of different cultural and religious frameworks related to gender and sexuality. This is demanding political stuff. Situated in the messy political and theoretical terrains of the relation between public space and the public sphere, this local moment called for political judgement about how cultural differences should be allowed to manifest in and through public space, giving consideration to the potential effects of these decisions on an inclusive multicultural democracy. The local authorities in Dandenong engaged in an admirable process of democratic labour as they puzzled over how to make decisions that were responsible and equitable, in the absence of a rulebook or precedents for success. Ultimately however this mode of experimental decision-making, which will become increasingly necessary to manage such predicaments in the future, was foreclosed by unwarranted and unhelpful media outrage. "Foreclosed" here stresses the preemptive nature of the loss; a lost opportunity for trialing approaches to governing cultural diversity that may fail, but might then be modified. It was condemned in advance of either success or failure. The role of the media rather than the discomfort of the local publics has been decisive in this event.This Multicultural SuburbDandenong is approximately 30 kilometres southeast of central Melbourne. Originally home to the Bunorong People of the Kulin nation, it was settled by pastoralists by the 1800s, heavily industrialised during the twentieth century, and now combines cultural diversity with significant social disadvantage. The City of Greater Dandenong is proud of its reputation as the most culturally and linguistically diverse municipality in Australia. Its population of approximately 138,000 comprises residents from 156 different language groups. More than half (56%) of its population was born overseas, with 51% from nations where English is not the main spoken language. These include Vietnam, Cambodia, Sri Lanka, India, China, Italy, Greece, Bosnia and Afghanistan. It is also a place of significant religious diversity with residents identifying as Buddhist (15 per cent) Muslim (8 per cent), Hindu (2 per cent) and Christian (52 per cent) [CGD]. Its city logo, “Great Place, Great People” evokes its twin pride in the placemaking power of its diverse population. It is also a brazen act of civic branding to counter its reputation as a derelict and dangerous suburb. In his recent book The Bogan Delusion, David Nichols cites a "bogan" website that names Dandenong as one of Victoria’s two most bogan areas. The other was Moe. (p72). The Sunday Age newspaper had already depicted Dandenong as one of two excessively dangerous suburbs “where locals fear to tread” (Elder and Pierik). The other suburb of peril was identified as Footscray.Central Dandenong is currently the site of Australia’s largest ever state sponsored Urban Revitalisation program with a budget of more than $290 million to upgrade infrastructure, that aims to attract $1billion in private investment to provide housing and future employment.The Cover UpIn September 2010, the Victorian and Civil and Administrative Appeals Tribunal (VCAT) granted the YMCA an exemption from the Equal Opportunity Act to allow a dress code for the Ramadan event at the Oasis swimming pool that it manages. The "Y" sees the event as “an opportunity for the broader community to learn more about Ramadan and the Muslim faith, and encourages all members of Dandenong’s diverse community to participate” (YMCA Ramadan). While pool management and the municipal council refer to the event as an "opening up" of the closed swimming session, the media offer a different reading of the VCAT decision. The trope of the "the cover up" has framed most reports and commentaries (Murphy; Szego). The major focus of the commentaries has not been the event per se, but the call to dress "appropriately." Dress codes however are a cultural familiar. They exist for workplaces, schools, nightclubs, weddings, racing and sporting clubs and restaurants, to name but a few. While some of these codes or restrictions are normatively imposed rather than legally required, they are not alien to cultural life in Australia. Moreover, there are laws that prohibit people from being meagerly dressed or naked in public, including at beaches, swimming pools and so on. The dress code for this particular swimming pool event was, however, perceived to be unusual and, in a short space of time, "unusual" converted to "social threat."Responses to media polls about the dress code reveal concerns related to the symbolic dimensions of the code. The vast majority of those who opposed the Equal Opportunity exemption saw it as the thin edge of the multicultural wedge, a privatisation of public facilities, or a denial of the public’s right to choose how to dress. Tabloid