Enhancing Primary Health Care through Interprofessional education: Insights from a Training Workshop.

Introduction: Strengthening primary care services with a focus on comprehensive Primary Health Care principles necessitates collaborative work practices within interprofessional teams. In Italy, the Local Health District of Florence embodies a comprehensive Primary Health Care -inspired model of primary care, prominently featuring the House of Community concept. This work presents findings and insights from a multidisciplinary, interprofessional education activity tailored for healthcare professionals, researchers, and students actively participating in the primary care reorganization. Methods: The activity was structured using a four-phase learning model (imaginative, analytical, common sense, and dynamic), aligning with four distinct activities (brainstorming, lecture, case study, and group project). Results: Key themes that emerged encompassed the significance of nurturing relationships among team members, the aspiration for an inclusive work environment, the vital role of community engagement and collaboration across various services, disciplines, and sectors beyond healthcare. Discussion: These themes highlight the essential attributes of successful primary care practices built on the principles of comprehensive comprehensive Primary Health Care. Throughout the innovation process of primary care services, interprofessional education training events emerged as indispensable components for bolstering implementation and ensuring sustainability. This study underscores the crucial role of interprofessional education in bridging the gap between theoretical constructs and practical application, emphasizing that comprehensive Primary Healthcare principles find tangible manifestation in real-world scenarios.

Preliminary Evaluation of Cortical and Medullary Echogenicity in Normal Canine Fetal Kidneys during the Last 10 Days of Pregnancy.

The objective of this study was to assess changes in the echogenicity of the cortex and medulla of canine fetal kidneys in relation to days before parturition (dbp), maternal size and litter size. Monitoring of 10 healthy pregnant bitches (2-8 years old, 8.8-40.3 kg bw) was conducted from -10 to 0 dbp using ultrasound. A single renal sonogram was obtained by scanning in a longitudinal section the three most caudal fetuses. The mean gray level (MGL) and SD of a manually drawn region of interest (ROI) in the renal cortex and medulla were measured using the Fiji Image J software (Image J 1.51h, Java 1.6 0_24 64 bit). A linear mixed model taking into account the maternal size as a fixed effect, dbp and litter size as covariates and the bitch as a random and repeated effect was used. The regression coefficients (b) were estimated. Cortical SD (C-SD) and cortico-medullary SD (C/M-SD) were influenced by dbp, with a significant decrease at the approaching day of parturition (b = 0.23 ± 0.06, p < 0.001 and b = 0.5 ± 0.02, p = 0.038, respectively). Maternal size had a significant impact on C/M-MGL with differences observed in large-sized (1.95 ± 0.13) compared to small- (1.41 ± 0.10, p = 0.027) and medium-sized bitches (1.51 ± 0.09, p = 0.016). The C/M-MGL was influenced by litter size, showing a decrease as the number of pups increased (b = -0.08 ± 0.03, p = 0.018). C-SD and C/M-SD were exclusively affected by dbp, and not by maternal and litter size. This suggests their potential as valuable parameters, warranting further investigations in future studies.

The Activity of Special Continuity Care Units in the City of Florence During the COVID-19 Pandemic.

Objectives: Worldwide, countries adopted different strategies in primary care (PC) to cope with the COVID-19 pandemic. This study aims to describe and evaluate the functions and activity load of a specific PC organizational model called "Special Continuity Care Units" (SCCU) in Florence, Italy, and to investigate the characteristics of the COVID-19 patients assisted by the service. Methods: The retrospective cross-sectional design used daily updated reports by SCCU team members to evaluate the activity load. The retrospective cohort study analyzed data of the demographics, clinical characteristics, and process outcomes of patients assisted during the second pandemic wave. Results: The analysis shows how the service activity load changed along with the epidemiological trend. Regarding people assisted by the SCCU, the median follow-up duration of symptoms was 6 days; male gender and being symptomatic were predictors of hospitalization. Conclusion: Some key characteristics can be described as indispensable in PC services facing health emergencies: model flexibility, the availability of resources, networking among services to enhance coordination and resource optimization, and close collaboration with general practitioners.

How to promote changes in primary care? The Florentine experience of the House of Community.

