Explore the vast range of titles available.

The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women’s perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the “welcomeness” of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.

Unaccompanied minors (UMs) are children under 18 who arrive on the territory of a foreign country without the care of a guardian. In many countries their access to social and health care services depends on their legal recognition as minors. For instance, in France, high rejection rates of minor status place unprotected UMs in social precarity, such that in Paris, civil society organizations (CSOs) have stepped in to offer social, medical, and psychological care to unprotected UMs. In the context of the COVID-19 pandemic however, CSOs had to adapt their care provision. We review promising CSO-led initiatives to ensure continuity of care for this population. In doing so, we highlight how, by promoting UMs’ healthy behaviors in the context of the pandemic, continued social interactions between CSO members and unprotected UMs may have contributed to disease prevention among UMs. In addition, CSOs have continued to advocate for sheltering unprotected UMs, calling on public authorities to take action.

The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women’s perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the “welcomeness” of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.

In France, government protection of unaccompanied minors (UMs) depends upon the recognition of their minority status and often result in a rejection. A significant proportion of UMs therefore find themselves unprotected. This qualitative study explores the contextual and individual factors that shape the physical and mental health needs of unprotected UMs in Paris. Interviews were conducted with UMs (n=12) and those working with them (n=36). A deductive-inductive thematic analysis was carried out. The study contributes to the analysis of the health determinants of unprotected UMs. It shows that institutional barriers limit the scope for action by civil society in the palliative care they receive. The consequence for them is living in conditions of instability and precariousness, with very little prospects for the future, which has a negative impact on their physical and mental health.

Background: The Colombian Association of Endocrinology, Diabetes and Metabolism (ACE) developed this clinical practice guideline with the aim of providing updated recommendations for the management and follow-up of individuals living with type 2 diabetes mellitus (T2DM) in Colombia. This update responds to the need to revise the recommendations established in the national guideline published in 2016, in light of recent and robust global scientific evidence that has substantially modified the therapeutic approach.Objective: The guideline emphasizes the preventive approach to cardiovascular and renal outcomes, as well as the integration of lifestyle interventions and the incorporation of technology as an essential component of a holistic approach to T2DM care.Methods: The guideline was developed using the GRADE methodology, in accordance with the AGREE II and Institute of Medicine standards. The process included the formulation of nine PICO questions, systematic literature searches, critical appraisal of evidence, and formulation of recommendations by an interdisciplinary panel with patient participation. Transparency was ensured through conflict-of-interest management and external international review.Main recommendations: Combination therapy with metformin and either a sodiumglucose cotransporter-2 inhibitor (SGLT2i) or a dipeptidyl peptidase-4 inhibitor (DPP-4i) is recommended for patients with significantly elevated HbA1c levels, while combinations with sulfonylureas are discouraged.In patients who do not reach glycemic targets with metformin monotherapy, adding an SGLT2i or a glucagon-like peptide-1 receptor agonist (AR GLP-1) is suggested, the latter being particularly indicated in individuals with overweight, obesity, or markedly elevated HbA1c.For patients with inadequate glycemic control despite oral antidiabetic therapy, the preferred next step is the addition of a AR GLP-1, especially in those with a body mass index (BMI) >27 kg/m². Basal insulin should be considered when glycemic control is not achieved with a AR GLP-1.In cases of T2DM associated with overweight or obesity, the use of AR GLP-1s or dual GLP-1/GIP receptor agonists is recommended. In individuals with class II or higher obesity, metabolic or bariatric surgery may be considered, provided it is accompanied by patient education, individualized risk–benefit assessment, and performed in specialized reference centers.Cardiorenal protective therapies (SGLT2i, AR GLP-1, finerenone) should be prioritized and initiated regardless of glycemic control or concomitant therapy, in individuals with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, according to individual clinical profiles.The use of real-time continuous glucose monitoring (CGM) systems is recommended in patients receiving multiple daily insulin doses and experiencing hypoglycemia or inadequate glycemic control.Finally, the guideline underscores the importance of continuous diabetes education and a multidisciplinary approach as cornerstones of comprehensive care for all individuals with T2DM.Conclusions: This guideline provides a practical and rigorous framework for the comprehensive management of T2DM in Colombia, with recommendations tailored to the national context and high potential to improve quality of life and reduce disease burden.

