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Chronic diseases such as diabetes, hypertension and cardiovascular diseases are prevalent in vulnerable populations, who often face difficulties in accessing adequate medical care. Primary care, especially family medicine, plays a central role in the prevention and control of these diseases, as it offers continuous, comprehensive and personalized care, focused on health promotion and the prevention of complications. This model of care is especially effective in communities that face economic, social and cultural barriers, allowing for early intervention and appropriate management of chronic conditions. The aim of this study is to analyze strategies for the prevention and control of chronic diseases in vulnerable populations, with a focus on family medicine. The aim is to identify effective approaches that can be used to improve the quality of life of these populations and reduce the incidence and progression of chronic diseases. The research was carried out through a qualitative literature review, focusing on articles published between 2017 and 2022. The aim was to explore the advances and challenges in the management of chronic diseases, with an emphasis on primary health practices, the impact of social determinants of health, and the role of technologies such as telemedicine in the management of these conditions. By providing continuous and comprehensive care, family medicine uses various strategies to prevent and control chronic diseases. These include regular patient follow-up, early screening for conditions such as hypertension and diabetes, and health education, which guides individuals on healthy behaviors and self-care. In addition, disease monitoring programs and interventions such as modifying eating habits and promoting physical activity have shown positive results in the management of chronic diseases. However, there are still significant challenges, such as the scarcity of resources and the lack of qualified professionals, which limit the effectiveness of these approaches in certain regions and social groups. Overcoming these barriers requires a joint effort between health professionals, managers and public policies. It is concluded that family medicine is a fundamental approach to the control and prevention of chronic diseases, especially in vulnerable populations. The strategies adopted in this model of care, such as continuous monitoring, health education and early intervention, have shown significant results in improving quality of life and reducing complications associated with chronic diseases. However, in order to optimize the results, it is necessary to overcome challenges related to access and the training of professionals, as well as ensuring adequate support for the implementation of public health programs that favour the population in situations of vulnerability. Implementing efficient public policies and expanding access to primary health care are essential to achieving effective control of chronic diseases. [ABSTRACT FROM AUTHOR]

Humanized prenatal care is a concept that aims to ensure that pregnant women receive respectful and personalized care, promoting an emotionally supportive and welcoming environment during pregnancy. This approach aims not only to ensure the physical health of the mother and fetus, but also to improve the psychological and emotional well-being of women during pregnancy, which can have a positive impact on maternal and fetal outcomes. Studies have shown that a humanized approach is a determining factor in reducing complications during pregnancy and childbirth, as well as strengthening the bond between mother and baby. This summary seeks to analyze the influence of humanized care during prenatal care on maternal and fetal outcomes, discussing the importance of welcoming and personalized practices for increasing the quality of care. It also examines how humanized care can have a positive impact on both the physical and emotional health of pregnant women, promoting more favorable outcomes for mother and baby. This study used a qualitative methodology based on a literature review, focusing on humanization practices in prenatal care, exploring their impact on maternal and fetal health and public policy guidelines in Brazil. Humanized prenatal care involves practices such as respect for the autonomy of the pregnant woman, active listening, inclusion of the family in the process and psychological support, as well as comprehensive care for the woman’s physical health. Research shows that pregnant women who receive this type of care have lower rates of anxiety and depression, factors that are associated with obstetric complications and negative outcomes. In addition, humanized care contributes to pregnant women’s adherence to prenatal appointments and tests, reducing the risks of premature births, low birth weight and neonatal mortality. Care that respects a woman’s individuality also facilitates the control of conditions such as hypertension and gestational diabetes, promoting a safer pregnancy. Humanized prenatal care therefore plays a crucial role in maternal and fetal outcomes, promoting a healthier pregnancy and reducing the risks associated with labour and birth. In addition to improving the physical health of the mother and fetus, humanized care strengthens the emotional health of the pregnant woman and facilitates the mother-baby bond, factors that are essential for the healthy development of the newborn. The implementation of humanized practices in health services is therefore a fundamental strategy for improving the quality of prenatal care and promoting better outcomes for mothers and babies. [ABSTRACT FROM AUTHOR]