Primary care (PC) has a central role in promoting health and preventing diseases, even during health emergencies. The COVID-19 pandemic has shown how strengthening comprehensive primary healthcare (c-PHC) services is key to ensuring community health. The Italian government decided to support PHC by investing resources from the Next Generation EU (NextGenEu) plan in the development of local health districts (LHDs) and local PC centers called "Houses of Community (HoC)". The Florence LHD (Tuscany)-in direct collaboration with the University of Florence-has represented the experimental context in which a c-PHC-inspired organizational model has been proposed and included the HoC as the nearest access point to PC services. Through multiprofessional collaboration practices, HoCs provide continuity of care as well as health and social integration. Different levels of action must coexist to initiate, implement, and sustain this new PC model: the organizational and managerial level, the experimentation of a new model of care, and the research level, which includes universities and LHD through participatory research and action approaches. This process benefits from health professionals' (HPs) participation and continuous assessment, the care for working relationships between HPs and services, an appropriate research methodology together with a "permeable" multidisciplinary research group, and educational programs. In this context, the HoC assumes the role of a permanent laboratory of experimentation in PC, supporting the effectiveness of care and answering what the Next Gen EU plan has been foreseeing for the rethinking of Italian territorial services.

Clinical use of the canine foetal kidney formula in dogs of different maternal sizes during the last ten days before parturition.

Data concerning the use of the canine foetal kidney length (L) formula in the prediction of parturition timing are still lacking. In our study, we aimed to evaluate the accuracy of the L formula in predicting the parturition date during the last 10 days of pregnancy. Twenty-five clinically healthy pregnant bitches, aged 2-9 years and weighing 3.5-52.2 kg, were ultrasonographically monitored from -11 to 0 days before parturition (dbp). Kidney L was measured for the three most caudal foetuses, and the parturition day was estimated using the kidney formula, whose accuracy was calculated as the percentage of cases estimated (ranges of ± 1 or ± 2 days) on the actual parturition date. A K-proportions test was performed to identify differences in the accuracy among maternal sizes and the sex ratio of pups, and a two-proportions z-test was performed to identify differences between litter size classes (≤ 7 vs. > 7 pups) and time ranges (-11/-5 and -4/0 dbp). An accuracy of 35% within ± 2 days was found in the range of -11/-5 dbp and an accuracy of 30% within ± 2 days was found in the range of -4/0 dbp. The accuracy differed between small (53% ±1 day and 60% ±2 days) and large (10% within ± 1 and ± 2 days) bitches (P = 0.019 within ± 1 day, and P = 0.007 within ± 2 days). For small litter sizes, the accuracy was 38% within ± 1 day and 44% within ± 2 days, and for large litter sizes, it was 14% within ± 1 and ± 2 days. A threshold value was found between litter size classes within ± 2 days. The use of the L formula during the last ten days of pregnancy did not seem to warrant good accuracy in the prediction of parturition date. Further studies on different maternal sizes should be performed.

Chronic Use of Deslorelin in Dogs: Six Cases (2005-2022).

Deslorelin is currently registered for the induction of temporary infertility in male dogs, male cats, male ferrets, and also prepubertal female dogs, but research has shown its usefulness for other conditions requiring chronic treatment. This paper presents six cases of dogs chronically treated with deslorelin for indications such as benign prostatic hyperplasia, control of fertility, abnormal reproductive behavior and urinary incontinence. All animals were in good health during treatment. Treatment duration was 2-9 years. No short-term side effects were observed except for flare-up reactions, which were observed only in 1/4 intact males. Two dogs developed a neoplasia: a spayed bitch treated for urinary incontinence developed a pituitary carcinoma, and an intact male dog implanted for control of fertility developed a bladder carcinoma. While the pituitary carcinoma seems unlikely to be related to deslorelin, the bladder carcinoma could be due to the neutered condition of the dog (which was treated for 9 years) as urinary tract neoplasia is more common in dogs following gonadectomy. Chronic treatment with deslorelin is regarded as safe when an animal is being treated for life. The possibility that a pause in the treatment might be helpful for the animal should be investigated.

Artificial intelligence for precision medicine in autoimmune liver disease.

