Abstract

Background
Italy’s Inner Areas are rural and remote regions characterized by low population density and limited access to essential services such as transport, healthcare, and education. These structural disadvantages contribute to persistent inequalities in educational attainment, making it more difficult for students to complete their studies and access higher education.

Methods
This study investigates the transition from upper secondary school to university by focusing on three key dropout points: (R1) dropping out during upper secondary education, (R2) not enrolling in university after graduation, and (R3) dropping out during the first year of university. High schools are grouped into administrative districts, which are classified according to their accessibility to universities using a travel-time index based on average public transport times, weighted by student flows. Districts are categorized as local (≤45 minutes), commuter (45–90 minutes), or out of town (>90 minutes).

Statistical Analysis
Log-linear models are employed to explore the relationships between the three dropout indicators, district accessibility, and a range of individual and socio-economic factors. This approach allows for the identification of spatial and social patterns that affect students’ educational trajectories.

Conclusions
The results aim to inform education and territorial policies by identifying areas where students face greater risks of educational exclusion. Interventions such as improved transport connections, expanded digital learning opportunities, and targeted financial support could help mitigate these challenges. Ultimately, the study contributes to reducing territorial disparities and promoting equal access to higher education across the country.

Robotic exoskeletons hold significant potential in motor rehabilitation by supporting the recovery of impaired functions. A critical factor for their effectiveness is the degree of embodiment, that is, the extent to which the device is integrated into the user's body and central nervous system. Current embodiment assessments primarily rely on subjective questionnaires, limiting their reliability. This study aimed to identify objective neurophysiological markers of exoskeleton embodiment by investigating sensory attenuation, a phenomenon in which self-generated stimuli are perceived as less intense than externally generated ones. Twenty-one able-bodied participants completed two experimental conditions: with and without the ALICE lower-limb exoskeleton. In each, electrical stimulation of the median nerve was either self-induced via a foot pedal or applied externally by the experimenter. Somatosensory evoked potentials (SSEPs) were recorded using 64-channel electroencephalography (EEG). Results showed a reduction in N60 amplitude during self-stimulation compared to external stimulation in both conditions, consistent with sensory attenuation. However, N60 amplitudes were higher when participants wore the exoskeleton, suggesting reduced predictive processing and a lower sense of embodiment. Additionally, a pronounced N100 component was observed during externally applied stimuli, likely reflecting attentional engagement. These findings suggest that the N60 and N100 components can serve as neurophysiological markers of embodiment and cognitive effort. Integrating these markers into evaluation protocols may inform the design of exoskeletons that are more seamlessly integrated with users, ultimately enhancing user acceptance

Background

Chronic kidney disease (CKD) is considered a model of accelerated aging. Systemic inflammation, oxidative stress, and vascular changes during CKD cause blood-brain barrier impairment, which in turn, induces brain damage and neurodegeneration. In Italy, an estimated 4.5 million patients are in the intermediate or advanced stages of the disease.

Pro-inflammatory cytokines can activate the kynurenine pathway (KP), causing the depletion of tryptophan (Trp) for serotonin synthesis. Neuroactive metabolites generated in KP such as kynurenine (KYN), quinolinic acid (QA) and picolinic acid (PA), contribute to CKD progression and cognitive dysfunction.

In addition, we evaluated two proteins correlated to cognitive decline and neurodegeneration, such as neurogranin (Neu) and α-sinucleine (α-Syn). Neu is a postsynaptic protein widely expressed in the dendritic spines of the associative cortex of the brain and is correlated with Alzheimer's disease. It plays a significant role in memory and learning through calcium/calmodulin signalling and is involved in synaptic plasticity and long-term potentiation. α-Syn is a small, highly charged protein predominantly expressed in neurons of the central nervous system. Although its physiological function remained unclear, α-Syn is implicated in movement disorders such as Parkinson’s disease, multiple system atrophy, and in neurodegenerative diseases.

The growing need for screening tests aimed at the early diagnosis of different types of diseases has prompted the international scientific community to search for and identify possible biomarkers of renal failure and cognitive decline.

Methods

In this observational study, 20 patients with two different stages of CKD (G2-G3 n=10; G5, End-Stage Renal Disease (ESRD), n=10) with a Mini-Mental State Examination score lower than 24 and 6 healthy subjects were enrolled. Urine and serum samples were collected. Serum levels of KYN, QA, Trp, Neu and α-Syn were assessed by ELISA, while PA levels were analysed in urine samples.

Results

In the clinical setting, ESRD patients showed elevated KYN/Trp ratio (p<0.0001), QA (p<0.0001) and Neu (p<0.05) values compared to the control group. In contrast, no differences were observed between G2-G3 patients and the healthy subjects. Furthermore, PA and α-Syn did not show significant variations compared to the control group.

Conclusions

These results highlight the complex relationship between serum levels of Trp and its metabolites with inflammation and cognitive decline in the context of CKD, and a potential role of Trp and its metabolites as early biomarkers for the diagnosis of mild cognitive decline. These findings suggest that KP may govern the complex interaction between kidney disease and neurological disorders.

The analyzed pathway is strongly implicated in CKD-associated mild cognitive impairment, as demonstrated by the reduction of Trp and the increase of QA in serum.

Orthostatic hypotension (OH) is a common condition among older adults, with a prevalence of around 20% , associated with adverse outcomes such as falls and hospitalization. Polypharmacy, commonly observed in late life due to multiple comorbidities, may increase the risk of adverse drug reactions and play a role in the onset of OH.

This study aimed to investigate the association between polypharmacy and the presence of OH in hospitalized older adults.

332 individuals aged 65 years or older, able to stand autonomously, were enrolled. Oncereached clinical stability, patients underwent a Comprehensive Geriatric Assessment (CGA), that included OH testing according to current standards. Patients were stratified in two groups based on the presence of OH which were homogeneous for the main demographic and clinical features.

Patients with OH had a significantly higher mean number of active medications (8.2±3.2) compared to those without OH ( 6.7±3.0; p<0.01) while the number of antihypertensive medications did not differ significantly. Logistic regression analysis confirmed that OH was significantly associated with the total number of chronic medications (p<0.01) while no significant interaction was found with age, sex, or number of antihypertensives.

Our findings suggest that polypharmacotherapy is independently associated with OH in hospitalized older adults. This may suggest that potential pharmacological interactions find in age-associated clinical complexity, such as chronic low-grade inflammation and impaired autonomic regulation, a driver to develop OH.

Background and Aims: Fabry Disease (FD) is a rare X-linked lysosomal storage disorder caused by mutations in the GLA gene, which encodes the enzyme α-galactosidase. The accumulation of globotriaosylceramide (Gb3) in various tissues and organs underlies the clinical manifestations of the disease, which range from muscular involvement to renal, peripheral nervous system, and cardiac dysfunction. Due to its X-linked inheritance, disease manifestations tend to be more severe in males, whereas females, owing to X-chromosome lyonization, generally present with milder forms. Patients with FD report a wide array of symptoms related to Gb3 accumulation in multiple organs and tissues, with fatigue and asthenia among the most frequently reported. In this study, we aimed to assess the role of cardiopulmonary exercise testing (CPET) in adult patients with Fabry Disease, to better characterize the pathophysiological profile of this patient population.

Results: From March 2024 to February 2025, we enrolled 63 patients with FD (mean age 44 ± 14 years, 68% female), 54% of whom were receiving enzyme replacement therapy. To better assess the impact of mutation severity on CPET parameters, we divided the population by sex, considering that men usually exhibit more severe forms of the disease than women. Men had longer exercise durations but achieved lower workloads relative to predicted values, both at the anaerobic threshold and at peak exercise. Additionally, their tests were often submaximal in terms of the percentage of maximum heart rate (HR) reached. Moreover, male patients showed lower VO₂/kg values at both the anaerobic threshold and peak exercise compared to female patients. Although not statistically significant, a trend was observed for carbon dioxide (CO₂) production, which tended to be higher in men than in women, both at the threshold and at peak effort. We then decided to assess the impact of cardiac involvement on CPET parameters, and thus the role played by cardiac impairment as a limiting factor for exercise capacity in these patients. Patients were divided based on the presence or absence of cardiac hypertrophy. Patients with cardiac hypertrophy tend to be older and are more frequently treated with beta-blockers and/or ARBs.

