What is known from the existing literature about the available interventions for pelvic floor dysfunction among female athletes? A scoping review

Background: Female athletes may be at higher risk of developing pelvic floor dysfunction (PFD). However, despite the great number of epidemiologic studies, the interventions have not been standardized. Aim: The present scoping review aimed to map and summarize the literature to identify the available interventions for PFD among female athletes. Methods: Seven databases were searched up to May 2021. Studies considering female athletes practising sports at any performance level with any type of PFD were eligible for inclusion. Any clinical intervention and any context were considered. No language, study design, and publication type restrictions were applied. Additional studies were identified through gray literature and the reference lists of articles included. The results were presented numerically and thematically. Results: From 2625 initial records, 35 studies met inclusion criteria. The majority of articles were narrative reviews, considering athletes with urinary incontinence practising multiple or high-impact sports. Authors discussed a wide range of interventions: preventive (n = 8); conservative (n = 35), pharmacological (n = 12), and surgical (n = 10). In particular, the Pelvic Floor Muscle Training was considered in 30 studies. Conclusions: This is the first scoping review to provide a comprehensive overview of the topic. Besides the great number of available interventions, specific programs and randomized controlled clinical trials for female athletes are still limited. Findings highlighted evident gaps in the primary research confirming that the current management is based on expert opinion. This review may be useful for the overall management, and it may represent a starting point for future research

Vaginal Health in Menopausal Women

The aim of this review is to provide an overview of genitourinary health in peri- and postmenopause, particularly of vulvovaginal atrophy (VVA), which is part of genitourinary syndrome (GSM). This condition has a high prevalence among post-menopausal women and negatively affects a woman's quality of life. Epidemiology, signs, symptoms, diagnostic criteria of VVA and target treatments for restoring vaginal health are discussed in light of the most recent literature. Issues related to this condition in menopausal women are under-diagnosed, lack objective diagnostic criteria, and consequently under-treated. Over the years, many treatments have been developed but their long-term effectiveness and safety have yet to be clearly defined. Patients are often dissatisfied and stop treatment, suggesting the need for a more personalized and tailored approach to achieve better compliance and thereby effectiveness. The aim of this paper is to provide an overview of the most recent literature on VVA in order to help the gynecologist in the management of this condition

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Metabolic risk factors and recurrence of pelvic organ prolapse after fascial surgical repair by vaginal route in postmenopausal women

Introduzione. Nonostante i miglioramenti tecnici, la chirurgia pelvica ricostruttiva rappresenta ancora una sfida con un tasso di recidiva anatomica del 9-40%. Dati recenti suggeriscono che la sindrome metabolica (SM) e le sue componenti possano essere associati a diagnosi e severità del prolasso degli organi pelvici (POP). Ad oggi non vi sono dati su SM e rischio recidiva di POP dopo chirurgia. Metodi. Sono state valutate la presenza di SM e delle sue componenti [rialzo di trigliceridi, circonferenza vita, pressione arteriosa e glicemia e riduzione del colesterolo HDL (HDL-C)] in donne in post-menopausa sottoposte a chirurgia vaginale per POP (comprensiva di isterectomia e colpo sospensione ai legamenti uterosacrali o sacrospinosi). Durante le visite di follow-up, è stata valutata la presenza di recidiva anatomica (stadio ≥II secondo POP-Q). Risultati. Sono state inserite nell’analisi 141 pazienti. L’età media al momento della chirurgia era di 63.1±9.6 anni ed il tempo medio di follow-up è stato di 21.1±9.3 mesi (range: 12-36 mesi). Nel corso dell’osservazione 4 donne hanno riferito bulging genitale (2.8%) e 31 donne hanno presentato una recidiva anatomica (21.9%). Nessuna paziente ha necessitato di re-intervento. La glicemia a digiuno presentava valori più alti nel gruppo di donne con recidiva (p=0.002) mentre il colesterolo HDL risultava più basso. Nelle donne con recidiva la prevalenza di ipertrigliceridemia o di iperglicemia era maggiore (p= 0.035 e p=0.030, rispettivamente). La presenza di una circonferenza vita ≥88 cm e di alterati valori glicemici erano fattori di rischio per la recidiva (p=0.031, OR 3.2, 1.3–14.1 95%CI e p=0.028, OR 2.9, 1.5–14.3 95%CI, rispettivamente). Conclusioni. Nella nostra coorte, alcuni aspetti metabolici, ed in particolare alterati livelli di trigliceridi e di glicemia a digiuno ed un’aumentata circonferenza vita, erano associati ad un aumentato rischio di recidiva di POP dopo chirurgia correttiva.Introduction. Despite technical improvements, pelvic reconstructive surgery still represents a challenge with anatomic recurrence rates ranging between 9 and 40%. Recent data suggest that metabolic syndrome (MS) and its components may be associated with the diagnosis and severity of pelvic organ prolapse (POP). To date, there are no data regarding metabolic risk factors and the recurrence of POP after surgery. Methods. The presence of MS and its components [elevated triglycerides (TG), waist circumference, blood pressure, and fasting glucose (FG) and decreased high-density lipoprotein cholesterol (HDL-C)] were evaluated in postmenopausal women undergoing vaginal surgery for POP (including hysterectomy and suspension of the vagina to the uterosacral or sacrospinous ligaments). During the postoperative follow-up visits, the presence of anatomic recurrences defined as POP-Q stage ≥II was assessed. Results. One hundred and forty-one patients were included in the analysis. The mean age at the time of surgery was 63.1 ± 9.6 years and the mean follow-up time was 21.1 ± 9.3 months (range: 12-36 months). During the follow-up period, 4 women reported genital bulging (2.8%), and 31 women presented with anatomic recurrence (21.9%). No patient required another surgical treatment. Fasting glycemia was higher in the group of women with POP recurrence (p = 0.002) while HDL-C was lower (even if remaining in the range of normality). In women with POP recurrence the prevalence of hypertriglyceridemia or hyperglycemia was higher (p = 0.035 and p = 0.030, respectively). The presence of waist circumference ≥88 cm and altered glycemic values were significant risk factors for POP recurrence (p=0.031, OR 3.2, 1.3-14.1 95% CI and p = 0.028, OR 2.9, 1.5-14.3 95% CI, respectively). Conclusions. In our cohort, some metabolic aspects such as increased waist circumference and elevated triglycerides and fasting glucose were associated with an increased risk of POP recurrence after corrective surgery