Autoimmune liver diseases (AiLDs) are rare autoimmune conditions of the liver and the biliary tree with unknown etiology and limited treatment options. AiLDs are inherently characterized by a high degree of complexity, which poses great challenges in understanding their etiopathogenesis, developing novel biomarkers and risk-stratification tools, and, eventually, generating new drugs. Artificial intelligence (AI) is considered one of the best candidates to support researchers and clinicians in making sense of biological complexity. In this review, we offer a primer on AI and machine learning for clinicians, and discuss recent available literature on its applications in medicine and more specifically how it can help to tackle major unmet needs in AiLDs.

Ultrasonographic changes in fetal gastrointestinal motility during the last ten days before parturition in dogs.

Fetal gastrointestinal motility (FGM) was suggested as useful to assess fetal maturity. Our study aimed to quantify FGM in relation to days before parturition (DBP), maternal size, and sex ratio of pups. During the last ten days of pregnancy, 23 clinically healthy pregnant bitches of 16 different breeds ranging in age from 2 to 9 years and body weight from 3.5 to 56.8 kg were monitored twice. The fetal intestine was observed in longitudinal and transversal scan on 3 of the most caudal fetuses in both uterine horns. Gestational age was counted backward from parturition day. The number of fetuses showing FGM was recorded in time in I (-11/-5 DBP) and II (-4/0 DBP). A Mann-Whitney test was performed to analyze variations of FGM% in relation to time and parity. A Kruskal-Wallis test was performed to identify variations of FGM% in relation to maternal size and sex ratio. Statistical significance was set at α = 0.05. A total of 147 FGM observations on 50 ultrasonographic monitoring points were performed. The FGM% was higher during time II compared to time I (median: 33%, range 0-100% vs. 100%, range 33-100%; P < 0.0001). FGM% was higher in small compared to large size bitches (median: 100%, range 67-100% vs. 67%, range 0-100%; P = 0.01). FGM% was not affected by parity and sex ratio. As previously reported, a significant increase in FGM% was observed in the last five DBP. FGM observation may be influenced by the maternal size, with easier evaluation in small size bitches, as well as ultrasound equipment and positioning.

Relationship between days before parturition and fetal kidney length, cortical thickness, medullary thickness and their ratio in dogs.

Canine gestational age can be estimated based on fetal kidney length (L) although accuracy, sensitivity and specificity decrease during the last 5 days of pregnancy. In humans, fetal renal cortical and medullary thickness (CT and MT) and their ratio (CT/MT) are described as useful tools for monitoring the development of fetal kidneys. The aim of this study was to evaluate a potential relationship between canine fetal kidney parameters and gestational age. Ten clinically healthy pregnant bitches of different breeds were monitored by ultrasound at least twice from -10 to 0 days before parturition (dbp). L, CT, MT and CT/MT were measured on the three most caudal fetuses of both uterine horns. Statistical analysis was performed using a linear mixed model considering maternal size (small ≤10 kg, N = 4, medium 11-25 kg, N = 3, and large 26-40 kg, N = 3) as fixed effect, dbp (-10 to 0) and litter size as covariates, and the bitch as a random and repeated effect. Dbp and L, CT, MT showed a negative and linear correlation, and their estimated regression coefficients were -0.68 ± 0.14, -0.04 ± 0.01 and -0.12 ± 0.02 mm, respectively (P < 0.01). CT/MT decreased as parturition approached, whereas MT and CT increased. A statistically significant difference was found for L between small and large bitches (17 ± 1 vs 24 ± 2 mm, P = 0.03) and, for CT, between small, medium and large bitches (1.57 ± 0.04 vs 1.77 ± 0.04 vs 1.99 ± 0.05 mm, P < 0.001). None of the renal parameters were affected by litter size. L, CT, MT and CT/MT are related to dbp and may be considered for predicting parturition in dogs.

Analytical and clinical performance of a fluorescence enzyme immunoassay for progesterone and determination of ovulation day in bitches.

