INTRODUCTION:Despite numerous definitions and theoretical models, healthy living remains conceptually fragmented, lacking a unified framework capturing its dynamic, multilevel, and life-course nature. We systematically identify and conceptually analyse definitions and theoretical models of healthy living (1) to characterise heterogeneity in definitions, dimensions, antecedents, and consequences, (2) to develop a typology, and (3) to propose a unifying conceptual model. METHODS:We conducted a systematic review with an embedded concept analysis. Embase, Medline, Cochrane Central, Web of Science, CINAHL, LILACS, and Google Scholar were searched from inception to May 18, 2025, without restrictions, following PRISMA 2020 guidelines. Eligible studies included conceptual analyses or theoretical models explicitly defining healthy living; empirical studies without conceptual grounding were excluded. Systematic review methods governed study identification, selection, and data extraction. Following this mapping stage, the Walker and Avant framework was applied to synthesise attributes, antecedents, and consequences, integrated with iterative thematic analysis. RESULTS:Of 10,067 records screened, 36 studies (1991-2025; 18 countries) were included. Definitions and theoretical justifications were highly heterogeneous. Nine conceptual dimensions and six categories of antecedents emerged, with most models emphasising physical, behavioural, and cognitive dimensions and individual-level determinants, while interactions across dimensions were rarely specified. Five major model types and ten subtypes emerged. We define healthy living as a dynamic, multidimensional life-course process integrating behavioural-physical, cognitive-psychological, social-relational, and contextual-structural dimensions. CONCLUSION:This study addresses longstanding conceptual fragmentation and proposes a four-dimensional model of healthy living, providing a foundation for theory, measurement, intervention design, and policy.
Wound management remains a fundamental component of plastic and reconstructive surgery [1]. Among the available treatment options, autologous fat grafting has gained attention due to its ability to support soft-tissue regeneration, enhance revascularization, and modulate immune responses through the secretion of bioactive molecules, cytokines, and growth factors [2]. It also provides anti-inflammatory, proangiogenic, and regenerative effects, which are particularly valuable in treating conditions affecting the hand and upper extremity [1,3]. Human adipose tissue represents a highly suitable implantable biomaterial owing to its rich reservoir of bioactive substances, such as extracellular matrix constituents, diverse growth factors, and stem or progenitor cell populations [2]. The present case illustrates how the use of autologous fat grafts as a biological dressing in a patient with a third-degree thermal burn and extensor tendon exposure in the hand resulted in favorable wound bed evolution and effective preparation for subsequent skin grafting. We present the case of a 47-year-old female patient with a 25 cm² soft-tissue defect on the dorsum of the left hand secondary to a third-degree thermal burn caused by contact with a metal sheet, with tendon exposure of the extensor mechanism of two fingers. The defect was managed using decanted autologous fat grafts, without centrifugation, serving as a "bioactive scaffold." Tissue quality was evaluated pre- and postoperatively using the POSAS (Patient and Observer Scar Assessment) scale and photographic comparison. The treatment resulted in defect contraction and healthy granulation tissue formation, with satisfactory clinical progression documented through images and scar assessment scores. Positive changes were observed in the POSAS scale, with improvements in vascularity, pigmentation, elevation, surface roughness, tissue flexibility, and wound surface area, including significant contraction of the wound and reductions in pain and pruritus. No complications were reported. Vascularity improved by 70% compared to the initial assessment, while pigmentation, volume, and roughness each improved by 50%. Flexibility showed a 60% improvement. The functional capacity of the hand was evaluated at the fourth postoperative month, showing a QuickDASH score of 2.3/100, indicating adequate hand rehabilitation [4]. Autologous fat grafting represents a safe, accessible, abundantly sourced, low-morbidity, simple technique to obtain, and a cost-effective surgical option for the treatment of complex wounds, particularly in the hand [5]. Its regenerative, angiogenic, and anti-inflammatory properties promote high-quality tissue formation, enhanced granulation, and wound contraction, ultimately improving both functional and aesthetic outcomes. In the clinical case presented, fat grafting enabled effective tendon coverage and preparation of the wound bed for skin grafting, as confirmed by objective improvements in POSAS scores. These findings highlight its potential for broader clinical application and integration into wound care protocols.
Candida infections remain a major challenge in intensive care units (ICUs), where host factors, invasive interventions, broad-spectrum antimicrobial use, and ICU-related selective pressures promote fungal colonization and invasive disease. We investigated yeast colonization dynamics, species distribution, antifungal susceptibility and associated risk factors in 329 critically ill patients. Overall, 262 patients (79.6%) became colonized with Candida spp, and candidiasis developed in 26 (7.9%). We recovered 880 yeast isolates; 207 were identified by both MALDI-TOF MS and ITS sequencing, demonstrating high concordance (96.7%, κ = 0.93). C. albicans, C. tropicalis and C. parapsilosis predominated. Longitudinal analysis of 568 isolates showed a significant shift in species composition over time (p = 0.031), despite stable alpha diversity, with modest but significant changes in beta diversity. Most taxa declined at follow-up, with variation across anatomical sites. In 78% of candidiasis cases, the causative species had been detected during prior colonization, with higher predictive value when detected closer to disease onset. Overall, 11.2% of isolates showed resistance to at least one antifungal agent according to clinical breakpoints, while most exhibited a wild-type phenotype according to epidemiological cutoff values. These findings indicate that ICU Candida colonization is highly prevalent, temporally dynamic and clinically informative, with site-specific and time-dependent shifts that anticipate invasive disease. Integrated longitudinal surveillance and accurate species-level identification may improve risk stratification, inform antifungal stewardship and support infection prevention strategies in critically ill patients.
Lower limb ulcers, especially in patients with diabetes mellitus, represent a major therapeutic challenge, particularly when complicated by severe infections such as necrotizing fasciitis. These conditions often require extensive surgical interventions, including amputation. We present the case of a 68-year-old female patient with poorly controlled type 2 diabetes mellitus who developed extensive necrotizing fasciitis in the left lower limb following trauma with plant material, resulting in a large soft tissue defect. The patient was not a candidate for regional or distant flaps due to her non-revascularizable micro- and macroangiopathic disease. A prior CT angiography showed complete occlusion of the anterior and posterior tibial arteries, evaluated by Orthopedics, who indicated amputation of the limb. Due to the patient's refusal to undergo amputation, autologous millifat grafts were selected for the salvage treatment strategy. This case highlights the potential of this technique as a limb salvage tool, demonstrating its effectiveness in complex clinical scenarios by promoting tissue regeneration and avoiding major ablative procedures.
La terapia de vacío endoluminal (Endo-Vac) podría ser una alternativa prometedora en el manejo endoscópico de fístulas o perforaciones gastrointestinales de difícil tratamiento. No obstante, uno de los obstáculos para su implementación es el alto costo asociado. Es por eso que se han desarrollado técnicas modificadas que emplean materiales de fácil adquisición y menor precio. En el presente reporte de caso, se describe el cierre endoscópico exitoso de una fístula anastomótica colorrectal mediante una técnica modificada de la terapia Endo-Vac. Se concluye que, a pesar de utilizar materiales distintos a los convencionales, esta opción podría representar una alternativa eficaz y de menor costo para el cierre de complicaciones anastomóticas, lo que facilita su implementación en entornos con limitaciones económicas.