Orthopaedic surgery has undergone significant evolution with the development of minimally invasive techniques (MIT) for the treatment of complex lower limb fractures. These innovations have transformed orthopaedic management, offering less traumatic and more effective alternatives to traditional procedures. IMTs are designed to reduce tissue damage, speed up recovery and minimize post-operative complications, making them increasingly relevant in today’s orthopaedic scenario. The aim of this study is to discuss recent advances in minimally invasive techniques in orthopaedic surgery for complex lower limb fractures. The research explores the benefits of these techniques, the challenges faced in clinical practice and the future prospects for their widespread adoption. The research was based on a literature review, with a qualitative approach, using the PubMed, Google Scholar, and Scielo databases. For a comprehensive and relevant analysis of the advances and challenges of minimally invasive techniques in orthopaedic surgery, specific descriptors reflecting the area of study were applied, with a time frame covering publications from 2018 to 2023. The analysis is based on a review of up-to-date literature, including clinical studies and meta-analyses that demonstrate the efficacy and safety of minimally invasive techniques. Innovations such as the use of external fixators, locked intramedullary rods and surgical navigation systems are highlighted. These approaches allow for precise stabilization of fractures with smaller incisions and less impairment of soft tissue vascularization. In addition, advances in intraoperative imaging and surgical instrumentation are discussed, which have improved the precision of procedures and reduced operative time. Challenges such as the learning curve and the cost of the technologies are also addressed. Thus, advances in minimally invasive techniques have revolutionized orthopaedic surgery, offering effective solutions for the treatment of complex lower limb fractures. Despite the challenges, such as the need for specialized training and investment in new technologies, the benefits for patients, including shorter recovery times and better functional results, are undeniable. The future of orthopaedic surgery will continue to benefit from these innovations, with the potential to further increase access and the quality of treatments. [ABSTRACT FROM AUTHOR]

Despite being widely implemented, sustainable urban drainage systems (SUDS) do not always function flawlessly. While SUDS have been tested extensively and seem to perform well on a laboratory or pilot scale, practitioners' experience is different: failures in SUDS occur regularly in practice, resulting in malfunctioning systems, water nuisance and high costs. To anticipate their malfunctioning, and thus to improve their performance, a better understanding of failures occurring in SUDS and their underlying causes is needed. Based on an explorative case-study approach, consisting of site visits and semi-structured interviews with urban water professionals, this study presents an inventory of technical failures in SUDS and an analysis of their root causes. In total, 70 cases in 11 Dutch municipalities have been documented. The results show that the interfaces between SUDS and other urban systems are prominent failure locations. In addition, we found that failures originate from the entire development process of SUDS, i.e., from the design, construction and user/maintenance phase. With respect to the causes underlying these failures, our results show that these are mainly socio-institutional in nature. These are valuable insights for both practitioners and scholars, contributing to a renewed socio-technical urban water system with more sustainable water management practices. HIGHLIGHTS This study analyzes the malfunctioning of SUDS in practice and identifies the causes underlying this malfunctioning.; We found that interfaces between SUDS and other urban systems are prominent failure locations.; The causes underlying these failures were mainly socio-institutional, rather than technical in nature.; Practitioners need to acquire new knowledge and develop their skills for the successful management of SUDS.;

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Abstract The prey of a recent described characid fish, so far endemic of the small lake Pratinha (Iraquara, Bahia, Brazil), a small (~2.5 mm) lentic gastropod, revealed to be a new (possible endemic) species. It is herein formally described as Heleobia brucutu sp. nov. The description includes anatomical features, revealing interesting idiosyncrasies such as egg laying attached to shell, and penis lacking glands, but with terminal papilla. The new species appears to be endemic of that small lake as much as its fish predator. As the species is now formally described and named, protective efforts must be implemented.