We evaluated the performance of a third-generation fluorescence enzyme immunoassay kit (FEIA; Tosoh Bioscience) for progesterone (P4) measurement in canine serum to identify the day of luteinizing hormone (LH) peak and ovulation in bitches. We conducted P4 assays on 54 serum samples using a FEIA and a chemiluminescence immunoassay (CLIA; Siemens). For the FEIA kit, the linearity test, recovery test, inter- and intra-assay CVs, and total error observed (TEo) were calculated. Serum samples from 28 bitches were used to evaluate the association of P4 concentration with the day of LH peak and the day of ovulation based on P4 thresholds (P4 ≥ 2 ng/mL, and doubling at 4-8 ng/mL in the following 48 h), and with pregnancy length. Linearity was 75-97% and 86-94% for high (37.0 ng/mL) and medium (3.8 ng/mL) pool serum samples, respectively. Recovery was 86.4-119%. Intra-assay CVs were 2.6%, 3.3%, and 5.2% for low (0.23 ng/mL), medium (6.24 ng/mL), and high (38.3 ng/mL) pool concentrations. Inter-assay CVs were 2.22% and 2.53% for P4 concentrations of 2.70 ng/mL and 8.2 ng/mL, respectively. TEo was 8.72% and 22.7% for P4 concentrations of 2 and 8 ng/mL, respectively. The mean pregnancy length from the day of LH peak and ovulation were 64.6 ± 1.7 and 63.3 ± 1.1 d, respectively. The third-generation FEIA kit that we tested was highly reliable.

Dysregulation of the Scribble/YAP/ß-catenin axis sustains the fibroinflammatory response in a PKHD1-/- mouse model of congenital hepatic fibrosis.

Congenital hepatic fibrosis (CHF), a genetic cholangiopathy characterized by fibropolycystic changes in the biliary tree, is caused by mutations in the PKHD1 gene, leading to defective fibrocystin (FPC), changes in planar cell polarity (PCP) and increased ß-catenin-dependent chemokine secretion. In this study, we aimed at understanding the role of Scribble (a protein involved in PCP), Yes-associated protein (YAP), and ß-catenin in the regulation of the fibroinflammatory phenotype of FPC-defective cholangiocytes. Immunohistochemistry showed that compared with wild type (WT) mice, in FPC-defective (Pkhd1del4/del4 ) mice nuclear expression of YAP/TAZ in cystic cholangiocytes, significantly increased and correlated with connective tissue growth factor (CTGF) expression and pericystic fibrosis, while Scribble expression on biliary cyst cells was markedly decreased. Cholangiocytes isolated from WT mice showed intense Scribble immunoreactivity at the membrane, but minimal nuclear expression of YAP, which conversely increased, together with CTGF, after small interfering RNA (siRNA) silencing of Scribble. In FPC-defective cholangiocytes, inhibition of YAP nuclear import reduced ß-catenin nuclear expression, and CTGF, integrin ß6, CXCL1, and CXCL10 mRNA levels, whereas inhibition of ß-catenin signaling did not affect nuclear translocation of YAP. Notably, siRNA silencing of Scribble and YAP in WT cholangiocytes mimics the fibroinflammatory changes of FPC-defective cholangiocytes. Conditional deletion of ß-catenin in Pkhd1del4/del4  mice reduced cyst growth, inflammation and fibrosis, without affecting YAP nuclear expression. In conclusion, the defective anchor of Scribble to the membrane facilitates the nuclear translocation of YAP and ß-catenin with gain of a fibroinflammatory phenotype. The Scribble/YAP/ß-catenin axis is a critical factor in the sequence of events linking the genetic defect to fibrocystic trait of cholangiocytes in CHF.

LSEA Evaluation of Lipid Mediators of Inflammation in Lung and Cortex of Mice Exposed to Diesel Air Pollution.