In terms of CPET parameters, no significant differences were observed, except for a lower peak heart rate, consistent with the prescribed pharmacological treatments.

Conclusions: The results of our study clearly indicate that the heart is not the primary determinant of the fatiguecharacterizing Fabry patients. The fact that even patients without cardiac hypertrophy exhibit a marked reduction in exercise capacity, with lower workloads achieved compared to predicted values, suggests that the main cause of this asthenia is related to skeletal muscle involvement. Here, the accumulation of Gb3 leads to a progressive decline in muscle contractile capacity, resulting in reduced exercise tolerance and the early onset of fatigue.

Promoting healthy lives and well-being of people is a key priority of the European social agenda, aligned with SDG 3. This goal has gained urgency in light of serious demographic shifts and the rapid ageing of populations across Europe. Research shows that poor work-life balance (WLB), the inability to effectively manage the professional and personal life, is associated with negative health outcomes and reduced well-being. While the literature has explored multiple determinants of WLB, there is a notable gap in studies focused on older workers, particularly in the context of retirement transitions.

This study addresses that gap by building on findings from a previous survey of Italian workers aged 55 and over, which explored how family expectations, social capital, and work-life balance influence retirement intentions. Drawing from these insights, the current study adopts a hybrid methodological approach to identify and predict the main drivers of WLB dissatisfaction in the same demographic. The analysis combines techniques to identify significant predictors with the development of an artificial neural network (ANN) to capture complex, non-linear patterns affecting WLB.

As a practical outcome, we introduce a digital application that classifies users into levels of WLB dissatisfaction based on their responses and highlights the key contributing factors. This tool aims to support data-informed interventions to improve well-being and facilitate retirement readiness.

The findings emphasize the importance of gathering targeted data on ageing workers and fostering coordinated action among policymakers and stakeholders to design responsive, evidence-based social policies that enhance individual well-being and optimize welfare systems.

Bone Marrow Adipose Tissue (BMAT) is a specialized fat depot within the bone marrow, composed of adipocytes, hematopoietic and mesenchymal stromal cells, and osteoblasts. Unlike white and brown adipose tissue, BMAT actively contributes to the bone microenvironment, influencing haematopoiesis and bone metabolism through endocrine signals, particularly adipokines like adiponectin. Alterations in BMAT volume and function are associated with age-related diseases such as osteoporosis, osteoarthritis, obesity, and type 2 diabetes. Aging is also linked to chronic low-grade metabolic acidosis, a persistent decrease in systemic pH that leads to lower bone mineral density and increased fracture risk. This acidic environment may also disrupt the bone marrow niche, affecting the balance between adipogenesis and osteogenesis and contributing to osteoporosis.

This study investigates how acidic extracellular pH (6.8), mimicking the aging bone marrow environment, impacts adipogenic differentiation and viability of bone marrow-derived mesenchymal stromal cells (BM-MSC). Using 2D differentiation protocols and Oil Red O staining, we observed that acidic pH significantly impairs adipogenic differentiation, as indicated by reduced lipid accumulation. In contrast, fully differentiated adipocytes were not affected in terms of viability but exhibited increased cell volume, resembling pathological BMAT expansion seen in osteoporotic conditions.

In conclusion, acidic pH hinders early adipogenic commitment of BM-MSC, while mature adipocytes remain viable and undergo phenotypic changes associated with bone fragility. These findings suggest a role for age-related acidosis in BMAT remodelling and osteoporosis progression. Future studies will focus on paracrine interactions between BMAT adipocytes and osteogenic cells under acidic conditions to further elucidate bone aging mechanisms.

Ageing is characterized by rigidity of chest walls, alveolar enlargement and alternations in the elasticity of the lungs and, consequently, in a reduction in vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in 1st second (FEV1). Moreover, age-related decline of pulmonary function has been associated with sarcopenia of the diaphragm. In this study we aimed to provide an insight into the association between muscle strength and z score of FVC, FEV1. In addition, we explored whether z scores of FVC and FEV1 are useful in the identification of sarcopenia evaluated by Handgrip strength (HGS). The study population was 398 subjects, mean age 42.98 ± 22.0 years, range 18-89 years, 162 (40%) females. Based on HGS measurements, probable sarcopenia was present in 71 subjects (17.83%). When compared with no sarcopenia group, patients with probable sarcopenia were older (p≤0.00001), more frequently females (p≤0.0001), with higher BMI (p=0.049) and more frequently presented with comorbidities such as hypertension, dyslipidemia, diabetes. Spirometry parameters such as FEV1, FVC, FEV1/FVC, z FEV1, z FVC were significantly lower in the probable sarcopenia group (p<0.001). Multivariable regression analysis adjusted for confounders such as age, gender, height, comorbidities and physical activity revealed that FEV1 and FVC were significantly and independently associated with HGS. In conclusion, FEV1, FVC and z scores have a positive association with muscle strength. FEV1 has a better performance in the identification of sarcopenia, a very prevalent condition in the elderly population.

Introduction: previous studies reported a close relationship between gait and cognitive performances in adults with Mild Cognitive Impairment or Dementia. However, to date, literature data concerning the association between gait parameters and cognitive performance in cognitively unimpaired adults are still scares. The aim of this study was to evaluate possible correlations between cognitive performance and gait parameters in individuals aged>50 years. Methods: This is a preliminary analysis of the “Instrumental Pattern of Cognitive Decline: a data-driven approach. DataCOG Study”. The DataCOG Study aims to enroll adults aged >50 years without psychiatric, neurological, ophthalmological or otorhinological disorders in order to assess possible correlations between cognitive performance and instrumental parameters such as gait analysis, audiometry, and eye movements. In the present preliminary analysis, we analyzed possible associations between gait analysis. Gait analysis was evaluated with the Timed Up and Go Test, performed with IMU. Cognitive performances were assessed with the computerized version of the Esame Neuropsicologico Breve 3 “ENB-3”. Results: Fifty-four participants (19 males, 35 females, mean age 64.0±7.8 years, mean education 14.2±3.8 years) were enrolled. Several statistically significant positive correlations between neuropsychological parameters and TUG performance were found. Gait duration was negatively correlated with the Embedded Figures Test (r = -0.374, p = 0.006), while Angular Speed was positively correlated with Embedded Figures Test (r =0.339, p=0.015) and the Episodic Memory (r = 0.300, p = 0.032). Conclusions: The present study supported the link between gait and cognition not only in patients with cognitive decline but also in individuals cognitively unimpaired.

Hand impairments caused by stroke, spinal cord injury, or muscular dystrophy often limit independence in activities of daily living. Recent developments in soft robotics offer more wearable alternatives but often lack adaptability across patients. This work introduces a hybrid prosthesis–exoskeleton system with a modular design. A wrist-mounted universal base integrates sensors, electronics, and a Twisted String Actuators (TSAs) to drive finger motion. Customizable finger modules are modeled in soft silicone and connected with tendon-driven system to the base, enabling rapid personalization based on the user’s anatomy or clinical condition. Tendons routed through internal guides allow controlled bidirectional motion, with tunable actuation parameters. Its combination of soft materials, modularity, and TSA-based actuation makes it suitable for both assistive and rehabilitative use, even outside clinical environments.

In the face of an ageing population and a country like ours in demographic decline, the lengthening of working life represents one of the most important challenges for policy makers and national governments.

Therefore, in order to address the implications of demographic transition and its impact on employment, national policies need to prepare the labour market and adapt traditional work structures to the needs of older workers, in order to promote a prolonged productive contribution and meet the objectives of sustainable development of employment.