newspapers reported on growing fears of Islamisation, while the more temperate opposition situated the decision as a crisis of human rights associated with tolerating illiberal cultural practices. Julie Szego reflects this view in an opinion piece in The Age newspaper:the Dandenong pool episode is neither trivial nor insignificant. It is but one example of human rights laws producing outcomes that restrict rights. It raises tough questions about how far public authorities ought to go in accommodating cultural practices that sit uneasily with mainstream Western values. (Szego)Without enquiring into the women’s request and in the absence of the women’s views about what meaning the event held for them, most media commentators and their electronically wired audiences treated the announcement as yet another alarming piece of evidence of multicultural failure and the potential Islamisation of Australia. The event raised specific concerns about the double intrusion of cultural difference and religion. While the Murdoch tabloid Herald Sun focused on the event as “a plan to force families to cover up to avoid offending Muslims at a public event” (Murphy) the liberal Age newspaper took a more circumspect approach, reporting on its small vox pop at the Dandenong pool. Some people here referred to the need to respect religions and seemed unfazed by the exemption and the event. Those who disagreed thought it was important not to enforce these (dress) practices on other people (Carey).It is, I believe, significant that several employees of the local council informed me that most of the opposition has come from the media, people outside of Dandenong and international groups who oppose the incursion of Islam into non-Islamic settings. Opposition to the event did not appear to derive from local concern or opposition.The overwhelming majority of Herald Sun comments expressed emphatic opposition to the dress code, citing it variously as unAustralian, segregationist, arrogant, intolerant and sexist. The Herald Sun polled readers (in a self-selecting and of course highly unrepresentative on-line poll) asking them to vote on whether or not they agreed with the VCAT exemption. While 5.52 per cent (512 voters) agreed with the ruling, 94.48 per cent (8,760) recorded disagreement. In addition, the local council has, for the first time in memory, received a stream of hate-mail from international anti-Islam groups. Muslim women’s groups, feminists, the Equal Opportunity Commissioner and academics have also weighed in. According to local reports, Professor of Islamic Studies at the University of Melbourne, Shahram Akbarzadeh, considered the exemption was “nonsense” and would “backfire and the people who will pay for it will be the Muslim community themselves” (Haberfield). He repudiated it as an example of inclusion and tolerance, labeling it “an effort of imposing a value system (sic)” (Haberfield). He went so far as to suggest that, “If Tony Abbott wanted to participate in his swimwear he wouldn’t be allowed in. That’s wrong.” Tasneem Chopra, chairwoman of the Islamic Women’s Welfare Council and Sherene Hassan from the Islamic Council of Victoria, both expressed sensitivity to the group’s attempt to establish an inclusive event but would have preferred the dress code to be a matter of choice rather coercion (Haberfield, "Mayor Defends Dandenong Pool Cover Up Order"). Helen Szoke, the Commissioner of the Victorian Equal Opportunity and Human Rights Commission, defended the pool’s exemption from the Law that she oversees. “Matters such as this are not easy to resolve and require a balance to be achieved between competing rights and obligations. Dress codes are not uncommon: e.g., singlets, jeans, thongs etc in pubs/hotels” (in Murphy). The civil liberties organisation, Liberty Victoria, supported the ban because the event was to be held after hours (Murphy). With astonishing speed this single event not only transformed the suburban swimming pool to a theatre of extra-local disputes about who and what is entitled to make claims on public space and publically funded facilities, but also fed into charged debates about the future of multiculturalism and the vulnerability of the nation to the corrosive effects of cultural and religious difference. In this sense suburbs like Dandenong are presented as sites that not only generate fear about physical safety but whose suburban sensitivities to its culturally diverse population represent a threat to the safety of the nation. Thus the event both reflects and produces an antipathy to cultural difference and to the place where difference resides. This aversion is triggered by and mediated in this case through the figure, rather than the (corpo)reality, of the Muslim woman. In this imagining, the figure of the Muslim woman is assigned the curious symbolic role of "cultural creep." The debates around the pool event is not about the wellbeing or interests of the Muslim women themselves, nor are broader debates about the perceived, culturally-derived restrictions imposed on Muslim women living in Australia or other western countries. The figure of the Muslim woman is, I would argue, simply the ground on which the debates are held. The first debate relates to social and public space, access to which is considered fundamental to freedom and participatory democracy, and in current times is addressed in terms of promoting inclusion, preventing exclusion and finding opportunities for cross cultural encounters. The second relates not to public space per se, but to the public sphere or the “sphere of private people coming together as a public” for political deliberation (Habermas 21). The literature and discussions dealing with these two terrains have remained relatively disconnected (Low and Smith) with public space referring largely to activities and opportunities in the socio-cultural domain and the public sphere addressing issues of politics, rights and democracy. This moment in Dandenong offers some modest leeway for situating "the suburb" as an ideal site for coalescing these disparate discussions. In this regard I consider Iveson’s provocative and productive question about whether some forms of exclusions from suburban public space may actually deepen the democratic ideals of the public sphere. Exclusions may in such cases be “consistent with visions of a democratically inclusive city” (216). He makes his case in relation to a dispute about the exclusion of men exclusion from a women’s only swimming pool in the Sydney suburb of Coogee. The Dandenong case is similarly exclusive with an added sense of exclusion generated by an "inclusion with restrictions."Diversity, Difference, Public Space and the Public SphereAs a prelude to this discussion of exclusion as democracy, I return to the question that opened this article: how did it come to this? How is it that Australia has moved from its renowned celebration and pride in its multiculturalism so much in evidence at the suburban level through what Ghassan Hage calls an “unproblematic” multiculturalism (233) and what others have termed “everyday multiculturalism” (Wise and Velayutham). Local cosmopolitanisms are often evinced through the daily rituals of people enjoying the ethnic cuisines of their co-residents’ pasts, and via moments of intercultural encounter. People uneventfully rub up against and greet each other or engage in everyday acts of kindness that typify life in multicultural suburbs, generating "reservoirs of hope" for democratic and cosmopolitan cities (Thrift 147). In today’s suburbs, however, the “Imperilled Muslim women” who need protection from “dangerous Muslim men” (Razack 129) have a higher discursive profile than ethnic cuisine as the exemplar of multiculturalism. Have we moved from pleasure to hostility or was the suburban pleasure in racial difference always about a kind of “eating the other” (bell hooks 378). That is to ask whether our capacity to experience diversity positively has been based on consumption, consuming the other for our own enrichment, whereas living with difference entails a commitment not to consumption but to democracy. This democratic multicultural commitment is a form of labour rather than pleasure, and its outcome is not enrichment but transformation (although this labour can be pleasurable and transformation might be enriching). Dandenong’s prized cultural precincts, "Little India" and the "Afghan bazaar" are showcases of food, artefacts and the diversity of the suburb. They are centres of pleasurable and exotic consumption. The pool session, however, requires one to confront difference. In simple terms we can think about ethnic food, festivals and handicrafts as cultural diversity, and the Muslim woman as cultural difference.This distinction between diversity and difference is useful for thinking through the relation between multiculturalism in public space and multicultural democracy of the public sphere. According to the anthropologist Thomas Hylland Eriksen, while a neoliberal sensibility supports cultural diversity in the public space, cultural difference is seen as a major cause of social problems associated with immigrants, and has a diminishing effect on the public sphere (14). According to Eriksen, diversity is understood as aesthetic, or politically and morally neutral expressions of culture that are enriching (Hage 118) or digestible. Difference, however, refers to morally objectionable cultural practices. In short, diversity is enriching. Difference is corrosive. Eriksen argues that differences that emerge from distinct cultural ideas and practices are deemed to create conflicts with majority cultures, weaken social solidarity