Airborne ultrafine particle (UFP) exposure is a great concern as they have been correlated to increased cardiovascular mortality, neurodegenerative diseases and morbidity in occupational and environmental settings. The ultrafine components of diesel exhaust particles (DEPs) represent about 25% of the emission mass; these particles have a great surface area and consequently high capacity to adsorb toxic molecules, then transported throughout the body. Previous in-vivo studies indicated that DEP exposure increases pro- and antioxidant protein levels and activates inflammatory response both in respiratory and cardiovascular systems. In cells, DEPs can cause additional reactive oxygen species (ROS) production, which attacks surrounding molecules, such as lipids. The cell membrane provides lipid mediators (LMs) that modulate cell-cell communication, inflammation, and resolution processes, suggesting the importance of understanding lipid modifications induced by DEPs. In this study, with a lipidomic approach, we evaluated in the mouse lung and cortex how DEP acute and subacute treatments impact polyunsaturated fatty acid-derived LMs. To analyze the data, we designed an ad hoc bioinformatic pipeline to evaluate the functional enrichment of lipid sets belonging to the specific biological processes (Lipid Set Enrichment Analysis-LSEA). Moreover, the data obtained correlate tissue LMs and proteins associated with inflammatory process (COX-2, MPO), oxidative stress (HO-1, iNOS, and Hsp70), involved in the activation of many xenobiotics as well as PAH metabolism (Cyp1B1), suggesting a crucial role of lipids in the process of DEP-induced tissue damage.

A case report of a rapid development of fetal anasarca in a canine pregnancy at term.

A 5-year-old healthy pluriparous pregnant Flat-coated Retriever bitch was monitored by ultrasound on post-ovulation days 30 and 57: no deviation from normality picture were observed. On day 60, one of the three most caudal fetuses showed ultrasonographic signs of fetal anasarca: subcutaneous edema and anechoic fluid in thoracic and abdominal cavities. There was an increased volume of extra-fetal fluids. On day 64 a Cesarean section was performed and one of the seven pups that were delivered, a female, showed generalized subcutaneous edema and died soon after birth. She weighed 660 g, compared to a mean of 472 g for the other 6 normal fetuses. A total of 295, 40 and 27.5 mL of liquid were collected from subcutaneous tissue, abdominal and thoracic cavity, respectively. Liver showed sub-glissonian necrotic areas. Molecular analyses with PCR method for canine Herpesvirus, Parvovirus, Adenovirus, Leptospira interrogans, Chlamydia spp., Neospora caninum and Toxoplasma gondii from pools of organs (spleen, kidney and brain) and pleural effusion tested negative. This is the first reported case of fetal anasarca with a rapid onset diagnosed on day 60 post-ovulation just three days after observing a normal ultrasonographic pattern in Flat-coated Retriever. Ultrasonographic diagnosis of fetal anasarca is of primary importance when assisting parturition, due to its inherent risk of dystocia. Ultrasonographic monitoring in the immediate prepartum period may be useful in all breeds as it may help to detect ultrasonographic alterations occurring right before term such as anasarca.

Usefulness of Maternal and Fetal Parameters for the Prediction of Parturition Date in Dogs.

An accurate parturition timing is of key importance for breeders and veterinarians in order to give professional assistance to parturition in dogs. However, pregnancy length calculated from the breeding date has a wide variability. Different parameters and formulas have been described and calculated, as well as their accuracy which is affected by various factors: stage of pregnancy, litter and maternal size. Therefore, the selection of the most appropriate parameter panel poses the challenge of weighing their influences and impact on the overall accuracy. The aim of this review is to analyze the parameters useful for parturition timing, especially their accuracy, and to propose the addition of fetal maturity and criteria for its evaluation to detect readiness for parturition. Parameters, as described in literature, are classified as: (i) maternal parameters, (ii) fetal parameters, (iii) ultrasonographic assessment of maternal and fetal heart rate and blood flow, (iv) parameters indicating fetal maturity. A focus on recently described parameters-such as fetal gastrointestinal motility and fetal lung development detected by quantitative ultrasound-is reported. Currently, the most accurate way to predict parturition day is represented by a prepartum progesterone drop, but the identification of a panel of ultrasonographic parameters combining their significance and their accuracy throughout pregnancy is still needed.

Salmon oil supplementation in dogs affects the blood flow of testicular arteries.