In this perspective, the paper focuses on the profound changes taking place on the employment side, analysing the tools that company management has to guide staff’s organisational choices and affect their permanence in the labour market: training, health care, agility, flexible retirement and working hours reduction, in order to combine organizational efficiency and intergenerational sustainability.

As global populations age and life expectancy rises, pension funds face mounting pressure to adapt their investment strategies. This paper investigates how the increase in life expectancy affects the equity allocation of pension funds across 12 OECD countries from 2010 to 2022. Our findings reveal a positive and significant association between life expectancy and pension funds' equity exposure in market-oriented financial systems, due to investors' higher financial literacy, lower risk aversion and greater stock market development. This relationship is further amplified in high-yield stock market environments, while market volatility and capitalization play no role. Our results suggest that demographic changes affect pension funds' asset allocation, offering important implications for policymakers seeking to align pension reform, capital market development, and demographic trends.

This work presents the development of innovative actuators based on shape memory alloys (SMA) and the comprehensive experimental campaign for characterization and validation of SMA spring performance in rehabilitative exoskeleton applications. The research integrates systematic actuator design optimization with advanced experimental evaluation protocols, employing a MATLAB-based computational framework that incorporates thermo-mechanical modeling, parametric optimization, and application-specific design constraints. Nine distinct configurations of NiTi tensile springs were systematically characterized, featuring wire diameters ranging from 0.5 mm to 0.8 mm, outer diameters spanning 3 mm to 6 mm, and spring indices between 6.00 and 8.00, enabling the identification of optimized spring configurations specifically tailored for rehabilitative exoskeleton requirements. The experimental validation was conducted through rapid actuation testing utilizing a dedicated characterization system equipped with innovative coupling terminals manufactured from CF-Nylon polymeric materials with precision EDM-fabricated metallic inserts, designed to ensure robust mechanical coupling and enhanced resistance to dynamic operational stresses. The comprehensive testing campaign demonstrated the superior effectiveness of optimized series-parallel electrical configurations for power control, revealing significant improvements in energy efficiency and operational stability while providing quantitative performance data encompassing displacement characteristics, thermal response dynamics, and load capacity under diverse operating conditions. These experimental findings establish critical design parameters and performance benchmarks for the implementation of SMA technology-based actuators in advanced rehabilitative systems, contributing novel insights into the optimization of smart material actuators for biomedical applications.

L’invecchiamento della popolazione e il decremento delle nascite in Italia hanno un forte impatto sul mondo del lavoro.

Tale impatto si traduce innanzitutto nel progressivo innalzamento dell’età per poter avere accesso alla pensione di vecchiaia; ciò implica che oggi un lavoratore – volente o nolente – si trova a dover restare nel mercato del lavoro più a lungo rispetto al passato.

A fronte di tale situazione si pone la questione di comprendere come adeguare il mondo del lavoro e il contesto aziendale al progressivo invecchiamento della popolazione.

L’approccio tradizionale del legislatore italiano sul tema nel corso degli anni è stato quello di individuare delle misure volte ad “accompagnare” il lavoratore anziano verso la pensione nell’ultimo periodo della carriera lavorativa; trattasi quindi di un approccio basato, in un certo senso, su una prospettiva di esclusione dal mondo del lavoro del lavoratore maturo.

Alla luce del continuo e progressivo invecchiamento dei lavoratori, quale fenomeno – ormai – strutturale, la nostra ricerca si è focalizzata, invece, sulle possibili politiche di invecchiamento attivo da attuare nel contesto lavorativo, al fine di rendere il posto di lavoro più inclusivo e adatto alle esigenze della popolazione anziana, anche nell’ottica di valutare l’adeguatezza o meno rispetto a tali esigenze della legislazione italiana attualmente vigente ed eventuali prospettive di riforma.

Skeletal muscle wasting is a hallmark of cachexia, a cancer-associated syndrome that severely affects patients’ quality of life. Emerging evidence indicates that at early stages of cachexia a large transcriptional network of genes involved in mitochondrial biogenesis, dynamics, and function is down-regulated in skeletal muscle, thus leading to mitochondrial dysfunction and muscle wasting. Here, by exploiting in vitro cachexia models and male cachectic mice, we report that i) tumor-induced impairment of cAMP/PKA/CREB1 signaling in skeletal muscle contributes to the downregulation of the transcriptional network sustaining mitochondrial function; ii) boosting cAMP signaling by targeting PDE4 in vivo rescues mitochondrial-related gene expression, mitochondrial dysfunction, and mitigates muscle wasting; iii) silencing of the cAMP-hydrolyzing phosphodiesterase 4D (PDE4D), whose transcript variants are deregulated in cachectic muscle, ameliorates mitochondrial function in cachectic muscles. Collectively, we identified tumor-induced impairment of cAMP/CREB1 signaling as a driver of skeletal muscle mitochondrial dysfunction occurring during cancer cachexia.

Background: The myokine irisin has been recently identified as a neuroprotective factor against the onset and/or progression of various neurodegenerative disorders in animal models, including that of Alzheimer’s disease (AD).

Purpose: We investigated irisin levels and their association with disease biomarkers and multi-domain cognition in a cohort of AD patients.

Methods: Cerebrospinal fluid (CSF) and serum irisin were evaluated by enzyme-linked immunosorbent assay in patients with AD, mild cognitive impairment (MCI), and subjective memory complaint (SMC), characterized according to amyloid/tau/neurodegeneration classification. Irisin levels were correlated with AD biomarkers (amyloid β 1-42, hyperphosphorylated tau, and total tau), Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) and cognitive and psychometric tests scores.

Results: CSF and serum irisin were reduced in AD and MCI patients compared to SMC, with lower levels in female AD patients. CSF irisin correlated positively with amyloid β 1-42 in both female and male patients, and negatively with CDR-SOB only in females. A negative trend between CSF irisin and total tau was observed in all patients and in the female subgroup. CSF and serum irisin positively correlated with global cognitive efficiency, along with specific cognitive domains, including memory, executive function, attention, visuospatial abilities, and language.

Conclusions: Our results evidenced the relationship between irisin and AD biomarkers, especially in females, and suggested the neuroprotective effect of the myokine for multiple cognitive domains in AD patients. Therefore, irisin could be a potential biomarker of AD continuum as well as of cognitive decline in Alzheimer dementia.

Alzheimer's disease is the leading cause of dementia in industrialized countries, and is a progressive neurodegenerative condition with significant implications not only for patients but also for their caregivers, who face a complex and multidimensional care burden. The phenomenon of loneliness perceived by caregivers, often linked to social isolation, is an important determinant of vulnerability, potentially aggravated by the daily management of neuropsychiatric disorders, the chronicity of the clinical course and the lack of adequate support systems. The present study aims to explore the correlations between the perception of loneliness of caregivers and the clinical, functional and behavioral characteristics of patients affected by cognitive decline.

A cross-sectional observational study was conducted at the Geriatrics Memory Clinic of the University of Naples "Federico II". 48 patients aged ≥65 years with a diagnosis of cognitive decline of various degrees were enrolled, together with their respective caregivers. The assessment included demographic parameters, MMSE scores, Comorbidity Index (CIRS), ADL/IADL scales for functionality, and Neuropsychiatric Inventory (NPI) for neuropsychiatric symptoms. The level of loneliness perceived by the caregiver was quantified using the UCLA Loneliness Scale. Statistical analysis was performed using SPSS software.

The results showed the absence of a significant association between the caregiver's perception of loneliness and the degree of cognitive deterioration or functional impairment of the patient. On the contrary, a statistically significant correlation emerged between the UCLA scores and the presence of specific behavioral disorders on the NPI scale, in particular anxiety (ρ = 0.375; p < 0.01), agitation (ρ = 0.348; p < 0.05), and apathy (ρ = 0.360; p < 0.05). Furthermore, caregivers with an external job showed a lower perception of loneliness.