and lead to unacceptable violations of human rights in minority groups. The suburban swimming pool exists here at the boundary of diversity and difference, where the "presence" of diverse bodies may enrich, but their different practices deplete and damage existing culture. The imperilled Muslim woman of the suburbs carries a heavy symbolic load. She stands for major global contests at the border of difference and diversity in three significant domains, multiculturalism, religion and feminism. These three areas are positioned simultaneously in public space and of the public sphere and she embodies a specific version of each in this suburban setting. First, there a global retreat from multiculturalism evidenced in contemporary narratives that describe multiculturalism (both as official policy and unofficial sensibility) as failed and increasingly ineffective at accommodating or otherwise dealing with religious, cultural and ethnic differences (Cantle; Goodhart; Joppke; Poynting and Mason). In the UK, Europe, the US and Australia, popular media sources and political discourses speak of "parallel lives,"immigrant enclaves, ghettoes, a lack of integration, the clash of values, and illiberal cultural practices. The covered body of the Muslim woman, and more particularly the Muslim veil, are now read as visual signs of this clash of values and of the refusal to integrate. Second, religion has re-emerged in the public domain, with religious groups and individuals making particular claims on public space both on the basis of their religious identity and in accord with secular society’s respect for religious freedom. This is most evident in controversies in France, Belgium and Netherlands associated with banning niqab in public and other religious symbols in schools, and in Australia in court. In this sense the covered Muslim woman raises concerns and indignation about the rightful place of religion in the public sphere and in social space. Third, feminism is increasingly invoked as the ground from which claims about the imperilled Muslim woman are made, particularly those about protecting women from their dangerous men. The infiltration of the Muslim presence into public space is seen as a threat to the hard won gains of women’s freedom enjoyed by the majority population. This newfound feminism of the public sphere, posited by those who might otherwise disavow feminism, requires some serious consideration. This public discourse rarely addresses the discrimination, violation and lack of freedom experienced systematically on an everyday basis by women of majority cultural backgrounds in western societies (such as Australia). However, the sexism of racially and religiously different men is readily identified and decried. This represents a significant shift to a dubious feminist register of the public sphere such that: “[w]omen of foreign origin, ...more specifically Muslim women…have replaced the traditional housewife as the symbol of female subservience” (Tissot 41–42).The three issues—multiculturalism, religion and feminism—are, in the Dandenong pool context, contests about human rights, democracy and the proper use of public space. Szego’s opinion piece sees the Dandenong pool "cover up" as an example of the conundrum of how human rights for some may curtail the human rights of others and lead us into a problematic entanglement of universal "rights," with claims of difference. In her view the combination of human rights and multiculturalism in the case of the Dandenong Pool accommodates illiberal practices that put the rights of "the general public" at risk, or as she puts it, on a “slippery slope” that results in a “watering down of our human rights.” Ideas that entail women making a claim for private time in public space are ultimately not good for "us."Such ideas run counter to the West's more than 500-year struggle for individual freedom—including both freedom of religion and freedom from religion—and for gender equality. Our public authorities ought to be pushing back hardest when these values are under threat. Yet this is precisely where they've been buckling under pressure (Szego)But a different reading of the relation between public and private space, human rights, democracy and gender freedom is readily identifiable in the Dandenong event—if one looks for it. Living with difference, I have already suggested, is a problem of democracy and the public sphere and does not so easily correspond to consuming diversity, as it demands engagement with cultural difference. In what remains, I explore how multicultural democracy in the public sphere and women’s rights in public and private realms relate, firstly, to the burgeoning promise of democracy and civility that might emerge in public space through encounter and exchange. I also point out how this moment in Dandenong might