The administration of fish oils is known to cause changes in several reproductive parameters of domestic animals. The ingestion of polyunsaturated fatty acids (PUFAs) of the omega-3 family, such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), has been described and correlated with changes in the semen quality, testosterone levels and male fertility. Nevertheless, few studies monitored and registered effects after ceasing supplementation. In the present study, we monitored the Doppler velocimetric and ultrasonographic parameters of nine dogs' testis for 90 days (D90) checking the effect of salmon oil supplementation, and monitoring continued for 60 days more, after ceasing supplementation (D150). Ultrasonographic evaluations comprised determining the Doppler velocimetric parameters, testicular and epididymal volume, and testicular echotexture. Peak systolic velocity (PSV) as well as final diastolic velocity (EDV) in the supratesticular arteries (STA), and marginal artery (MA) increased during the period of treatment and kept that level up to D150. There was no difference between the fish-oil supplementation period and the unsupplemented one regarding the testicular and epididymal volume and echogenicity and heterogeneity characteristics. A negative correlation was found between heterogeneity of testis and sperm production (r = -.41, p = .008). Doppler velocimetry indices were affected by the supplementation, leading to an increase in testicular blood flow.

Effect of sterilization on the canine vaginal microbiota: a pilot study.

BACKGROUND: Surgical sterilization is the most effective method of contraception for dogs. It also prevents pyometra and reduces the risk of mammary tumour development. However, this procedure also has negative effects, such as urinary incontinence. Steroid hormone deprivation following gonadectomy could also affect canine vaginal mucosa conditions and the microbial community colonizing the vaginal tract. This hypothesis was tested by comparing the vaginal cytology and microbial community of two groups of bitches, including 11 in anoestrus and 10 sterilized bitches (post-pubertal sterilization in the last 4 years). Bacteria were identified through metataxonomic analysis, amplifying the V3-V4 regions of 16S rRNA gene, and culturing methods. RESULTS: Vaginal mucosa cytology was suggestive of dystrophic conditions in sterilized bitches, whereas a typical anoestrus pattern with parabasal and intermediate cells was appreciable in anoestrous animals. Metataxonomic analysis revealed large inter-individual variability. Salmonella, Mycoplasma and Staphylococcus were present in moderate quantities in almost all the samples in both groups. Mollicutes (class level) and Tenericutes (phylum level) were commonly present in moderate quantities in anoestrus samples, whereas these microbes were present at high levels in a single sample from the sterilized group. Based on culturing, a higher number of different species were isolated from the anoestrous bitches, and Mycoplasma canis was exclusively identified in an anoestrous bitch. Staphylococcus spp. was the most frequently isolated genus in both groups, followed by Streptococcus spp., and, among gram-negative bacteria, Escherichia spp. and Haemophilus spp. A comparison of the numbers of the most frequently isolated genera of bacteria from vaginal cultures of bitches revealed that Pasteurella and Proteus were the most frequently identified in sterilized animals based on metataxonomic analysis (p-value = 0.0497 and 0.0382, respectively), whereas Streptococcus was significantly and most frequently isolated from anoestrous bitches using culture methods (p value = 0.0436). CONCLUSIONS: In this preliminary investigation, no global patterns of the vaginal bacteria community were noted that characterized the condition of the bitches; however, cytology suggested local modifications. Sterilization after puberty caused minimal alterations in the vaginal microbial community of bitches within 4 years after surgery.

The Immunological Basis of Liver Allograft Rejection.

Liver allograft rejection remains a significant cause of morbidity and graft failure in liver transplant recipients. Rejection is caused by the recognition of non-self donor alloantigens by recipient T-cells. Antigen recognition results in proliferation and activation of T-cells in lymphoid tissue before migration to the allograft. Activated T-cells have a variety of effector mechanisms including direct T-cell mediated damage to bile ducts, endothelium and hepatocytes and indirect effects through cytokine production and recruitment of tissue-destructive inflammatory cells. These effects explain the histological appearances of typical acute T-cell mediated rejection. In addition, donor specific antibodies, most typically against HLA antigens, may give rise to antibody-mediated rejection causing damage to the allograft primarily through endothelial injury. However, as an immune-privileged site there are several mechanisms in the liver capable of overcoming rejection and promoting tolerance to the graft, particularly in the context of recruitment of regulatory T-cells and promotors of an immunosuppressive environment. Indeed, around 20% of transplant recipients can be successfully weaned from immunosuppression. Hence, the host immunological response to the liver allograft is best regarded as a balance between rejection-promoting and tolerance-promoting factors. Understanding this balance provides insight into potential mechanisms for novel anti-rejection therapies.