In conclusion, our data suggest that caregiver loneliness is predominantly modulated by the impact of the patient’s neuropsychiatric symptoms and the caregiver’s degree of social integration. Early identification of these factors can guide multidisciplinary interventions aimed at supporting the psychological well-being of caregivers, promoting personalized strategies and effective support networks to improve the overall quality of care.

Background. Atrial fibrillation (AF), the most common age-related cardiac arrhythmia, is linked to an elevated risk of thromboembolic events. Despite the use of guideline-recommended direct oral anticoagulants (DOACs), a significant proportion of AF patients show a residual risk of thromboembolic events, driven by mechanisms that are not fully understood.

Objective. We conducted a pilot study to characterize the platelet function in DOACs-treated AF patients, to explore whether an association between platelets and the residual thromboembolic risk exists.

Methods. Within the Age-It project of the National Recovery and Resilience Plan, we examined the platelet phenotype, reactivity and mitochondrial function using flow cytometry, and quantified 12 inflammatory cytokines of patients with permanent AF treated with DOACs and without a history of stroke (n=18, 66±13 years, 39% females), as compared to an age-, sex-, and comorbidity-matched control group, without AF (n=18, 65±11 years, 39% females).

Results. Unstimulated circulating platelets of AF patients treated with DOACs showed a low-adhesive phenotype, compared to matched controls. Upon stimulation, platelets of DOACs-treated AF were hyporeactive to ADP and PAR1 stimulation, but hyper-reactive to GPVI stimulation (adjusted p<0.01). The lower responsiveness to ADP correlated with increased plasmatic concentrations of IFN-γ (r=-0.539; p<0.05) and TNF-α (r=-0.472; p<0.05). The higher reactivity to GPVI was associated with an increased mitochondrial function, which positively correlated with TNF-α levels.

Conclusions. Individuals with AF treated with DOACs exhibit low-grade inflammation and an altered platelet reactivity, suggesting a potential mechanism behind their residual thromboembolic risk. Further well-powered studies are needed to test whether the observed platelet phenotype is implicated with the residual thromboembolic events in patients with AF treated with DOACs.

on behalf of Working Package 1 Spoke 3 AGE-IT

Human evolution has established physical activity as the fundamental means of maintaining health and physiological function throughout life. To deepen our understanding of aging and its link to physiological resilience, this study examined heat management and physiological stress responses during exercise for ten healthy adults, balanced by sex and distributed among six age ranges (20–29, 30–39, 40–49, 50–59, 60–69, 70–79 years). Participants completed a structured treadmill protocol starting with rest, followed by walking at increasing intensities corresponding to 65%, 75%, and 85% of their estimated maximal heart rate (HR_max), the eldest group was excluded from the highest intensity of HR_max for safety measures.

Thermal data was collected using three synchronized systems: (1) A FLIR A700 SC infrared camera (640 × 512 pixels = 327,680 floating-point temperature values per frame) at 30 Hz for 21 minutes, providing high-resolution spatiotemporal skin temperature mapping; (2) A greenteg AG CALERA Core Body for Research sensor recording core and localized skin temperature at 1 Hz; and (3) Skin-mounted thermocouples logging temperature at 1 Hz for direct validation. These datasets were cross validated to ensure measurement accuracy. By fusing and validating heterogeneous data streams, this approach offers potential precision in physiological thermodynamics, revealing exercise-induced thermal signatures correlated with aging. The framework supports applications in longevity prediction and personalized exercise prescription. This study highlights the role of thermodynamic modeling in understanding physiological resilience and human body thermoregulation across the age spectrum.

The incidence of cancer increases significantly with age, with the risk of cancer being 10 times higher and mortality 15 times higher in older people than in younger patients. Therapeutic choices require a personalized approach to optimize survival and quality of life and genotyping (particularly, pharmacogenetic analysis) is essential for personalizing treatments and reduce the risk of toxicity. Objective 1 of the CODIGE project focuses on conducting a comprehensive analysis of the clinical, socioeconomic, and genotypic determinants that characterize the elderly cancer population (aged over 65) compared to younger patients. An observational study design was implemented to examine these determinants. The study population includes patients with solid tumours who received treatment with a fluoropyrimidine-based chemotherapy regimen. A total of 618 patients were successfully enrolled in this component of the study, with 47% of participants under the age of 65 and 53% aged 65 years or older. Several variables were collected to facilitate a comprehensive analysis. These include demographic and socioeconomic characteristics, lifestyle factors (alcohol and smoking), clinical parameters (tumour type and stage, genotypic profile, biological parameters), existing non-oncologic comorbidities, details of the chemotherapy regimen and other oncologic treatments, as well as information on chronic non-oncologic therapies. Objective 2 of the CODIGE project focuses on a comprehensive risk assessment in elderly cancer patients compared to their younger counterparts. Specifically, this objective aims to evaluate the risk of all-cause mortality, hospital admissions, and adverse drug reactions related to both chemotherapy and chronic therapies by analysing these outcomes. The methodology used is able to examine actual clinical outcomes without intervention in relation to the sociodemographic and clinical characteristics of the study population during the natural course of disease and treatment-related events. The expected outcomes for this objective are: all-cause mortality, hospitalization, and adverse events. These outcome measures provide a comprehensive assessment of the risks associated with cancer treatment in elderly patients. The analysis of these outcomes in relation to sociodemographic and clinical characteristics will provide valuable information on the factors that predict adverse outcomes in different age groups, potentially contributing to the definition of more personalized approaches to cancer treatment in elderly

Background The sympathovagal balance reflects the proper functioning of the autonomic nervous system (ANS). One of the most widely used methods to assess this balance is Heart Rate Variability (HRV) analysis. In particular, the low frequency/high frequency (LF/HF) ratio provides a useful measure of ANS activity. Several studies have shown that HRV alterations—especially parasympathetic dysfunction under resting conditions—may be associated with prodromal stages of dementia.

Objective The aim of this study is to investigate whether variations in sympathovagal balance are associated with nutritional status, assessed using the Mini Nutritional Assessment (MNA), and cognitive function, evaluated through the Mini-Mental State Examination (MMSE) adjusted for educational level.

Materials and Methods From May 2023 to March 2024, 71 patients attending the Geriatrics Outpatient Clinics at “Federico II” University Hospital in Naples were enrolled. All participants underwent 24-hour ECG Holter monitoring and MNA assessment. A subgroup of 31 patients also completed the MMSE. Eight patients were excluded due to poor compliance with study procedures. HRV was evaluated through both time and frequency domain analyses, specifically using the standard deviation of normal-to-normal R-R intervals (SDNN) and the LF/HF ratio.

Results Of the 71 patients enrolled, 28 were female and 41 males, with a mean age of 75.16 ± 6.5 years. The mean LF/HF ratio was 2.64 ± 2.61. The average MNA score was 23.78 ± 3.77, while the average MMSE score was 24.76 ± 3.94. Non-parametric statistical analysis revealed a direct correlation between nutritional status (MNA score) and LF/HF ratio. A significant direct correlation was also found among MMSE scores, LF/HF ratio, and MNA scores.

Conclusions This study suggests that sympathovagal balance, particularly a shift toward sympathetic predominance, is positively associated with better cognitive performance and nutritional status in older adults. These findings support the potential relevance of autonomic nervous system modulation in the assessment of early cognitive and functional decline. However, due to the limited sample size, larger studies are needed to validate these preliminary observations and to better understand the underlying mechanisms.

Background

Older adults with multimorbidity are often excluded from clinical trials. Traditional disease-centered endpoints may be inadequate for this population, which presents unique challenges related to frailty, disability, and functional decline.

Objectives

To systematically review the literature to identify outcomes considered important in interventions targeting older adults with multimorbidity, based on both patient and healthcare professionals’ perspectives.

Methods

This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42023478249). We searched five electronic databases for primary quantitative and qualitative studies including patients aged ≥60 years with ≥2 chronic conditions. Outcomes were categorized into six domains. We conducted a narrative synthesis and compared outcome types across quantitative and qualitative research.

