Azienda Sanitaria Locale Roma 3

Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in theelderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment. Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: totalarthroplasty,partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age. The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively. Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.

<h3>Background and Importance</h3> Frail institutionalised older adults frequently receive 10 or more medications, exposing them to clinically relevant drug–drug interactions, dosing errors and unnecessary treatments. Published evidence shows that structured medication review reduces inappropriate prescribing, but real-world practice often lacks standardised data collection and consistent multidisciplinary evaluation. A practical model capable of identifying specific medication-related problems and enabling rapid corrective action is needed to improve safety and optimise therapy in this population. <h3>Aim and Objectives</h3> The aim was to implement and assess a digital, stepwise medication review process in long-term care residents. Objectives were: (1) detect concrete prescribing problems; (2) apply targeted interventions such as deprescribing, dose correction or therapy substitution; (3) standardise the review process across clinicians; (4) evaluate early changes in medication appropriateness and regimen complexity. <h3>Material and Methods</h3> A four-step operational workflow was used. Data collection: A structured digital form captured comorbidities, functional and cognitive status, lab results, complete medication list, therapeutic indication for each drug, and previous ADRs. Medication analysis: Each drug was assessed for indication, dose, frequency, interactions, contraindications and duplication using Summary of Product Characteristics, three interaction checkers, BEERS, START/STOPP and Anticholinergic Burden score. For every issue, a specific action (eg, reduce dose, discontinue, replace, modify timing, initiate monitoring) was documented. Multidisciplinary teleconsultation: Pharmacist, physician and geriatrician reviewed each proposal and approved final therapeutic changes. Follow–up: At 3, 6 and 12 months, Medication Appropriateness Index (MAI), adherence indicators, tolerability data and new interactions were reassessed. <h3>Results</h3> Nine residents completed the full review. Median medication count was 11. All residents had at least one inappropriate prescription. Issues identified included lack of indication (38%), dosing errors (45%), clinically relevant interactions (52%) and duplication (31%). All residents received concrete interventions: deprescribing of unnecessary drugs, dose adjustments, therapy substitutions or scheduling changes. No unexpected adverse events occurred during early follow-up. Initial reassessment shows reduced regimen complexity and improved MAI scores. <h3>Conclusion and Relevance</h3> The workflow proved directly applicable in routine practice, producing measurable corrections to therapy and structured deprescribing. Early data show improved medication appropriateness and reduced pharmacological burden. The model is operational, reproducible and suitable for wider use in long-term care settings. <h3>Conflict of Interest</h3> No conflict of interest

Migrants are at increased risk for psychiatric disorders and suicidality due to cumulative adversities across all phases of migration. Childhood maltreatment is a well-known risk factor for depression and suicidal behavior, yet its specific contribution among migrant psychiatric patients remains insufficiently explored. This study examined the associations between different forms of childhood maltreatment, depressive symptoms, and suicidal ideation in migrant inpatients, and tested whether depression mediates these relationships. In this cross-sectional bi-center study, 102 migrant inpatients hospitalized in two university psychiatric units in Rome were assessed using structured interviews. Childhood maltreatment was evaluated with the Childhood Trauma Questionnaire (CTQ), depressive symptoms with the Beck Depression Inventory-II (BDI-II), and suicidal ideation with the Columbia-Suicide Severity Rating Scale (C-SSRS). Group differences by continent of origin were analyzed using ANOVAs, while Pearson correlations examined associations among variables. Mediation models tested whether depressive symptoms mediated the link between childhood maltreatment and suicidal ideation. Over one-third of participants reported recent suicidal ideation, and depressive symptoms were in the moderate range. Migrants from Asia showed higher suicidal ideation compared to Europeans, while participants from the Americas reported more severe depressive symptoms. All forms of childhood maltreatment were intercorrelated and significantly associated with both depressive symptoms and suicidal ideation. Mediation analyses showed complete mediation for emotional abuse and partial mediation for physical and sexual abuse. Findings underscore the need for trauma-informed and culturally sensitive psychiatric care addressing early adversity, depressive symptoms, and migration-related stressors to reduce suicide risk in this vulnerable population.

