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Vulvar vaginal atrophy is a common condition affecting postmenopausal women, significantly impacting their quality of life. Fortunately, various treatment options are available, ranging from hormonal to non-hormonal therapies. Ospemifene has emerged as a promising non-hormonal alternative for managing vulvar vaginal atrophy. Its targeted approach, unique mechanism of action, favorable safety profile particularly for breast tissue, and efficacy make it a valuable option for women seeking relief from symptoms such as vaginal pain, dryness and dyspareunia and cannot receive estrogen supplementations. This is particularly the case for breast cancer survivors or women with a significant family history of estrogen-dependent cancers. Hence, tailored treatment plans, considering individual preferences and health circumstances, are essential in optimizing outcomes and improving the overall well-being of affected individuals.

BackgroundSpondyloarthropathies (SpA) are chronic inflammatory arthritis, characterized by both peripheral and axial skeletal involvement and some typical extra-articular marks; they tend to associate with several comorbidities and can increase the risk of an impaired quality of life (QoL). Already published data show SpA expression differs based on gender; in particular, women are at higher risk of a more pronounced peripheral disease activity and show a greater burden of the disease, thus having worse values of Patient Reported Outcomes (PROs). It is well known that a compromission in physical functioning and psychological sphere may compromise productivity of patients and subsequently increase health costs.ObjectivesThe aim of our study was to assess the differences between male and female sex in the prevalence of mood disorders, fatigue and parameters of QoL in a monocentric cohort of patients with SpA.MethodsAdult patients diagnosed with Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) according to the CASPAR (ClASsification criteria for Psoriatic Arthritis) and to Assessment of SpondyloArthritis international Society (ASAS) criteria, regularly followed at the SpA clinic of our unit, were consecutively enrolled from April to December 2022. Epidemiologic, clinic and clinimetric data were collected. Each patient filled in the following Patient Reported Outcomes: Hospital Anxiety and Depression Scale (HADS), FACIT-Fatigue (FACIT-F) and SHORT-FORM 36 (SF-36). Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values <0.05 were considered significant.ResultsA total of 200 patients were enrolled; 85 (42.5%) were women, with a mean age of 56.84±12.22 years and a mean disease duration of 12.91±10.3 years. One hundred and thirty-five patients (67.5%) had a diagnosis of PsA (M/F 79/56), while 59 (29.5%) had a diagnosis of AS (M/F 36/23) and 6 (3%) of Enteropathic Arthritis (M/F 0/6). Women showed worse FACIT-F values than men, (mean 35.20 vs 40.23, p-value 0.002) and a greater impairment of QoL expressed by statistically significant lower values of almost all the domains of SF-36 (exception for Global Health). Moreover, the values of HADS resulted higher in female sex both for the anxiety and depression domains (p-value <0.001 and 0.039 respectively).ConclusionThe analysis of our cohort confirmed that women affected by SpA suffer from anxiety and depression more often than men, develop a higher level of fatigue and have an overall worse QoL in both psychological and physical domains. These data should sensitize rheumatologists in the assessment of this subgroup of patients. The clinician should not only focus on the disease activity evaluation and therapy or in managing of the comorbidities, but also on the psychological and functional status of the patients, developing strategies able to avoid or delay the onset of their impairment in daily life and to optimize with specific therapies, rehabilitation or psychological support their compromission, when already established. This approach could finally improve the social burden and health cost of women with SpA.Figure 1.References[1]Wright GC, Kaine J, Deodhar A. Understanding differences between men and women with axial spondyloarthritis. Semin Arthritis Rheum. 2020 Aug;50(4):687-694. doi: 10.1016/j.semarthrit.2020.05.005. Epub 2020 May 25. PMID: 32521322.[2]Swinnen TW, Westhovens R, Dankaerts W, de Vlam K. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther. 2018 Jul 27;20(1):156. doi: 10.1186/s13075-018-1626-8. PMID: 30053895; PMCID: PMC6062924.AcknowledgementsTo all the dear collegues I work with.Disclosure of InterestsNone Declared.