Results

Seventy-one studies were included (53 quantitative, 16 qualitative, 2 mixed-methods). The most frequently reported outcomes fell under Psychosocial outcomes / General health (69.0%), followed by Care process outcomes (52.1%) and Healthcare utilization and costs (49.3%). Qualitative studies more often addressed Mental health outcomes (43.8%). Maintaining independence, physical function, and quality of life emerged as most important outcomes for older adults.

Conclusions

In intervention studies involving older adults with multimorbidity, outcomes should move beyond disease-specific measures to include independence, physical function and quality of life. Outcome selection should account for patient heterogeneity, frailty, and life expectancy to ensure relevance and impact in this complex population.

Craft work in Italy is experiencing numerous difficulties, including the constant decrease in the overall number of artisans, and many companies complain about a difficulty in finding and attracting young people among their workforce. This is a social problem that leads to the disappearance of all the knowledge, skills and knowledge possessed by artisans. The role of artisans within the economy, society and culture of local communities is well known in literature (Sennett 2008). Custodians of traditional techniques and knowledge, they represent a point of reference for their conservation and valorization. However, little attention has been given to the theme of the transmission to the new generations of artisan "know-how" that includes knowledge, skills and abilities typical of this work. This contribution intends to fill this gap by analyzing the theme of the transmission of "Know-How" within Veneto craftsmanship.
Through 30 semi-structured interviews with Master craftsmen and apprentices working in Veneto and a statistical survey (composed of 6000 Cati interviews conducted throughout Italy) on the attitudes and behaviors of 65-year-old citizens, this research intends to analyze their representations in relation to childhood, apprenticeship and the various transformations that have allowed them to manifest the technè (Gilli 1988) or acorn (Hillman 2009), of which they are bearers, through work activity. Not recognizing and enhancing this dimension risks reducing artisan work and the transmission of its knowledge to the mere application of techniques and the "wise use of the hands", both learned through the repetition of the same gesture for a long period of time. The final objective is to identify "good practices", or possible solutions, that bring Master craftsmen and apprentices closer together, in order to facilitate the transmission of knowledge, skills and artisan knowledge.

This systematic review focuses on reducing susceptibility to online misinformation among adults, a challenge of growing relevance in the digital age. Whereas the spread of false or misleading information has become a major societal concern, especially on social media platforms, the evidence base for effective interventions remains limited. Our review aimed to identify and synthesize empirical studies that evaluated interventions designed to enhance adults’ ability to detect and resist online misinformation.

Following a rigorous screening and selection process, five studies met the inclusion criteria. These studies employed diverse intervention strategies, ranging from media literacy training to cognitive inoculation techniques, and consistently demonstrated some degree of effectiveness in improving participants’ critical evaluation skills and decreasing their vulnerability to false information. Despite these promising findings, the overall number of empirically robust studies in this area remains very small. This gap is particularly striking when compared to the urgency of the misinformation problem, which continues to influence public opinion, political processes, and public health behaviors. The limited empirical foundation highlights a pressing need for further research to develop, test, and refine interventions that are scalable, evidence-based, and tailored to adult populations.

In conclusion, although initial findings suggest that certain interventions can help reduce adults’ susceptibility to online misinformation, this field is still in its early stages. Expanding this research is essential for informing public policy, educational programs, and digital platform strategies aimed at mitigating the impact of misinformation in contemporary society.

Background

Chronic heart failure (HF) is a condition that is continuously growing globally, with incidence and prevalence increasing with age and life expectancy. It is estimated that approximately 40 million people worldwide are affected, with a growing trend due to the aging population and the rise in cardiovascular risk factors. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) initially developed for the treatment of type 2 diabetes, have also proven effective in the treatment of heart failure, reducing the risk of hospitalization and mortality. Frailty is a state of physiological vulnerability associated with aging, caused by an alteration in the body's homeostatic reserve capacity and a reduced ability to cope with stress, such as acute illnesses. Cognitive decline is an important element of aging and one of the crucial domains of frailty. This systematic review and meta-analysis aimed to determine the association between cognitive frailty and the use of SGLT2i in patients with HF.

Methods

We searched for the most recent scientific literature on the main biomedical databases: PubMed/MEDLINE and Scopus about the use of SGLT2i in patients with HF. We focused on selecting original articles found in the literature regarding the study of the effects of this class of drugs on cognitive decline in patients with HF.

Results

Three hundred thirty-six patients with HF treated with SGLT2i were identified. Cognitive performance, assessed by Montreal Cognitive Assessment (MoCA) at the end of the follow-up period, was significantly improved compared to baseline (Mean Differences: 1.03, 95 % CI: 0.03–2.04 I² = 93.80% p=0.04).

Conclusions

This systematic review and meta-analysis indicate a potential role of SGLT2i in ameliorating cognitive domain of frailty in patients with HF. However the heterogeneity was high, which suggests that future studies are necessary to explore the role of SGLT2i in cognitive frailty among patients with HF.

Aging weakens the immune system, leading to immunosenescence (i.e. loss of naïve T cells) and chronic inflammation (inflammageing). This leads to the increased vulnerability to infections and cardiovascular events.

Physical activity (PA) is a cost-effective strategy to promote healthy aging and reduce cardiovascular risk. Indeed, regular exercise helps regulate immune responses and supports tissue repair. As the incidence of myocardial infarction (MI) increases with age and accelerates age-related features, we investigated where a regular PA program could improve post-MI recovery.

In a study of 53 post-MI patients, 28 were randomized to a perform a supervised PA program while 25 only received an educational intervention (control)

Immune cell profiles were analyzed at 1, 6, and 12 months. The PA group showed a significant increase in naïve CD4+ and CD8+ T cells and favorable changes in monocyte subsets. Both groups had reduced T cell activation markers over time. Only the PA group showed trends toward increased HDL cholesterol and reduced BMI.

Conclusion: Regular physical activity may counteract age-related immune decline and frailty after MI.

Fall prevention in elderly is important because they can lead to fractures with consequent increased risk of mortality, limitation or loss of autonomy and increased risk of institutionalization. For this reason, it is important to identify patients at risk of falling, to underline possible causes, to plan rehabilitation treatments and to promote physical activity.

As part of the AGE-it project, the aim of our task is to determine a model for the prevention of falls in the elderly, through: characterization and determination of the elderly population at risk of falling and mapping of needs; identification of innovative solutions and their applications in the elderly population at risk of falls; development and implementation of fall risk prevention interventions in elderly patients; clinical-functional evaluation of the effectiveness of fall risk prevention protocols; processing of data and economic-health intervention models for the prevention of the risk of falling in elderly patients.

Prevention of falls is important because they can lead to fractures and, specifically, fracture of the proximal neck of the femur can lead to an increased risk of mortality in the elderly; limitation or loss of autonomy; increased risk of institutionalization.

For this reason it is important to identify patients at risk of falling, ascertain the pathologies that cause it, plan rehabilitation treatments and promote physical activity.

our prevention model has the following objectives: awareness of the importance of prevention: multi-domain approach; the identification and evaluation of risk factors and determinant indices of frailty (e.g. nutrition, physical functionality, etc.); the identification and implementation of realistic and effective interventions (multidomain); Integration of rehabilitation programs with AFA (adapted physical activity) and correct nutrition.

in this context it is important to focus on physical exercise. Adequate exercise with regular weight-bearing and muscle-strengthening exercises can improve physical performance, bone mass, muscle strength and balance and can also reduce the risk of falls.

Furthermore, we focused on the sarcopenic elderly patient.

we set up the review by asking ourselves this question: Which rehabilitation interventions are effective for preventing the risk of falling in elderly sarcopenic patients?

preliminary data shows that more evidence on aerobic training, muscle strengthening, balance exercises, flexibility and resistance.

The objective of this review is to design personalized training for the sarcopenic elderly patient at risk of falling.