Background/Objectives: Nutritional patterns influence the gut-brain axis and immune signaling with potential consequences for depression and anxiety. We conducted a review focused on clinically meaningful psychiatric outcomes (symptom severity/diagnosis) to synthesize recent evidence (2020-2025) on Mediterranean-style dietary interventions; ultra-processed food (UPF) exposure; and psychobiotic/prebiotic strategies, integrating mechanistic insights relevant to practice. Methods: Searches in PubMed/MEDLINE, Scopus, and Web of Science (January 2020-October 2025) combined terms for diet, Mediterranean diet (MD), UPF, microbiota, probiotics, psychobiotics, depression, and anxiety. Eligible designs were randomized/controlled trials (RCTs), prospective cohorts, and systematic reviews/meta-analyses reporting clinical psychiatric outcomes in adults. We prioritized high-quality quantitative syntheses and recent RCTs; data were extracted into a prespecified matrix and synthesized narratively. Results: Recent systematic reviews/meta-analyses support that MD interventions reduce depressive symptoms in adults with major or subthreshold depression, although large, long-term, multicenter RCTs remain a gap. Exposure to UPF is consistently associated with higher risk of common mental disorders and depressive outcomes in large prospective cohorts. Psychobiotics (specific probiotic strains and prebiotics) show small-to-moderate benefits on depressive symptoms across clinical and nonclinical samples, with heterogeneity in strains, dosing, and duration. Mechanistic reviews implicate microbiota-derived metabolites (short-chain fatty acids) and immune-inflammatory signaling (including tryptophan-kynurenine pathways) as plausible mediators. Conclusions: Clinically, emphasizing Mediterranean-style dietary patterns, reducing UPF intake, and considering targeted psychobiotics may complement standard psychiatric care for depression. Future work should prioritize adequately powered, longer RCTs with standardized dietary protocols and microbiome-informed stratification to clarify responders and mechanisms.

Despite national and international guidelines on Helicobacter pylori management, limited evidence exists on how these recommendations are applied in routine clinical practice. This nationwide survey, conducted by the Italian Association of Hospital Gastroenterologists and Endoscopists and the Italian Federation of General Practitioners (FIMMG), aimed to identify the empirical first- and second-line treatments most commonly recommended in Italy. Members of societies were invited via email to anonymously complete an original 20-item questionnaire. Ten therapeutic regimens were proposed, with treatment durations classified as 7, 10, or 14 days. Respondents reported the type of proton-pump inhibitor (PPI) used, total daily dose (mg/day), and whether probiotics and/or lactoferrin were recommended. PPI doses were standardized according to acid inhibition potency and categorized as low, standard, or high. Among the 1262 respondents [358 gastroenterologists (GEs) and 904 general practitioners (GPs)], the first-line regimen most frequently prescribed was the triple therapy with PPI, clarithromycin and amoxicillin (35.2%; 12% of GEs vs. 44.4% of GPs; P < 0.0001), followed by bismuth quadruple therapy - three-in-one capsule (BQT-TSC: 31.2%; 51.4 vs. 23.3%, P < 0.001), and sequential therapy (21.7%; 26.8 vs. 19.7%, P < 0.001). For second-line, BQT-TSC was the most prescribed regimen (53.1%; GEs versus GSs: not statistically significant). 10-day courses and low-dose PPIs predominated, and approximately 1/3 of respondents recommended probiotics. Empirical regimen selection, PPI dosing, and probiotic use frequently diverged from guideline recommendations. These findings highlight the need to align clinical practice with evidence-based standards to improve eradication rates, optimize cost-effectiveness, and preserve healthcare resources.

EP3.1, e-Poster Terminal 3, September 3, 2025, 10:35 - 11:00Female Genital Mutilation (FGM) is a severe violation of human rights that significantly impacts women’s health. The SAMIFO Center, a regional public health facility within ASL Roma 1, has been providing healthcare, rehabilitation, and social support to forced migrants and foreign minors since 2006. The center has developed an integrated approach to address FGM, combining surgical, reparative, and psychosocial interventions. For women with Type 3 FGM (infibulation), a personalized care pathway is implemented, involving obstetric-gynecological evaluations, psychological counseling, and deinfibulation surgery, in collaboration with S. Filippo Neri Hospital in Rome. This multidisciplinary approach aims to restore a functional female identity, support psychosexual recovery, and enable the possibility of physiological childbirth.Additionally, the Health Passport for the prevention of FGM was introduced to combat the continuation of this practice, especially among second-generation migrant women. Available in nine languages, this document, realized with CCM funds, provides information on FGM, its health consequences, and the italian legal framework surrounding it. It also serves as a tool for raising awareness among pregnant women and protecting girls from mutilation practices, while promoting reproductive health education. The passport has been effective in engaging families and fostering cultural change, contributing to FGM prevention and improving the health and well-being of women and girls. Both surgical and informational interventions are essential for safeguarding women’s rights, promoting their health, and combating violence associated with FGM.

EP3.2, e-Poster Terminal 3, September 3, 2025, 13:05 - 14:00IntroductionIn 2024 immigrants represented 8.9% of the population residing in Italy. They have better overall health conditions compared to the native population. However, the presence of formal and informal barriers often limits their appropriate access to healthcare, which needs to be closely monitored. The objective of this study is to compare the differences in access to emergency care between Italians and immigrants.MethodsThe National Institute for Health, Migration and Poverty (INMP) coordinates a monitoring system for the health status and healthcare of the resident immigrant population, which currently includes 10 regions (Piedmont, Lombardy, Trento and Bolzano Autonomous Provinces, Emilia-Romagna, Tuscany, Umbria, Lazio, Puglia, and Sicily), where 75% of the total residents in Italy and 83% of foreign nationals live.To date, the monitoring system covers the period 2016-2022. Data collected by the regions through different healthcare information systems are summarized in a set of 60 indicators covering hospital care, maternal-child care, and emergency care services.ResultsDuring the observation period (2016-2022), the percentage distribution of emergency department visits by triage code showed a higher proportion of white and green codes among immigrants compared to Italians, with trends remaining fairly stable over time. The 2022 data show the following proportions for foreigners and Italians: 16.3% vs 10.2% for white codes and 68.1% vs 64.2% for green codes, among men; 13.4% vs 9.7% for white codes and 70.5% vs 65.5% for green codes, among women.ConclusionsIt can be hypothesized that the failure to promptly or adequately care for immigrants leads to acute events that require emergency department visits for conditions that could be managed in different care settings, such as primary healthcare and specialist care. Furthermore, the use of emergency services by immigrants for less severe conditions suggests inappropriate use due to difficulties in accessing primary care.