Spondyloarthritis (SpA) are a group of systemic autoimmune diseases, mainly affecting musculoskeletal system, with typical axial or peripheral forms. Recent data from the literature show significant differences in SpA subsets, levels of disease activity, drug efficacy and quality of life between male and female sex. [1, 2] It is well known how disease activity and comorbidities could compromise physical function and quality of life of SpA patients. To describe the clinical characteristics of women with SpA in our single-centre cohort compared to men, in relation to clinical characteristics, disease activity, therapy and comorbidities. Adult patients with a diagnosis of Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA) according to CASPAR (ClASsification criteria for Psoriatic Arthritis) and to Assessment of SpondyloArthritis international Society (ASAS) criteria, regularly followed at the SpA clinic of our unit, were consecutively enrolled from April to December 2022. Their epidemiologic, clinic and clinimetric data were collected. Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values <0.05 were considered significant. A total of 200 patients were enrolled, 115 male (57.5%) and 85 female (42.5%) with comparable mean age values (M 56.13±14.48 years, F 56.84±12.22 years; p=0.508) and with a significantly shorter disease duration in women (12.9±10.3 years vs 17.05±12.08 years; p<0.001). No differences in the distribution of PsA or AxSpA based on gender were observed. Six patients had a diagnosis of enteropathic SpA; all of them were women. Taking into account the clinimetric evaluations, female patients show higher values of both Disease Activity Index for Psoriatic Arthrititis DAPSA (15.63 vs 9.40; p=0.003), Leeds Enthesitis Index (LEI) (0.46 vs 0.16; p=0.02) and Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index (0.7 vs 0.4; p=0.05). The total number of drugs [both Biological disease modifying anti-rheumatic drugs (bDMARDs) and conventional synthetic DMARDs)] taken for disease control was 4.47±2.45 for women and 3.79±2.07 for men (p=0.012); no differences were observed between the 2 groups for any specific drug. Among the comorbidities, none of them was more prevalent in men, while osteoporosis (OP) (p=0,006), mood disorders (0,009), fibromyalgia (FM) (p<0,000015), osteoarthritis (OA) (0,007) and thyroid disease (p<0,000015) were significantly more frequent in women. Women of our cohort show a significantly higher risk of developing an inflammatory bowel disease than men. Female patients have also higher levels of peripheral disease activity, both on joints and enthesis; moreover, they show a significantly lower persistence in drug therapy. Besides, they have a more complex disease, suffering more frequently of OP, OA, FM and thyroid diseases than men. Finally, it is very interesting to note how women tend to develop a much more complex disease, even with a significantly shorter disease duration than male patients. These data confirm how rheumatologists should focus on the assessment of women with SpA, aiming at promoting a closer monitoring of gastrointestinal symptoms, peripheral arthritis and enthesitis and at preventing the development of comorbid conditions, thus optimizing also their quality of life and physical functioning. [1]Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford). 2020 Oct 1;59(Suppl4):iv38-iv46. doi: 10.1093/rheumatology/keaa543. PMID: 33053194; PMCID: PMC7566372. [2]Duruöz MT, Gezer HH, Nas K, Kiliç E, Sargin B, Kasman SA et al, Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study. Joint Bone Spine. 2021 Jul;88(4):105177. doi: 10.1016/j.jbspin.2021.105177. Epub 2021 Mar 23. PMID: 33771757. NIL. None Declared.

Introduction Pleural infection is a significant global healthcare challenge. While medical thoracoscopy (MT) is well-established for undiagnosed or malignant pleural effusion, its effectiveness in management of pleural infection lacks robust evidence. Moreover, data on the optimal timing of intervention in pleural infection are still scarce.  Objective To assess the probability of subsequent surgical referral in adult hospitalized patients with stage 2-3 pleural infection/empyema according to type and time of first procedures accounting for confounders. Methods We conducted a multi-centre observational study. We retrospectively collected baseline demographic and clinical characteristics, RAPID score, type and time of first-line intervention. We evaluated their impact on probability of surgical referral, length of hospital stay (LOS) and 90-day mortality using multivariable logistic/multiple quantile regression models. Results We included 509 patients from 14 Italian centres (75.4% male, median (interquartile range) age 63 (49-76) years). Thoracentesis and chest tube placement were associated with a significant higher probability of subsequent surgical referral compared to MT (OR 6.0, 95% CI 1.8-20.6, p=0.004; OR 7.8, 95% CI 2.6-22.5, p<0.001, respectively). Additionally, chest drain insertion and upfront surgery were related to a longer LOS compared to MT (Regression Coefficient Estimates: 4.9; 95% CI 1.5-8.4; 5.2; 95% CI 1.0-9.5, respectively). Furthermore, a delayed intervention, regardless of type, resulted in a longer LOS. Conclusion Our large real-world study provides valuable insights into management and outcomes of pleural infection, revealing different approaches among centres and suggesting that a timely MT, when adopted as first-line intervention, could reduce the probability of subsequent surgical referral, However, further prospective studies are required to confirm these findings.