We also defined the needs of the elderly sarcopenic patient using the person blueprint tool.

the tools are represented by:

• ISOKINETIC TEST (It allows you to measure muscle strength, work and power during joint rotations performed with maximum voluntary effort. The most frequently studied movement is knee extension/flexion);
• MUSCLE ULTRASOUND (measures muscle trophism);
• STRENGTH PLATFORM (A strength platform is a tool that allows you to detect and measure the forces that are produced during physical exercise);
• DYNAMOMETER (to measure the intensity of a force);
• VIRTUAL REALITY REHABILITATION SYSTEM (excellent tool for the rehabilitation of the elderly patient).

Our clinical studies are represented by:

• evaluation of strength and endurance training in patients with risk of falls and sarcopenia assessed with isokinetic method;
• assessment of improvement in strength and trophism and its impact on fall risk.

Falls occur a lot due to an obstacle during the patient's walking (a carpet, a step). The aim of a next study will be to define the type of obstacle that causes the fall to create compensation strategies.

Cristiana Abbafati, Department of Legal and Economic Studies, Sapienza University of Rome, Rome

Emanuela Resta, Department of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Rome

The present study utilizes panel data from 2004 to 2021 across Italian regions to examine the impact of health on total factor productivity (TFP). TFP, which is predominantly propelled by technological progress, is indispensable for sustained economic growth and competitiveness. A two-step approach is employed, initially estimating the Cobb-Douglas production function to calculate total factor productivity (TFP). The subsequent step involves the analysis of the determinants of TFP. The primary focus of this study is on health indicators, particularly the years lived with disability (YLD). In the broader context of an aging population, health is considered a valuable asset. The health of the workforce is of critical importance, as it impacts factors such as knowledge retention, labor force participation and productivity. The results of this study should confirm that investments in health, when made collectively, exert a positive influence on TFP at the regional level. A comprehensive understanding of productivity dynamics is imperative, and it underscores the necessity for customized policies that address local economic and demographic conditions to enhance TFP.

Several genome-wide association studies have identified common variants in the UMOD gene, encoding uromodulin, as age-dependent risk factors for chronic kidney disease (CKD) and hypertension, with effects most evident after age 65. We previously showed that risk alleles are linked to increased UMOD expression and modelled this effect in transgenic mice overexpressing wild-type uromodulin (Tg^Umodwt/wt).

To investigate the underlying mechanisms, we studied aged (12-month-old) mice with different Umod gene dosage: Tg^Umodwt/wt, non-transgenic control (Umod^+/+), and knock-out (Umod^-/-) mice. Additionally, to model CKD, 7-month-old mice from each group received low-dose aristolochic acid (AA, 4 mg/kg weekly for 5 weeks). At the same age, we also profiled serum and kidney proteome.

At 12 months, kidney function and tubular damage were similar between groups. Nevertheless, Tg^Umodwt/wt mice exhibited increased renal expression of pro-inflammatory markers and senescence-associated β-galactosidase activity, suggesting that chronic uromodulin overexpression promotes an inflammatory and senescent state, likely predisposing to CKD with aging. Upon AA treatment, Umod^-/- mice showed significantly less kidney dysfunction, damage, inflammation, and fibrosis than Umod^+/+ or Tg^Umodwt/wt mice. Proteomic analysis revealed that uromodulin overexpression alters kidney expression of proteins involved in platelet and complement activation, coagulation, mineral absorption, and cell senescence, some of which were oppositely regulated in serum. These findings are currently under validation.

Overall, our results support an age-related, gene dosage-dependent role of UMOD in kidney damage and highlight molecular pathways potentially linking uromodulin expression to CKD and hypertension risk.

We explore the professional trajectories of women over 50 who, following a career interruption or a previous professional failure, undertake a lifelong learning path — identified in the Italian context as the Tirocinio Formativo Attivo (TFA) — to enter the teaching profession. This phenomenon represents one of the effects of the social metamorphosis described by Robert Castel (2019), in which educational work increasingly takes on the characteristics of care work, carried out by a predominantly feminized (Bourdieu, 2004), aging, and often precarious workforce. Although age represents a competitive disadvantage in an educational context where the care burden is not equitably shared between school and family, and where organizationally hostile environments persist, many of these women activate unconventional strategies of territorial mobility, leverage individual resources, and recontextualize prior skills. The process of professional reinvention not only reveals the systemic criticalities of the educational field and the precarious school recruitment system (Gargiulo & Carbone, 2022)—as outcomes of social stratification and the increasing overlap between life time and work time—but also highlights the transformative capacity of adult subjectivities in redefining their role in education. Through a mixed-methods analysis, this contribution aims to describe the economic, symbolic, and cultural mechanisms that enable such transitions, ultimately advocating for the development of more inclusive training policies, age- and gender-sensitive recruitment systems, and accessible digital technologies to support the professional requalification of over-50 social groups.

The paper studies the processes of “familiarisation” among immigrants in Italy from a socio-demographic viewpoint, with the aim of profiling a variety of family types and examining the family trajectories of individuals in connection with related aspects, such as: mobility and citizenship planning, national sense of belonging, housing stability, socio-economic autonomy. Based on data from the FOLCSI 2024 survey (“Formazione, Occupazione, Lavoro di Cura e Salute degli Immigrati e delle persone con background migratorio presenti in Italia”), the study covers over 12,000 foreign individuals born in Countries of High Emigration Pressure and living in four Italian regions (Lombardy, Lazio, Campania, Puglia), with or without a regular residence permit. Two complementary analytical axes are followed: 1) individuals with a partner and/or children, who can establish or reconstruct a family unit in Italy; 2) “single” individuals without partner or children, in transition towards autonomy from the family of origin, or potentially in conditions of isolation and marginality. In line with the AGE-IT framework, the contribution emphasises the high degree of familiarisation and long-term stabilisation of foreigners as a strategic lever for demographic rebalancing in the face of the rapid ageing of the Italian population, as well as the importance of supporting a gradual transition towards an intercultural and intergenerational society.

Women over the age of 65 represent approximately 40% of patients who develop breast cancer. Breast density, a crucial factor in assessing breast cancer risk even in the elderly population, also for the spread of hormone replacement therapy (HRT). This study proposes a novel method combining Magnetic Resonance Imaging (MRI) with radiomics, clustering analysis, and the Random Forest algorithm to classify breast density. We used a dataset of 136 MRI scans, extracting 93 radiomic features from each slice. K-Means clustering was employed to assign labels, followed by Random Forest classification. Our approach was evaluated across different classes of radiomic features, achieving the highest performance using First-Order features, with an accuracy of 0.89 ± 0.05, precision of 0.90 ± 0.07, specificity of 0.91 ± 0.06, and sensitivity of 0.87 ± 0.09. Notably, the Gray Level Size Zone Matrix (GLSZM) and Gray Level Dependence Matrix (GLDM) also showed strong results, with sensitivities of 0.96 ± 0.04 and 0.86 ± 0.11, respectively. These findings demonstrate the potential of integrating MRI-based radiomics and machine learning to enhance breast density classification, offering a more reliable and objective alternative to traditional mammography and supporting radiologists in clinical decision-making.

Worldwide, societies are undergoing a significant demographic shift due to rapid population ageing. This poses serious challenges to the long-term viability of public pension and healthcare systems. Scholars and policymakers have considered replacement migration as a potential solution — specifically, the introduction of working-age immigrants to offset the demographic imbalance. Can this policy be justified? On what grounds? This paper addresses this crucial, yet overlooked, question.

On Bou-Habib’s view (2019), replacement migration is justified because it would provide immigrants with significant opportunities to improve their lives, while imposing negligible costs on other affected groups (the host population, the sending population, and future people). This view needs to be complemented by what we call the respect view.

On our view, for a policy to be justified it must not only benefit people but also express the right attitudes towards them. According to relational egalitarians, this expressive requirement is formulated as the requirement not to express, whether explicitly or implicitly, demeaning, stereotyping or inferiorising attitudes towards people, and as the requirement to recognise and treat them as moral equals.