Air pollution and gynecological diseases

Implementation of industry and vehicular traffic led to a great diffusion of air pollution with a major impairment of air quality especially in urban areas over the last decades. Air pollution is an environmental contaminant containing thousands of harmful compounds derived from exhaust emissions containing a mixture of gaseous, liquid, and solid substances. Evidences associating air pollution exposure to respiratory and cardiovascular systems have been growing in the last decades as these are the most frequently affected organs. Anyway, constantly increasing data are available regarding an increased risk of women\u2019s health disorders after exposure to air pollution. In fact, recent studies have underlined that common and widespread air pollutants could affect both reproductive health and pregnancy outcomes. Indoor and outdoor air pollution has been associated to a higher risk of malignant and benign gynecological diseases. Furthermore, exposure to toxic air pollution particles can have a detrimental role on ovarian function starting from the intrauterine time of life both affecting time of puberty and of menopause but also harming the fertility potential of women. It has been demonstrated that air pollutants are able to decrease the success rate of IVF techniques. These results are derived from animal and human epidemiological data, even if some limitations of the available literature should be acknowledged; in fact, evidences of the biological mechanisms are still limited, and the reliability of information on personal exposures is sometimes scarce. Future toxicological and clinical studies are mandatory to confirm previously hypothesized associations and to clarify the involved mechanism. If possible, they should be also useful in identifying which subgroups of subjects are most prone to air pollution exposure in order to implement public health strategies and preventive efforts against the dangerous effects of air pollution

Air pollution effects in pregnancy

Greater diffusion of industries and vehicular traffic caused a major impairment of air quality especially in urban areas. The adverse impact on respiratory and cardiovascular systems and the association with lung cancer have been highlighted in several reports. Furthermore, recent evidences highlighted air pollution as a risk factor for the development of type 2 diabetes. It is well known that children, elderly, and pregnant women are more vulnerable to the effects of air pollution. Embryos and fetuses are particularly subject to damage from air pollutants given the susceptibility of developing organs. Consistent data from different continents have demonstrated an increased risk of negative gestational outcomes in mothers exposed to air pollution. In particular, air pollutants have been associated with several adverse birth outcomes such as preterm delivery and low birth weight. However, from available data it is not clear whether the effects are due to a specific pollutant or to the interactions of different molecules, and it is still not clear in which trimester the exposure is more harmful to the fetal development. The exact mechanism of maternal air pollution exposure on adverse birth outcomes is still partially unknown, but some authors hypothesized that oxidative stress, inflammation, and hemodynamic changes associated with air pollutants can impair oxygen and nutrient transport to the fetus. Despite an ever-growing volume of studies, scientific literature regarding this topic is still characterized by enormous heterogeneity in designs and settings leading to several inconclusive results. Further research is therefore needed to identify molecules and mechanism through which air pollution can impair gestational outcomes. These data could lead to implementation of prevention politics and help health-care providers to give useful and more detailed information to mothers

Update on male hormonal contraception

Despite increases in female contraceptive options, 40–45% of pregnancies across the world are still unplanned. While several effective female contraceptive methods have been developed, contraceptive choices for men are still limited to the male condom with its high failure rates and to vasectomies, which are invasive and not reliably reversible. Several studies have demonstrated a great interest among men and women for effective, reversible, and safe male contraceptive methods. Over the years, numerous studies have been performed to develop male hormonal and nonhormonal safe and effective contraceptives. A variety of new molecules are under development as oral or transdermal hormonal contraceptives for men demonstrating few side effects. In our overpopulated world, the development and commercialization of a male contraceptive method that will allow both men and women to take an active role in family planning is mandatory and further research on this topic is required