Background and Purpose. People with balance disorders are characterized as having difficulty with transitional movements, such as the sit-to-stand movement. A valid and feasible tool is needed to help clinicians quantify the ability of people with balance disorders to perform transitional movements. The purpose of this study was to describe the concurrent and discriminative validity of data obtained with the Five-Times-Sit-to-Stand Test (FTSST). The FTSST was compared with the Activities-specific Balance Confidence Scale (ABC) and the Dynamic Gait Index (DGI). Subjects and Methods. Eighty-one subjects without balance disorders and 93 subjects with balance disorders were recruited for the study. Each subject was asked to stand from a 43-cm-high chair 5 times as quickly as possible. The ABC and DGI scores were recorded. Results. Subjects with balance disorders performed the FTSST more slowly than subjects without balance disorders. Discriminant analysis demonstrated that the FTSST correctly identified 65% of subjects with balance dysfunction, the ABC identified 80%, and the DGI identified 78%. The ability of the FTSST to identify subjects with balance dysfunction was better for subjects younger than 60 years of age (81%). Discussion and Conclusion. The FTSST displays discriminative and concurrent validity properties that make this test potentially useful in clinical decision making, although overall the ABC and the DGI are better than the FTSST at discriminating between subjects with and subjects without balance disorders.

Background and Purpose. The Functional Gait Assessment (FGA) is a 10-item gait assessment based on the Dynamic Gait Index. The purpose of this study was to evaluate the reliability, internal consistency, and validity of data obtained with the FGA when used with people with vestibular disorders. Subjects. Seven physical therapists from various practice settings, 3 physical therapist students, and 6 patients with vestibular disorders volunteered to participate. Methods. All raters were given 10 minutes to review the instructions, the test items, and the grading criteria for the FGA. The 10 raters concurrently rated the performance of the 6 patients on the FGA. Patients completed the FGA twice, with an hour's rest between sessions. Reliability of total FGA scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the FGA was assessed using the Cronbach alpha and confirmatory factor analysis. Concurrent validity was assessed using the correlation of the FGA scores with balance and gait measurements. Results. Intraclass correlation coefficients of .86 and .74 were found for interrater and intrarater reliability of the total FGA scores. Internal consistency of the FGA scores was .79. Spearman rank order correlation coefficients of the FGA scores with balance measurements ranged from .11 to .67. Discussion and Conclusion. The FGA demonstrates what we believe is acceptable reliability, internal consistency, and concurrent validity with other balance measures used for patients with vestibular disorders.

Background The Covid-19 pandemic has had a recognised impact in widening health inequalities, both between and within countries, with a major impact on socially disadvantaged population groups such as Migrants and Ethnic Minorities (MEMs). While there is growing evidence on the matter worldwide, data specific to the WHO European Region is scarce. The issue, however, is pressing, since it is estimated that almost 10% of the population living in the WHO European Region is made up of migrants. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. Methods We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Fourteen researchers were involved in selection, study quality assessment, data extraction and analysis. Results Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. 82% of the studies were conducted in the UK. Conclusions These findings highlight the disproportionate impact of Covid-19 on MEMs population, with an increased risk of all the adverse outcomes taken into consideration. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policy-makers to consider the socio-economic barriers when designing health promotion plans. Key messages • The combination of disadvantage socioeconomic conditions with COVID-19 transmission characteristics put migrants and ethnic minorities at a higher risk of facing sever health outcomes. • The amount of evidence on the inequal impact of COVID-19 on migrants and ethnic minorities produced by European countries is poor. This gap must be filled to develop effective health promotion plans.