We argue that replacement migration would unlikely meet this respect-based requirement, at least under the current non-ideal conditions of widespread backlash against migrants. Indeed, in our political climate, the risk is to convey the message that immigrants are ‘invaders’ who will ‘replace’ us, perhaps even ethnically — even if this is not what the legislators intended. This means that a policy of replacement migration is likely to reproduce demeaning stereotypes about migrants, fostering hostility and contempt that undermine their equal status.

This expressive disrespect could also have further, pernicious, consequences — unnoticed by Bou-Habib’s account (2019): it could increase immigrants’ vulnerability to various harms, including violence, exploitation, domination, and of course, status-based harms.

We will conclude that replacement migration policies are unlikely to meet the threshold for moral justification.

The built environment of socio-health care facilities for primary care represents a promoter of healthy lifestyles, especially for ageing. This research aims at developing Design Guidelines of waiting spaces in primary care territorial facilities: i) to promote healthy lifestyles ii) to prevent chronic diseases and physical and cognitive decline through interactive technologies and diffuse physical activity; iii) to support fragility and mental wellbeing through sensory environments; iv) to combat loneliness and involve people in social interactions through an inclusive built environment for all. According to these goals, the research mixed different research methods in five main phases to develop Design Guidelines as an effective tool for professionals in order to design healthy and active environments able to keep all people in good health. As additional results, the Design Guidelines for waiting spaces have been applied in two main case studies: a virtual reality pilot of a sensory waiting space and a physical pilot in the waiting spaces of a House of the Community in Florence, Italy. The project of the physical pilot will be presented in this contribution to understand how to use Guidelines in the design process, describing the application of strategies and operative solutions in detail, and the value of this tool to improve health promotion by design.

Introduction: Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disease
often associated with metabolic, psychological, and functional comorbidities. Despite its impact, diagnosis is frequently delayed, and care pathways are fragmented. Digital health technologies offer an opportunity to redesign care models for complex chronic conditions like HS.

Methods: Using the European Commission’s Blueprint on Digital Transformation of Health and
Care, we developed a multidisciplinary, user-centered care pathway for patients with moderate-to-severe HS. A retrospective analysis of HS patients informed the creation of a Blueprint Persona to identify unmet needs. An interdisciplinary Focus Group—comprising dermatologists, plastic surgeons, endocrinologists, nutritionists, psychologists, physiatrists, nurses, and digital health experts—met to define the clinical pathway and identify suitable mHealth tools. A pilot study was designed for Hurley stage II–III patients referred to a tertiary care center.

Results: The pathway includes personalized interventions across dermatology, surgery,
endocrinology, nutrition, wound care, psychological support, and physical rehabilitation, supported by mHealth tools such as mobile apps and remote monitoring systems. Primary outcomes include treatment adherence, quality of life, and digital tool usability. Secondary outcomes cover disease severity, metabolic parameters, psychological well-being, and functional status. A matched control group will be used for comparison.

Discussion: This integrative model addresses the complexity of HS through a holistic, scalable, and digitally supported framework. It aims to improve patient engagement, care coordination, and long- term outcomes.

Conclusion: If validated, this multidisciplinary, mHealth-enhanced pathway could represent a
replicable model for chronic disease management in digitally transforming health systems.

Hypogonadism is a condition in which there is a reduced production of testosterone by the testicle and which leads, in addition to specific symptoms, to an increase in cardiovascular risk. In the last years, Information and Communication Technology (ICT) have progressively emerged gaining more importance in clinical practice increasing patients' compliance with the management of the underlying pathology, and therefore guaranteeing a better therapeutic yield. The aim of this study was to analyze the approaches and solutions that address the social and health unmet needs of young male patients with hypogonadism. 800 young males between 15 and 30 years old were enrolled in a screening project to evaluate andrological status, and 55 subjects showed a condition of hypogonadism. this allowed us to identify a person-case with blueprint technology, to be able to summarize the unmet clinical and social needs that could be common to the identified typical patient. The theoretical elaboration male hypogonadism personas were developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Four main needs were identified to improve young male patients with hypogonadism: improve the social relationships of young patients suffering from hypogonadism, as well as sexual health, mood, and therefore guarantee successful aging by avoiding the cardiovascular complications commonly associated with male hypogonadism that are not adequately treated. The hypothesized mHealth solutions were to allow patients diagnosed with hypogonadism to use an app that allows them to schedule all the medical visits scheduled in the therapeutic diagnostic process, monitor clinical, psychological, and biochemical progress, and be able to consult the medical team remotely for support. Further research is needed to evaluate how mHealth services enable young male patients with hypogonadism to manage their conditions and improve their quality of life.

Introduction: Fabry disease (FD) is a disorder caused by impaired α-galactosidase-A (GLA) activity and relative accumulation of globotriaosylceramide (Gb3). Progressive cardiac alterations are a common features and the main cause of death in FD patients. However, the pathogenesis of cardiac involvement in FD is not fully understood, and the current therapies remain ineffective. Energetic alterations observed in FD cellular models suggest that, beyond the mechanical storage of Gb3, additional mechanisms, such as mitochondrial dysfunction, may also be involved. We aimed to explore the pathogenetic role of mitochondrial and energetic alterations in FD cardiomyopathy and their targeting as therapeutic strategy.

Methods and Results: We employed a humanized mouse model of FD (R301Q-Tg/GLA knockout) and derived embryonic fibroblasts (MEFs) as well as adult cardiomyocytes (CMs), to evaluate mitochondrial biology and the impact of its alterations on cardiac manifestations. FD-MEFs exhibit reduced ATP content, impaired mitochondrial respiration and ROS overproduction, alongside the accumulation of exhausted mitochondria resulting from unsuccessful mitophagy. FD mice display diastolic dysfunction, altered hemodynamics and single-cell-contractile abnormalities. Remarkably, alterations of cardiac mitochondria precede the onset of clinical phenotype. L-Arginine supplementation induces NO/PGC-1α dependent mitochondrial rescue, preventing the development of cardiac signs in FD mice.

Conclusions: Our data show that early perturbation of mitophagy and accumulation of exhausted mitochondria induce oxidative stress and energetic collapse, which are ultimately responsible for FD-cardiac phenotype. Mitochondrial targeting is a promising strategy to restore FD cell homeostasis early; we propose L-Arginine supplementation as potential adjuvant therapy to promote mitochondrial-health in FD.

Background As the proportion of older adults rises globally, health systems must prioritize active aging to ensure quality of life. Nurses are central figures in this transition (WHO, 2002), yet their roles and competencies remain under-explored. This review investigates how nursing practice supports aging well through equitable and person-centered care.

Methods Following the Joanna Briggs Institute guidance and PRISMA-ScR standards (Peters et al., 2020), this scoping review employed the PCC framework. Searches across PubMed, CINAHL, and Google Scholar identified 223 records; 9 met inclusion criteria focused on nursing competencies in individuals aged 65+ across all care settings.

Results Care environments included home care, hospitals, and communities. Nurses engaged in four major competency domains:

• Clinical management, such as geriatric and nutritional assessments (Bélanger et al., 2018)
• Health promotion, notably motivational interventions for physical activity (Sari & Kitiş, 2024)
• Psychosocial support, tackling isolation and communication barriers
• Technological integration, through digital literacy and telehealth support (Ma et al., 2022)

Implementation relied on person-centered models and multidisciplinary collaboration, yet system-level obstacles (e.g. care fragmentation, low investment in prevention) persist.

Implications To scale effective nursing interventions, nursing education must embrace gerontology and digital care. Policies should incentivize inclusive, preventative practices. These insights align with Age-It’s mission, offering actionable strategies to optimize nursing contributions in aging societies.

References

World Health Organization. (2002). Active Ageing: A Policy Framework. Geneva: World Health Organization.

Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119–2126.