Contexto: la Asociación Colombiana de Endocrinología, Diabetes y Metabolismo (ACE) desarrolló esta guía de práctica clínica con el propósito de emitir recomendaciones actualizadas para el manejo y seguimiento de las personas que viven con diabetes mellitus tipo 2 (DM2) en Colombia. Esta actualización responde a la necesidad de revisar las directrices establecidas en la guía nacional publicada en 2016, a la luz de la evidencia científica reciente y robusta disponible a nivel mundial, la cual ha generado cambios sustanciales en la aproximación terapéutica. Objetivo: la guía enfatiza el enfoque preventivo de desenlaces cardiovasculares y renales, así como la integración de intervenciones en el estilo de vida y la incorporación de la tecnología como parte esencial del abordaje holístico de la persona con DM2.Metodología: la guía fue elaborada mediante la metodología GRADE, en concordancia con los lineamientos de AGREE II e Institute of Medicine. El proceso incluyó la formulación de nueve preguntas PICO, búsquedas sistemáticas, evaluación crítica de la evidencia y formulación de recomendaciones en un panel interdisciplinario con participación de pacientes. La transparencia se garantizó con gestión de conflictos de interés y revisión externa internacional.Principales recomendaciones: se recomienda iniciar terapia combinada con metformina e inhibidor del cotransportador sodio-glucosa tipo 2 (iSGLT2) o inhibidor de la dipeptidil peptidasa-4 (iDPP-4) en pacientes con niveles significativamente elevados de HbA1c, desaconsejándose las combinaciones con sulfonilureas.En pacientes que no alcanzan la meta glucémica con monoterapia con metformina, se sugiere añadir un iSGLT2 o un agonista del receptor de GLP-1 (AR GLP-1), ´éste último especialmente en presencia de sobrepeso, obesidad o HbA1c marcadamente elevada.En caso de control glucémico inadecuado pese al uso de antidiabéticos orales, se recomienda como primera opción la adición de un AR GLP-1, particularmente en pacientes con índice de masa corporal (IMC) > 27 kg/m². La adición de insulina basal se sugiere cuando no se logra el control con AR GLP-1.En el contexto de diabetes tipo 2 asociada a sobrepeso u obesidad, se aconseja el uso de AR GLP-1 o agonistas duales GLP-1/GIP. En personas con obesidad grado 2 o superior, puede considerarse la cirugía metabólica o bariátrica, siempre que esté acompañada de educación, evaluación individual del riesgo-beneficio y sea realizada en centros de referencia especializados.Las terapias cardiorrenoprotectoras (iSGLT2, AR GLP-1, finerenona) deben priorizarse e iniciarse de manera independiente al grado de control glucémico o a la terapia concomitante, en personas con enfermedad cardiovascular aterosclerótica, insuficiencia cardíaca o enfermedad renal crónica, según el perfil clínico individual.Se recomienda el uso de sistemas de monitoreo continuo de glucosa (MCG en tiempo real) en pacientes que reciben múltiples dosis de insulina y presentan hipoglucemias o control glucémico inadecuado.Finalmente, se enfatiza la importancia de la educación diabetológica continua y del enfoque multidisciplinario en el manejo integral de todas las personas con diabetes tipo 2.Conclusiones: esta guía constituye una herramienta práctica y rigurosa para la atención integral de la DM2 en Colombia, con recomendaciones adaptadas al contexto nacional y con alto potencial para mejorar la calidad de vida y reducir la carga de la enfermedad.