be read as a singular contribution to dealing with this global problematic of living with difference; of democracy in the public sphere. Public urban space has become a focus for speculation among geographers and sociologists in particular, about the prospects for an enhanced civic appreciation of living with difference through encountering strangers. Random and repetitious encounters with people from all cultures typify contemporary urban life. It remains an open question however as to whether these encounters open up or close down possibilities for conviviality and understanding, and whether they undo or harden peoples’ fears and prejudices. There is, however, at least in some academic and urban planning circles, some hope that the "throwntogetherness" (Massey) and the "doing" of togetherness (Laurier and Philo) found in the multicultural city may generate some lessons and opportunities for developing a civic culture and political commitment to living with difference. Alongside the optimism of those who celebrate the city, the suburb, and public spaces as forging new ways of living with difference, there are those such as Gill Valentine who wonder how this might be achieved in practice (324). Ash Amin similarly notes that city or suburban public spaces are not necessarily “the natural servants of multicultural engagement” (Ethnicity 967). Amin and Valentine point to the limited or fleeting opportunities for real engagement in these spaces. Moreover Valentine‘s research in the UK revealed that the spatial proximity found in multicultural spaces did not so much give rise to greater mutual respect and engagement, but to a frustrated “white self-segregation in the suburbs.” She suggests therefore that civility and polite exchange should not be mistaken for respect (324). Amin contends that it is the “micro-publics” of social encounters found in workplaces, schools, gardens, sports clubs [and perhaps swimming pools] rather than the fleeting encounters of the street or park, that offer better opportunities for meaningful intercultural exchange. The Ramadan celebration at the pool, with its dress code and all, might be seen more fruitfully as a purposeful event engaging a micro-public in which people are able to “break out of fixed relations and fixed notions” and “learn to become different” (Amin, Ethnicity 970) without that generating discord and resentment.Micropublics, Subaltern Publics and a Democracy of (Temporary) ExclusionsIs this as an opportunity to bring the global and local together in an experiment of forging new democratic spaces for gender, sexuality, culture and for living with difference? More provocatively, can we see exclusion and an invitation to share in this exclusion as a precursor to and measure of, actually existing democracy? Painter and Philo have argued that democratic citizenship is questionable if “people cannot be present in public spaces (streets, squares, parks, cinemas, churches, town halls) without feeling uncomfortable, victimized and basically ‘out of place’…" (Iveson 216). Feminists have long argued that distinctions between public and private space are neither straightforward nor gender neutral. For Nancy Fraser the terms are “cultural classifications and rhetorical labels” that are powerful because they are “frequently deployed to delegitimate some interests, views and topics and to valorize others” (73). In relation to women and other subordinated minorities, the "rhetoric of privacy" has been historically used to restrict the domain of legitimate public contestation. In fact the notion of what is public and particularly notions of the "public interest" and the "public good" solidify forms of subordination. Fraser suggests the concept of "subaltern counterpublics" as an alternative to notions of "the public." These are discursive spaces where groups articulate their needs, and demands are circulated formulating their own public sphere. This challenges the very meaning and foundational premises of ‘the public’ rather than simply positing strategies of inclusion or exclusion. The twinning of Amin’s notion of "micro-publics" and Fraser’s "counterpublics" is, I suggest, a fruitful approach to interpreting the Dandenong pool issue. It invites a reading of this singular suburban moment as an experiment, a trial of sorts, in newly imaginable ways of living democratically with difference. It enables us to imagine moments when a limited democratic right to exclude might create the sorts of cultural exchanges that give rise to a more authentic and workable recognition of cultural difference. I am drawn to think that this is precisely the kind of democratic experimentation that the YMCA and Dandenong Council embarked upon when they applied for the Equal Opportunity exemption. I suggest that by trialing, rather than fixing forever a "critically