La riforma del Terzo settore realizza l’esigenza di dare veste sistematica alla disciplina degli Enti del primo libro del codice civile perseguendo logiche autonome dal codice civile. Tuttavia, il successo dell’iniziativa dipenderà dall’analisi costi / benefici che ciascuna organizzazione non profit svolgerà prima di assoggettarsi alle regole del Codice del Terzo settore. / 𝑇ℎ𝑒 𝑅𝑒𝑓𝑜𝑟𝑚 𝑐𝑎𝑟𝑟𝑖𝑒𝑠 𝑜𝑢𝑡 𝑡ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑖𝑐𝑎𝑙 𝑛𝑒𝑒𝑑 𝑡𝑜 𝑠ℎ𝑎𝑝𝑒 𝑎 𝑠𝑦𝑠𝑡𝑒𝑚𝑎𝑡𝑖𝑐 𝑏𝑜𝑑𝑦 𝑜𝑓 𝑟𝑢𝑙𝑒𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑛𝑜𝑛-𝑝𝑟𝑜𝑓𝑖𝑡 𝑜𝑟𝑔𝑎𝑛𝑖𝑧𝑎𝑡𝑖𝑜𝑛𝑠 𝑗𝑢𝑠𝑡 𝑠𝑘𝑒𝑡𝑐ℎ𝑒𝑑 𝑖𝑛 𝑡ℎ𝑒 𝐹𝑖𝑟𝑠𝑡 𝐵𝑜𝑜𝑘 𝑜𝑓 𝑡ℎ𝑒 𝐶𝑖𝑣𝑖𝑙 𝐶𝑜𝑑𝑒. 𝐻𝑜𝑤𝑒𝑣𝑒𝑟, 𝑡ℎ𝑒 𝑠𝑢𝑐𝑐𝑒𝑠𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑖𝑛𝑖𝑡𝑖𝑎𝑡𝑖𝑣𝑒 𝑖𝑠 𝑙𝑖𝑘𝑒𝑙𝑦 𝑡𝑜 𝑑𝑒𝑝𝑒𝑛𝑑 𝑜𝑛 𝑡ℎ𝑒 𝑐𝑜𝑠𝑡 / 𝑏𝑒𝑛𝑒𝑓𝑖𝑡 𝑎𝑛𝑎𝑙𝑦𝑠𝑖𝑠 𝑡ℎ𝑎𝑡 𝑒𝑎𝑐ℎ 𝑛𝑜𝑛-𝑝𝑟𝑜𝑓𝑖𝑡 𝑜𝑟𝑔𝑎𝑛𝑖𝑧𝑎𝑡𝑖𝑜𝑛 𝑤𝑖𝑙𝑙 𝑝𝑒𝑟𝑓𝑜𝑟𝑚 𝑏𝑒𝑓𝑜𝑟𝑒 𝑢𝑛𝑑𝑒𝑟𝑔𝑜𝑖𝑛𝑔 𝑡ℎ𝑒 𝑟𝑒𝑔𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑝𝑟𝑜𝑣𝑖𝑑𝑒𝑑 𝑏𝑦 𝑡ℎ𝑒 𝑇ℎ𝑖𝑟𝑑 𝑆𝑒𝑐𝑡𝑜𝑟 𝐶𝑜𝑑𝑒.

No presente artigo narro minha inserção como pedagoga e professora substituta de 2ª série na Escola Padre Francisco Silva da Rede Municipal de Campinas, quando assumo a responsabilidade por um grupo de alunos com histórias de rótulos, estigmas e pré-conceitos. Algumas questões que me inquietavam: mudar a imagem negativa que o grupo tinha de si mesmo, melhorar as relações no grupo, estabelecer democraticamente alguns princípios dentro do grupo. Um dos caminhos delineados para possibilitar essas mudanças no grupo foram as atividades desenvolvidas a partir do projeto de Ciências que denominei “Nossa Horta”. O encontro com os colegas da escola nos momentos de reflexão conjunta foi um outro caminho que me possibilitou delinear outras estratégias. In the present article I narrate my experience like substitute professor of 2do degree in the School Padre Francisco Silva of the Municipal Network of Campinas, when I assume the responsibility of a group of students that have histories of labels, estigmas and preconceptions. Some questions that troubled me: to change the negative image that the group had of itself, to improve the relations in the group and to establish democratically some principles within the group. One of the delineated ways to make possible those changes in the group were the activities developed in the project of Sciences that I denominated "Our Orchard". The gathering with other professors of the school at the moments of joint reflection was another way that it made possible to me to delineate other strategies.