Impact of the Built Environment and the Neighborhood in Promoting the Physical Activity and the Healthy Aging in Older People: An Umbrella Review.

(1) Background: The aim of this study is to establish which specific elements of the built environment can contribute to improving the physical activity of self-sufficient, noninstitutionalized and living in the city adults > 65 years. (2) Methods: An extensive literature search was conducted in several database. Umbrella review methodology was used to include the reviews that presented a sufficient methodological quality. (3) Results: Eleven reviews were included. The elements positively associated with physical activity in older adults were: walkability; residential density/urbanization; street connectivity; land-use mix-destination diversity; overall access to facilities, destinations and services; pedestrian-friendly infrastructures; greenery and aesthetically pleasing scenery; high environmental quality; street lighting; crime-related safety; traffic-related safety. The elements that were negatively associated with physical activity were: poor pedestrian access to shopping centers; poor pedestrian-friendly infrastructure and footpath quality; barriers to walking/cycling; lack of aesthetically pleasing scenery; crime-related unsafety; unattended dogs; inadequate street lighting and upkeep; traffic; littering, vandalism, decay; pollution; noise. (4) Conclusions: Evidence shows that specific elements of the built environment can contribute to promoting older people's physical activity. The city restructuring plans should take into consideration these factors.

Health System Response during the European Refugee Crisis: Policy and Practice Analysis in Four Italian Regions.

The decentralization of the provision of health services at the subnational level produces variations in healthcare offered to asylum seekers (ASs) across the different Italian regions, even if they are entitled to healthcare through the national health service. The present study aims to map the healthcare path and regional policies for ASs upon arrival and identify challenges and best practices. This is a multicentric, qualitative study of migrant health policies and practices at the regional level within four Italian regions. For the analysis, a dedicated tool for the systematic comparison of policies and practices was developed. The collection and analysis of data demonstrated the presence of many items of international recommendations, even if many gaps exist and differences between regions remain. The analysis of practices permitted the identification of three models of care and access. Some aspects identified are as follows: fragmentation and barriers to access; a weakness in or lack of a governance system, with the presence of many actors involved; variability in the response between territories. The inclusion of ASs in healthcare services requires intersectoral actions, involving healthcare sectors and other actors within local social structures, in order to add value to local resources and practices, reinforce networks and contribute to social integration.

Ultrasonographic analysis of fetal gastrointestinal motility during the peripartum period in the dog.

The aim of this study was to investigate fetal gastrointestinal motility (FGM) of dogs using ultrasonic imaging and its association with vaginal and rectal temperature, serum progesterone concentrations and fetal heart rate. Pregnant bitches were examined after day 54 of gestation and there were determinations of vaginal and rectal temperature and serum progesterone concentrations. The fetal abdomen was evaluated for 30 s using longitudinal and transversal assessments, and FGM was scored as 0 (no peristalsis) or 1 (evident peristalsis). Number of fetuses with a 1 or 0 score were determined for each bitch (number and the percentage of fetuses with FGM). A total of 135 FGM measurements were recorded. There was FGM in 0/3, 0/6, 1/6 (16.7 %), 3/20 (15 %), 5/18 (27.3 %), 18/28 (64.3 %), 12/17 (70.6 %), 14/22 (63.6 %), 6/9 (66.7 %), 4/6 (66.7 %) fetuses from day -9 until 0 preceding parturition, respectively. In the last 5 days before parturition, 63.3 % of fetuses had FGM. Vaginal and rectal temperature were strongly and positively correlated (P < 0.001). Vaginal temperature was positively correlated with progesterone concentrations and fetal heart rate (P < 0.01), and there was a small negative correlation with FGM (r = -0.331, P < 0.05). Due to ease of data collection, the assessment of FGM is a valuable procedure for evaluation of fetal maturity in dogs. Vaginal and rectal temperatures are reliable variables to be assessed during the last week of pregnancy for estimating the time of parturition.