Therapy with Anti-androgens in Gender Dysphoric Natal Males

In adult gender dysphoric natal males, where full development of male secondary sexual characteristics has already taken place, the goal of cross-sex hormonal therapy is the suppression of testosterone secretion to achieve regression of male characteristics and the development of feminine secondary sexual characteristics. For this reason, in transwomen an almost complete suppression of endogenous androgen production and action with combined administration of estrogens is required. The aim of therapy is to maintain hormone levels within the normal physiological range for the individual\u2019s desired gender. Practice guidelines describe eligibility for puberty suppression in adolescents that have met the criteria for gender dysphoria and that have experienced at least Tanner stage 2 puberty. In these subjects if dysphoria persists, cross-hormonal therapy is generally started after 16 years of age

Advances in male hormonal contraception

Contraception is a basic human right for its role on health, quality of life and wellbeing of the woman and of the society as a whole. Since the introduction of female hormonal contraception the responsibility of family planning has always been with women. Currently there are only a few contraceptive methods available for men, but recently, men have become more interested in supporting their partners actively. Over the last few decades different trials have been performed providing important advances in the development of a safe and effective hormonal contraceptive for men. This paper summarizes some of the most recent trials

Multi-input deep Neural Networks to Estimate Population from Satellite Imagery

Knowing the number and the distribution of the inhabitants on a territory, is a fundamental and necessary aspect to manage a community. The birth and mortality, employment and aging indices, calculated in relation to the population, not only have statistical or demographic value, but also make it possible to guide investments, support for employment and incentive plans for businesses. This is how census proves useful to a government and public administration in the development of a country’s economic policy. Some well-developed countries use administrative data for population estimation, or a combination of these and sample surveys. In many countries in the world, however, the census is still carried out using the traditional method of collecting data directly from the population, asked to fill in a paper or via e-mail questionnaire. Censuses of this kind require a lot of time and considerable economic resources and are therefore uncommon and often inaccurate, especially in remote and hard-to-reach areas or zona where there is a lack of institutions/organisations coordinating all the procedures. Moreover, population mapping is generally entrusted to municipalities which can carry out surveys at different times, hence introducing space-temporal heterogeneity and bias. The rapid development of the IT sector and the increasing availability of big data have led many researchers to experiment with new techniques for population estimation. In particular, the deep learning and the convolutional neural networks (CNN) could allow to obtain homogeneous population estimates without high costs, in a short time and with a good accuracy using also unstructured data, in particular satellite images, easily downloadable from the web. This article shows the results of a research conducted in two phases. In the first phase a CNN architecture Inception-ResNet-v2 has been used to provide population estimates at county and sub county level. The model converts satellite images into population density estimates. The neural network was trained using satellite images remotely sensed by Sentinel-2 in the years 2015-2016 and related to Lazio (Italy), with dimensions of 2km × 2km and a resolution of 10m. The model was first tested on the provinces of Naples and Grosseto, and subsequently on portions of the territory of Lazio. Population data provided by the National Institute of Statistics during the last ten-year census of 2011 were used to construct the target variable of the dataset and validate the results obtained. The time discrepancy between the population values and the images they refer to cannot be bridged, as the last available Istat data is, as mentioned, 2011 and Sentinel-2 was launched for the first time in June 2015. Therefore, the gap will have to be considered in the final estimates. Both regression and classification tasks were performed. In an attempt to improve these results, the use of multi-input neural networks was tested in the second phase of this research to analyse data of different nature (numeric / categorical variables, images, texts, etc.) jointly. A multi-input neural network merges in a single solution the architectures used to handle satellite images as CNN and architectures for the processing of auxiliary tabular data such as the Multi Layer Perceptron. As auxiliary information, it was deemed useful to help the network recognise the different uses to which the buildings in the images were destined. One way to obtain this information is to consider a land cover map, the Corine Land Cover (CLC). Using the map, it is possible to quantify the amount of land, in percentage terms, within each tile occupied by: built-up "Urban" type, which includes all types of residential buildings, more general "Artificial surfaces", "Agricultural areas", "Forests and semi-natural areas" and "Swamplands and Waterbodies". We created a dataset of Region of Lazio, the Province of Naples and the Province of Grosseto, with satellite tiles and CLC class percentages. Multi-input networks implemented showed a fair improvement in performance respect the first phase. In particular, it provided good results on the Grosseto dataset, while the estimates obtained on the Naples test data were still not satisfactory. The neural network showed difficulties in making correct estimates for tiles with high population density, above about 20.000 inhabitants. Focusing on the results obtained with the best performing network, it was noted that the data from Lazio and Naples, images with very similar characteristics, had very different target values: given the same number of buildings, the number of residents in Naples is much higher than in the Lazio region. This points out how this network is unable to capture the different population density that characterizes the data. We therefore sought to improve network performance by providing input information that could help the network capture the different population density. This new neural network has improved the previous ones, showing a strong generalization capacity. These studies have therefore shown that the goal of providing a tool capable of supporting the population census, exploiting now easily accessible data, such as satellite images, can be achieved. Obviously, it is essential to train the networks on a dataset that is as representative as possible. The use of auxiliary information has proved to be very useful, in fact satellite images alone can induce the network to make incorrect predictions, as the network can determine the presence of inhabited centers but is not able to distinguish the corresponding population density