BackgroundApproximately 1.3 million women living with HIV (WLWH) become pregnant each year. Despite advancements in antiretroviral therapy (ART) there remains a paucity of data on the efficacy and safety of ART in pregnancy and birth outcomes.Material and MethodsThis is a retrospective case record analysis of 31 WLWH delivering 33 pregnancies between 2019 and 2023, followed at San Paolo Hospital, Milan. Effect of use of ART during pregnancy, preterm birth (PTB), intrauterine growth restriction (IUGR) and birth outcomes, were analysed. Data were retrieved from medical records and presented descriptively.ResultsThe median age of the women was 36 years (IQR 33;38). Among 33 pregnancies, 7(21%) occurred in newly diagnosed HIV women, while 26(79%) occurred in women in active follow-up. 5(71%) of newly diagnosed women initiated ART during the first trimester, with all regimens being INSTI-based. In experienced patients, at the time of discovering the pregnancy, 16(61%) were on an INSTI-based regimen, 6(24%) were on therapy with PI, and 4 (15%) were on NNRTI therapy. 6 patients (23%) changed their ART regimen to an INSTI-based therapy (table 1). Viremia was undetectable at delivery in all patients except one who was non-adherent to therapy (HIV-RNA 69 copies/mL). Both treatment-naive and experienced patients began pregnancy with favorable CD4 counts (median CD4+ 676 cells/uL, IQR 476;778) that remained stable throughout gestation. In most patients, pregnancy occurred spontaneously, with only 1 patient resorting to assisted reproductive technology (ART). Regarding pregnancy outcome, 22(67%) of the patients delivered. In the remaining cases, pregnancy resulted in an abortion, a voluntary termination and 4 patients (12%) were lost to follow-up. 91% of the newborns were delivered at term. 13(59%) patients had a vaginal delivery and 9(41%) had a cesarean section: only in one case the indication for cesarean section was due to detectable viremia. At the third-trimester ultrasound, 91% of the babies had a EFW (estimated fetal weight) percentile above the 50th (median 55th percentile, IQR 50;70). Regarding the newborns, 99% had a normal birth weight with a median birth weight of 3230 g (IQR 2973;3485). All newborn received ZDV prophylaxis for 6 weeks and no one was breastfed. All newborns tested negative for HIV-RNA.ConclusionIn our cohort, all women except one achieved undetectable viremia prior to delivery, and no adverse birth outcomes such as low birth weight or preterm delivery were observed. However, a relatively high proportion of women (all foreigners) was lost to follow-up, underscoring the importance of monitoring and support for the optimization of care in WLWH during pregnancy and beyond. Viral suppression should be prioritized in all pregnant women with HIV to prevent both vertical transmission and adverse birth outcome.Abstract P-53 Table 1Demographic profile and ART regimen in pregnant WLHW

This paper presents an overview of the recent developments of modifier-adaptation schemes for real-time optimization of uncertain processes. These schemes have the ability to reach plant optimality upon convergence despite the presence of structural plant-model mismatch. Modifier Adaptation has its origins in the technique of Integrated System Optimization and Parameter Estimation, but differs in the definition of the modifiers and in the fact that no parameter estimation is required. This paper reviews the fundamentals of Modifier Adaptation and provides an overview of several variants and extensions. Furthermore, the paper discusses different methods for estimating the required gradients (or modifiers) from noisy measurements. We also give an overview of the application studies available in the literature. Finally, the paper briefly discusses open issues so as to promote future research in this area.

In urban areas, the “built” is defined by many different elements. Not only buildings but also open spaces containing green areas, viability, urban furniture, underground facilities. While the H-BIM sector focuses, rightly, on buildings of great historical significance, in our case it is been consider a part of the built that it usually not analyse: the urban open space. One of the interesting themes is the possibility of having a single tool that integrates the different objects present in a complex environment such as the urban area. The process with BIM model could allow a huge saving in terms of time and costs considering public tender, maintenance or construction phase of a project. Facility management operating through BIM is another relevant theme considering the whole life of a construction. Finally, another important theme is the connections between elements above the ground (visible elements) and subsoil (not visible elements), not only for the administrations but also if related to the HBIM environment.The paper reports the analysis of the experience performed, particularly related to questions about detail and accuracy of the BIM model.A methodology for modelling open spaces is been assuming, it is described possible improvements and considerations on the result.