Background: Interleukin (IL)-1 plays a crucial role in the pathogenesis of Adult onset Still's disease (AOSD). Objectives: To evaluate the efficacy and safety of anakinra (ANA) and canakinumab (CAN) in a large group of AOSD patients. Methods: Data on clinical, serological features, and concomitant treatments were retrospectively collected at baseline and after 3, 6, and 12 months from AOSD patients (Yamaguchi criteria) referred by 18 Italian centers. Pouchot's score was used to evaluate disease severity. Results: One hundred forty patients were treated with ANA; 4 were subsequently switched to CAN after ANA failure. The systemic pattern of AOSD was identified in 104 (74.2%) of the ANA-treated and in 3 (75%) of the CAN-treated groups; the chronicarticular type of AOSD was identified in 48 (25.8%) of the ANA-treated and in 1 (25%) of the CAN-treated groups. Methotrexate (MTX) was the most frequent disease modifying anti-rheumatic drug (DMARD) used before beginning ANA or CAN [91/140 (75.8%), 2/4 (50%), respectively]. As a second-line biologic DMARD therapy in 29/140 (20.7%) of the patients, ANA was found effective in improving all clinical and serological manifestations (p < 0.0001), and Pouchot's score was found to be significantly reduced at all time points (p < 0.0001). No differences in treatment response were identified in the ANA-group when the patients were stratified according to age, sex, disease pattern or mono/combination therapy profile. ANA primary and secondary inefficacy at the 12-month time point was 15/140 (10.7%) and 11/140 (7.8%), respectively. Adverse events (AEs) [mainly represented by in situ (28/47, 59.5%) or diffuse (12/47, 25.5%) skin reactions and infections (7/47, 14.8%)] were the main causes for discontinuation. Pouchot's score and clinical and serological features were significantly ameliorated at all time points (p < 0.0001) in the CAN-group, and no AEs were registered during CAN therapy. Treatment was suspended for loss of efficacy only in one case (1/4, 25%). Conclusion: This is the largest retrospective observational study evaluating the efficacy and safety of IL-1 inhibitors in AOSD patients. A good response was noted at 3 months after therapy onset in both the ANA- and CAN-groups. Skin reaction may nevertheless represent a non-negligible AE during ANA treatment. [ABSTRACT FROM AUTHOR]

Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50-90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed. Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications. Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes.

The purpose of this study is to determine the prevalence and the patterns of movement disorders (MD) in outpatients submitted to the chronic use of cinnarizine (cz) or flunarizine (fz), and to establish the main risk factors for MD development. Over a period of 3 months, data were collected from outpatients who were chronic users of cz or fz in a municipal health institute. A total of 26 outpatients were included and all of them were submitted to a protocol that included DSM-4 diagnosis criteria for drug-induced movement disorders, parkinsonism (PK) and depression. Parkinsonism was diagnosed in 34% of the patients, PK plus akathisia, PK plus akathisia and bucco-linguo-masticatory syndrome (BLMS), isolated BLMS and dystonia were found in 4% patients each. Patients with BLMS had the highest median age and the longest average period in which they used the drugs. The affected group, when compared to the non-affected one, presented with higher rates of depression. This study demonstrates the existence of a direct relationship between the time of use of cz and fz, the age and the prevalence of PK and other MD. It also suggests that these drugs increase the incidence of depression.