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Introduction Hemophilic arthropathy affects people with hemophilia (PwH) and causes joint dysfunction and disability. Brazil has a unique situation and implemented policies to improve health care for PwH. The aim of this study was to evaluate the Functional Independence Score in Hemophilia (FISH), Hemophilia Joint Health Score (HJHS), and associated factors among adult PwH attending a Hemophilia Comprehensive Care Center in Brazil. Methods A post hoc analysis was conducted, including 31 patients who had submitted to a physical evaluation during a previously published cross-sectional study performed from June 2015 to May 2016 at the Brasília Blood Center Foundation, Brazil. Results The mean age was 30.8±9.4 years, and 80.6% had severe hemophilia. FISH was 27.0±3.8, and HJHS 18.0±10.8. The ankle was the most often affected joint (25/31, 80.6%). There were significant correlations between FISH and HJHS scores and the Hemophilia Quality of Life Questionnaire for Adults. Patients with severe hemophilia ( P = 0.029) and PwH aged ≥ 30 years ( P = 0.049) had lower FISH scores. Monthly household income > 2 Brazilian minimum wages was independently associated with improved HJHS ( P = 0.033). The factors simultaneously associated with better HJHS and FISH were age < 30 years ( P = 0.021) and monthly household income < 2 minimum wages ( P = 0.013). Conclusion FISH and HJHS showed favorable scores despite being performed in a country with unfavorable socioeconomic conditions. In addition to hemophilia severity and age, monthly household income was independently associated with functional and articular state of PwH. The results highlight the importance of the free provision of coagulation factors in Brazil., Competing Interests: Conflicts of InterestNone declared

This case study is an example of narrative medicine applied to promote self-awareness and develop humanistic contents in medical education. The impact and the human appeal of the narrative lie in the maturity and empathy shown by a student when reporting his dramatic experience during the care given to a newborn (with Patau syndrome and multiple malformations diagnosed at birth) and to her mother. The narrative approach helped the student to be successful in bringing out the meaning behind the story and to position himself from the mother's and newborn's perspective. The student's introspection changed a seemingly scary interaction into a positive experience, overcoming many initial negative emotions, such as fear, disappointment, horror, hopelessness, and insecurity in the face of the unexpected. It is uplifting how the student was strengthened by the power of maternal love to the point of overcoming any remaining feelings of eugenics or rejection. Other important lessons emerging from the case study were the art of listening and the value of silence. This narrative shows how the development of narrative competence can help establish a good physician-patient relationship, because the physician or the student with such competence usually confirms the patient's value and demonstrates concern for them, focusing on what they say and allowing genuine contact to be established, which is necessary for effective therapeutic alliance. The student's interpretations of the meaning of love and value of life inspired him on his reframing process of a medical practice marked by vicarious suffering.

This case study is an example of applying narrative medicine as a useful tool for health professionals to manage an existential and complex scenario such as the suicide of a sibling. Some suicides are like baobab trees—these large and resilient trees grow deep roots for many years, only spreading their limbs above ground once they are firmly established. Like the baobab, when suicide or a suicide attempt occurs, suicidal ideations are well cultivated and have often already been repeatedly planted. Consequently, suicide is often difficult to prevent: once the death seed is planted, it is difficult to recreate life. Every year, more than 800,000 people die by suicide worldwide (1.4% of all deaths), which is approximately 1 person every 40 seconds. These unexpected deaths, predominantly occuring among young and middle-aged adults, have a continuing ripple effect and result in a huge economic, social, and psychological burden for individuals, families, communities, and countries. The complexity of suffering and pain experienced by suicidal individuals and their families, regardless of the success or failure of the suicidal act, is intensified by strong stigmas attached to traditional concepts of sin and eternal damnation. This unfortunate reality emerges in the narrative as a tragic family drama, which is permeated by deep feelings of helplessness. But suicide is preventable. Prevention requires 3 important factors: knowledge, public support, and creation of strategies to enact social change. Now is the time to act and make suicide prevention an imperative goal.

We present a case in which narrative medicine was used to assist a patient with amyotrophic lateral sclerosis who was dependent on mechanical ventilation and prolonged hospitalization. Implementing narrative medicine led to the development of more effective communication that strengthened the therapeutic relationship, enhanced humane care practices, and resulted in greater physical and psychological comfort for the patient. Narrative medicine is a discipline that has been progressively incorporated into medical training to restore a humane and individual physician-patient relationship. The patient is viewed, not merely as a case to diagnose, but as a person with a story that evokes emotions in those who assist him or her. In fact, narrative medicine can be understood as a model of medical practice based on narrative competence, ie, the ability to acknowledge, to absorb, to interpret, and to respond to a person's story. It strengthens empathy, rescues patient individuality, and facilitates solutions to conflicts in complex settings, such as critical care units, where clinicians are constantly exposed to existential issues, both moral and ethical.