Early relapse in multiple myeloma (MM) is a major predictor of poor prognosis, regardless of cytogenetic risk or treatment intensity. Here we analyzed 1026 MM patients treated across 12 Italian hematology centers. FHR was defined as progression-free survival (PFS) ≤18 months in transplant-eligible (TE) and ≤12 months in non-transplant-eligible (NTE) patients. Logistic regression and ROC analysis were used to identify significant predictors of FHR and build a risk score. FHR status was identified in 175 patients (17%). These patients had significantly shorter PFS (7 vs. 57.5 months) and overall survival (19 months vs. not reached; p < 0.001). FHR status was associated with higher median LDH, lower Hb level, higher creatinine level and lower platelets count. Modified EASIX formula was built by these significant continuous variables, to be tested in a logistic analysis: [(LDH × creatinine)/(Hb × PLT) × 100]. A significantly higher rate of FHR was found with a score > 2.0 (89% vs. 11%, p < 0.001). Multivariate logistic analysis selected the above formula, ECOG PS ≥ 2 and ISS III as factors associated with FHR. Scoring these variables according to OR, three groups of patients were segregated with a rate of FHR patients of 7%, 29.5%, and 63.5%, respectively. Treatment with anti-CD38 monoclonal antibodies was associated with lower FHR frequency. This study proposes a simple, clinically applicable model to identify FHR MM patients early in their disease course. However, very in-depth biological tools, not available in clinical practice, are needed to identify singularly risk of becoming FHR.

Disclosure: E. Camajani: None. C. Camilla: None. M. Spizzichini: None. D. Masi: None. R. Rebecca: None. M. Spoltore: None. C. Lubrano: None. L. Gnessi: None. C.G. Moretti: None. M. Caprio: None. M. watanabe: None.Obesity is a complex condition influenced by a combination of genetic, environmental, and behavioral factors, and it significantly impacts overall health. The management of obesity requires an integrated approach, with dietary therapy as its cornerstone. Among nutritional strategies, the Very Low Energy Ketogenic Therapy (VLEKT) has gained attention for its ability to induce rapid weight loss while minimizing lean mass loss and enhancing satiety. However, for many patients, dietary interventions alone often fall short in achieving sustainable long-term results. In this context, GLP-1 receptor agonists have demonstrated efficacy in reducing and maintaining body weight through appetite modulation and improved glycemic control long term.This single-center, prospective observational study evaluated the efficacy and safety of VLEKT alone (VLEKT group) compared to its combination with liraglutide (VLEKT +Lira group) over a four-month observation period.All participants followed a VLEKT with meal replacements for at least 45 days. The nutritional intervention provided approximately 800 kcal/day, consisting of 4-5 meal replacements daily and one serving of low glycemic index vegetables at lunch and dinner. The macronutrient composition was as follows: carbohydrates <50 g daily, protein 1.2-1.5 g/kg of ideal body weight, and fat comprising the remainder of the calorie intake. Meal replacements were then gradually replaced by protein dishes primarily made of egg, lean meat, and fish. Fats were primarily derived from extra virgin olive oil, fish, and seeds. Calorie intake was gradually increased up to approximately 1200 kcal/daily.Participants in the VLEKT+Lira group were prescribed liraglutide in addition to the dietary intervention. The initial dose was 0.6 mg daily, which was gradually uptitrated based on individual patient tolerance. Dose adjustments were made under close medical supervision to ensure safety and optimize treatment efficacy.Both strategies resulted in significant reductions in body weight and improvements in metabolic parameters. However, the VLEKT +Lira group experienced greater weight loss (-20.4% vs -14.7%, p = 0.013) and a more pronounced reduction in insulin resistance (p<0.001). Ketone levels were higher in the combination group, suggesting improved adherence to the dietary regimen. Despite the metabolic benefits, the VLEKT +Lira group reported a higher incidence of adverse effects, including nausea (p<0.001), heartburn (0.004), reflux (p=0.009), and mental and physical fatigue (p=0.003 and p=0.02, respectively). Safety parameters, including liver enzymes and renal function, remained stable in both groups.These findings suggest that the combination of VLEKT and obesity medications represents an effective strategy for obesity management, although the increased incidence of adverse effects needs careful clinical monitoring.Presentation: Sunday, July 13, 2025