exclusive" access to the suburban swimming pool for two hours per year, they were in fact working on the practical problem of how to contribute in small but meaningful ways to a more profoundly free democracy and a reworked public sphere. In relation to the similar but distinct example of the McIver pool for women and children in Coogee, New South Wales, Kurt Iveson makes the point that such spaces of exclusion or withdrawal, “do not necessarily serve simply as spaces where people ‘can be themselves’, or as sites through which reified identities are recognised—in existing conditions of inequality, they can also serve as protected spaces where people can take the risk of exploring who they might become with relative safety from attack and abuse” (226). These are necessary risks to take if we are to avoid entrenching fear of difference in a world where difference is itself deeply, and permanently, entrenched.ReferencesAmin, Ash. “Ethnicity and the Multicultural City: Living with Diversity.” Environment and Planning A 34 (2002): 959–80.———. “The Good City.” Urban Studies 43 (2006): 1009–23.Berlant, Lauren, and Michael Warner. “Sex in Public.” Critical Inquiry 24 (1998): 547–66.Cantle, Ted. Community Cohesion: A Report of the Independent Review Team. London, UK Home Office, 2001.Carey, Adam. “Backing for Pool Cover Up Directive.” The Age 17 Sep. 2010. ‹http://www.theage.com.au/victoria/backing-for-pool-coverup-directive-20100916-15enz.html›.Elder, John, and Jon Pierick. “The Mean Streets: Where the Locals Fear to Tread.” The Sunday Age 10 Jan. 2010. ‹http://www.theage.com.au/national/the-mean-streets-where-the-locals-fear-to-tread-20100109-m00l.html?skin=text-only›.Eriksen, Thomas Hyland. “Diversity versus Difference: Neoliberalism in the Minority Debate." The Making and Unmaking of Difference. Ed. Richard Rottenburg, Burkhard Schnepel, and Shingo Shimada. Bielefeld: Transaction, 2006. 13–36.Fraser, Nancy. “Rethinking the Public Sphere: A Contribution to the Critique of Actually Existing Democracy.” Social Text 25/26 (1990): 56–80.Goodhart, David. “Too Diverse.” Prospect 95 (2004): 30-37.Haberfield, Georgie, and Gilbert Gardner. “Mayor Defends Pool Cover-up Order.” Dandenong Leader 16 Sep. 2010 ‹http://dandenong-leader.whereilive.com.au/news/story/dandenong-oasis-tells-swimmers-to-cover-up/›.Habermas, Jürgen. The Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society. Cambridge, MA: MIT P, 2001.Hage, Ghassan. White Nation: Fantasies of White Supremacy in a Multicultural Society. Sydney: Pluto, 1998.hooks, bell. "Eating the Other: Desire and Resistance." Media and Cultural Studies Keyworks. Eds. Meenakshi Gigi and Douglas Kellner. Malden, MA: Blackwell, 2001. 366-380.Iveson, Kurt. "Justifying Exclusion: The Politics of Public Space and the Dispute over Access to McIvers Ladies' Baths, Sydney.” Gender, Place and Culture 10.3 (2003): 215–28.Joppke, Christian. “The Retreat of Multiculturalism in the Liberal State: Theory and Policy.” The British Journal of Sociology 55.2 (2004): 237–57.Laurier, Chris, and Eric Philo. “Cold Shoulders and Napkins Handed: Gestures of Responsibility.” Transactions of the Institute of British Geographers 31 (2006): 193–207.Low, Setha, and Neil Smith, eds. The Politics of Public Space. London: Routledge, 2006.Massey, Doreen. For Space. London: Sage, 2005.Murphy, Padraic. "Cover Up for Pool Even at Next Year's Ramadan.” Herald Sun 23 Sep. 2010. ‹http://www.heraldsun.com.au/news/victoria/cover-up-for-pool-event-during-next-years-ramadan/story-e6frf7kx-1225924291675›.Nichols, David. The Bogan Delusion. Melbourne: Affirm Press, 2011.Poynting, Scott, and Victoria Mason. "The New Integrationism, the State and Islamophobia: Retreat from Multiculturalism in Australia." International Journal of Law, Crime and Justice 36 (2008): 230–46.Razack, Sherene H. “Imperilled Muslim Women, Dangerous Muslim Men and Civilised Europeans: Legal and Social Responses to Forced Marriages.” Feminist Legal Studies 12.2 (2004): 129–74.Szego, Julie. “Under the Cover Up." The Age 9 Oct. 2010. < http://www.theage.com.au/victoria/under-the-coverup-20101008-16c1v.html >.Thrift, Nigel. “But Malice Afterthought: Cities and the Natural History of Hatred.” Transactions of the Institute of British Geographers 30 (2005): 133–50.Tissot, Sylvie. “Excluding Muslim Women: From Hijab to Niqab, from School to Public Space." Public Culture 23.1 (2011): 39–46.Valentine, Gill. “Living with Difference: Reflections on Geographies of Encounter.” Progress in Human Geography 32.3 (2008): 323–37.Wise, Amanda, and Selveraj Velayutham, eds. Everyday Multiculturalism. Houndsmills: Palgrave Macmillan, 2009.YMCA. “VCAT Ruling on Swim Sessions at Dandenong Oasis to Open Up to Community During Ramadan Next Year.” 16 Sep. 2010. ‹http://www.victoria.ymca.org.au/cpa/htm/htm_news_detail.asp?page_id=13&news_id=360›.