Bélanger, E. et al. (2018) 'Domains and determinants of a person-centered index of aging well in Canada: a mixed-methods study,' Can J Public Health, 109(5–6), pp. 855–865. https://doi.org/10.17269/s41997-018-0114-x.

Sari, E.S. and Kitiş, Y. (2024) 'The effect of nurse‐led motivational interviewing based on the trans‐theoretical model on promoting physical activity in healthy older adults: A randomized controlled trial,' International Journal of Nursing Practice, 30(2). https://doi.org/10.1111/ijn.13252

Ma, T., Zhang, Y., Li, X., Wang, J., & Chen, L. (2022). The new role of nursing in digital inclusion: Reflections on smartphone use and willingness to increase digital skills among Chinese older adults. Geriatric Nursing, 48, 118–126. https://doi.org/10.1016/j.gerinurse.2022.09.004

Background: Ageism constitutes a widespread form of workplace discrimination in the European Union, especially in Italy. While research has identified a "double jeopardy" for older women in Italian workplaces, knowledge about other age-gender intersections remains limited. This study examines how ageism and sexism affect workers across age and gender groups, investigating their impact on employee retention through the mediating role of workplace authenticity—defined as acting in accordance with one's true self.

Methods: Data were collected from 308,939 employees across 832 Italian firms using the Great Place To Work Trust Index Survey. Three hypotheses were tested: (1) ageism and sexism negatively affect authenticity and retention; (2) gender and age moderate these effects; and (3) reduced authenticity mediates the relationship between discrimination and retention. Hierarchical linear mixed models and MLMED macro were employed for analysis.

Results: Women over 55 reported higher levels of both sexism and ageism than other groups, while women generally reported lower authenticity than men. However, men showed greater vulnerability to discrimination's effects on authenticity and retention, suggesting women may have developed stronger resilience. Analysis confirmed authenticity mediates the relationship between discrimination and retention at both individual and organizational levels.

Main Implications: The findings reveal cumulative effects of different discrimination forms, highlighting the need for organizations to address demographic-based stereotypes. Organizations should implement targeted interventions for vulnerable groups while supporting employee authenticity. Resilience strategies of older women could inform approaches to maintaining authenticity as a buffer against discrimination's negative effects on workforce retention.

This study investigates how the quality of brief dyadic vocal exchanges (under 5 minutes) on a virtual platform and the nature of the conversational topic (abstract vs. concrete) influence physical, interpersonal, and psychological closeness, motor resonance, and interoceptive bodily activation across generations. Sixty-four young adults (<30 y) and forty-eight older adults (>65) engaged in audio-only conversations on either abstract or concrete topics. Greater perceived pleasantness and the partner’s contribution were associated with increased psychological and physical closeness, while perceived conversational difficulty reduced it. Following the interaction, participants completed a finger-tapping task and highlighted active bodily regions using body maps.

In young adults, perceived similarity with the partner predicted greater automatic imitation after abstract-topic conversations. In contrast, both self and other’s contributions increased motor interference after discussing concrete topics. In older adults, both contributions enhanced facilitation and interference regardless of topic. Across age groups, internal (vs. external) bodily activation was more frequently reported, with older adults showing stronger activation overall. For both age groups, internal activation increased with greater conversational engagement—when the exchange was experienced as pleasant, intimate, and mutually contributive. Conversely, internal activation decreased when the conversation was perceived as difficult.

These findings suggest that short vocal interactions, even in the absence of visual feedback, can enhance interpersonal closeness and bodily attunement. The perceived quality of the conversation plays a more central role than the topic itself. Additionally, age-related differences emerge in how social dialogue modulates motor resonance and interoceptive bodily awareness.

To face ecological disasters, one of the major emergencies of modern times, fostering pro-environmental behaviors appears crucial. While research explored various behavioral drivers, few studies addressed the conceptual representation of ecological events at different ages. Our preregistered study fills this gap, examining how different generations conceptualize ecology, considering evidence that suggests a link between climate change abstractness and willingness to act pro-environmentally.

Older (>65 yo) and younger (18-35 yo) individuals performed multiple tasks targeting conceptual processing (categorization), semantic organization (rating), and conceptual representation (feature generation) of ecological (e.g., deforestation) compared to concrete (e.g., spoon) and abstract (e.g., affirmation) concepts. In the categorization task, participants responded to critical ecological, concrete, and abstract words but refrained from responding to animal words. The rating task involved evaluating critical words on semantic aspects (e.g., Abstractness, Familiarity), and the feature generation task involved listing properties true for each concept. Innovatively, participants were tested in three possible settings (indoor, natural outdoor, urbanized outdoor) to test whether exposure to nature impacts categorization.

Results showed that, independent of the setting, ecological concepts were similar to abstract concepts, especially in semantic organization and conceptual representation, or more abstractly characterized than them, especially in conceptual processing. Age differences were minimal, but older adults characterized ecological concepts more concretely than younger adults.

Theoretically, the multifaceted characterization of ecological phenomena highlights the necessity of overcoming the classical concrete-abstract dichotomy. From a societal point of view, the abstractness of ecological concepts may inform policies aimed at promoting pro-environmental behaviors.

Cell-free DNA, which includes Alu interspersed repeats, circulates in plasma and originates from both healthy and diseased cells. In older adults, cfDNA has recently gained recognition as a prognostic marker that can be used to identify individuals at higher risk of mortality and to guide personalised care. Our previous work showed that high levels of Alu cfDNA are associated to an increased risk of death in elderly patients with cardiovascular disease (CVD). Additionally, our previous analyses revealed that Alu and alpha satellite (ALR) centromeric repeats, another major component of cfDNA, exhibit an inverse relationship with cfDNA fragment length and integrity. The aim of this study was to investigate whether adding ALR analysis to cfDNA characterisation would improve the prognostic and diagnostic effectiveness of this biomarker in geriatric cardiovascular patients. Plasma samples from 244 older adults hospitalised at INRCA for CVD were analysed to assess Alu cfDNA abundance and integrity via real-time PCR. Additionally, we applied a novel real-time PCR assay to quantify ALR satellite DNA. Strong correlations were found between Alu and ALR levels, but cfDNA integrity negatively correlated with the relative abundance of Alu cfDNA and positively with the relative abundance of ALR cfDNA. Noteworthy, ALR concentration was the only cfDNA parameter significantly associated with specific comorbidities, particularly stroke and arrhythmias. Moreover, the Alu/ALR ratio was a robust predictor of survival across age subgroups, enhancing the prognostic power beyond that of Alu alone. Combined Alu and ALR analysis could improve the clinical risk stratification of geriatric patients.

Senescent cells are resistant to apoptosis, and they acquire a pro-inflammatory phenotype generating a pro-inflammatory environment. They are characterized by an excessive release of SASP (secretory phenotype associated with senescence) factors, favouring the development of a persistent low-grade chronic inflammation defined as "inflammaging" typical of ageing and responsible for the onset of different age-related disorders. The presence of different kind of senescent cells was observed in various neurodegenerative disorders, such as heart disease, diabetes, Alzheimer’s Disease (AD), mood disorders, and neuropathic pain. So, targeting cellular senescence could be an innovative intervention to modulate the development of these diseases. In this work we investigated the onset of the presence of cellular senescence in different areas, such as spinal cord, brain, heart, of an animal model of chronic multiple sclerosis, Experimental Autoimmune Encephalomyelitis (EAE), as an in vivo model of chronic pain. The correlation between the development of clinical symptoms and the development of cellular senescence was examined. First, we investigated the development of clinical symptoms, then, to define senescence phenotype, an ex-vivo analysis was performed. Protein expression of cellular senescence marker was assessed by western blot analysis and immunofluorescence technique. From day 14, MOG animals showed a progressive worsening of clinical symptoms, such as motor disability, hypersensitivity to painful stimuli, and mood and cognitive impairment. At day 28 an increase in protein expression of cellular senescence markers was observed. These results showed a correlation between the onset of cellular senescence and the development of neurodegenerative disorders.