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Context Arterial Hypertension (AH) and Diabetes Mellitus (DM) are diseases that are getting worse all over the world. Linked to this advance, is the growing digital health market with numerous mobile health applications, which aim to help patients and professionals in the proper management of chronic diseases. The aim of this study was to analyze, through a systematic review and meta-analysis, the effectiveness of using mobile health applications in monitoring AH and/or DM in the adult and elderly population. Methods The systematic review and meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metanalyses guidelines and involved searching five databases – Medline/PubMed, Embase, CINAHL, Virtual Library in Health and Cochrane Library. The review included randomized and cohort clinical trials testing the effects of the intervention on changing biochemical parameters and clinical efficacy in people treated for AH and/or DM. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain effect distribution between studies, by Stata® software (version 11.0) and publication bias was examined by visual inspection of graphs and Egger test. Results We included 26 studies in the systematic review and 17 in the meta-analysis. These studies were published between 2014 to 2022 in 14 countries. Were reported improvement in knowledge and self-management of AH and DM, social motivation with treatment and behavioral change, reduction in glycated hemoglobin values, fasting glucose and blood pressure, improvement in adherence to drug treatment, among others. The result of the meta-analysis showed that there is evidence that the use of mobile applications can help reduce glycated hemoglobin by 0.39% compared to the usual care group. Conclusions Monitoring and self-monitoring of behaviors and health care related to AH and DM in adults and the elderly through mobile applications, has clinically significant effectiveness in reducing glycated hemoglobin levels. Future studies should provide more evidence and recommendations for best practices and development of digital health interventions. Trial registration PROSPERO. International Prospective Registry of Systematic Reviews. CRD42022361928.

Background Multimorbidity is defined as the presence of two or more multifactorial diseases or conditions. In this context, the focus of this study is on arterial hypertension (AH) and diabetes, two chronic diseases with high global prevalence and incidence, whose clinical, physical, and behavioral factors must be critically analyzed over the long term, particularly within the primary care setting, where interventions are most effective and impactful. The objective of the study was to prospectively assess baseline levels of clinical, physical, and behavioral parameters and their changes over three years in adults and older adults with AH and/or diabetes receiving primary care. Methods A three-year prospective cohort study involving 357 individuals previously diagnosed with AH and/or diabetes. These individuals received an intervention based on general guidance regarding health care, healthy choices, and positive behavioral changes. This intervention took place at the beginning of the study (T0 – baseline) and at the end of the study (T1 – follow-up), and the patients were divided as follows: Group 1 (diabetes diagnosis only); Group 2 (AH only); and Group 3 (diabetes and AH). Changes in physical, clinical, anthropometric, and behavioral parameters among the groups were statistically analyzed between T0 and T1 using the Kruskal–Wallis H test and the chi-square test. Additionally, post hoc multiple comparisons were performed using Tukey’s test and Dunn’s test with Bonferroni adjustment. Effect sizes were estimated using Cohen’s d with corresponding 95% confidence intervals. Results Within-group comparisons revealed a significant reduction in physical activity levels in Group 2, while Group 3 showed improvements in HbA1c (d = − 0.40; p  = 0.034), SBP ( p  = 0.025), DBP ( p  = 0.003), and BMI ( p  = 0.003). Between-group comparisons at T1 indicated moderate to large differences in triglycerides (d = 0.53; p  = 0.009), which increased over the follow-up period and a significant difference in light physical activity (d = 0.35; p  = 0.043). Conclusions The results indicate that lifestyle improvements in patients diagnosed with hypertension and/or diabetes are associated with improvements in cardiometabolic indicators. Although group interventions are important, individualized approaches tend to promote better adherence and self-care, demonstrating that chronic disease management strategies in primary care can help reduce the burden on health care services. Trial registration Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-45hqzmf.

Background Technological advances based on mobile health (mHealth), the field of digital health (eHealth) aimed at managing health services and care and their concomitant transformations, have become increasingly important in the 21st century. In this context, care for individuals diagnosed with Chronic Non-Communicable Diseases (CNCDs) deserves to be highlighted. The aim of this study is to present the creation, development and implementation of the Telehealth Center of the Federal University of Viçosa (NUTELES - UFV), for the monitoring and management of health care for individuals with Arterial Hypertension (AH) and/or Diabetes Mellitus (DM). Methods This study, carried out in 2022 and 2023, involved 374 patients diagnosed with AH and/or DM in the health micro-region of Viçosa/MG, Brazil, comprising nine municipalities. The research aims to describe the creation, development and implementation of a software (NutelesApp) for the collection, storage, management and analysis of epidemiological research in public health, focusing specifically, on the monitoring and management of health care for individuals with AH and/or DM monitored by Primary Health Care (PHC). The parameters collected and analyzed were obtained through a questionnaire applied to patients, consisting of 70 questions, subdivided into 12 classes of questions. The epidemiological survey data was collected using mobile devices and analyzed using computer techniques based on statistical analysis. Once the field teams had completed their work, the files were transferred to servers for general analysis processing, using estimates of means, prevalence and respective standard errors, calculated using the Statistical Package for Social Science (SPSS) program, which takes into account the planning variables and includes the basic weights resulting from the sampling process. This study was approved by the Human Research Ethics Committee and registered, prior to recruitment, by the Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-45hqzmf (Last approval date: 11/30/2022). Results The information obtained through data collection with subsequent exploratory analysis of epidemiological data using the NutelesApp software suggests that mobile applications intended for the purpose of monitoring and managing healthcare for people with AH and/or DM should address the variables necessary to support a process of understanding the health conditions and/or disease of the individual as a whole and provide short- and long-term learning. Regarding the results of the survey using the software, the variables of 374 people were analyzed. Majority are female (73.2%) and white (43.5%). Most patients are elderly (average 64 years), with blood pressure levels within the normal range for this population, BMI indicates overweight, AC increased risk for cardiovascular events and CC within the recommendation value. All biochemical parameters analyzed were above normal limits. Conclusions The description of the creation and development of the software includes practical examples of its implementation, the results collected and its applicability in real scenarios, presenting determining criteria that can provide assertive and timely interventions for monitoring and managing the health and/or disease parameters of patients with HA and/or DM. In addition, the beneficial consequences of using this application will extend to health units and their respective management, improving the services provided by PHC and enhancing strategies and actions for health promotion and disease prevention.

Background: Brazil must make progress toward eliminating tuberculosis as a public health problem and achieving the goal of reducing treatment interruption to below 5%. Improving adherence requires a thorough understanding of the factors that influence this outcome. Objectives: To identify epidemiological, socioeconomic, and health service-related factors associated with tuberculosis treatment interruption in Brazilian municipalities from 2018 to 2022. Methods: This ecological study utilized secondary data from all Brazilian municipalities. Independent variables were organized into three blocks: epidemiological, health service coverage, and socioeconomic. A zero-inflated beta regression model was employed to analyze both the proportion and zero-inflated components. Results: The mean treatment interruption rate was 8.1%. Interruption was associated with the proportion of laboratory-confirmed cases, Family Health Strategy coverage, and the proportion of the population residing in rural areas. Tuberculosis incidence, sputum smear microscopy, molecular rapid tests, contact investigation, directly observed therapy, AIDS detection rate, Gini index, household crowding, and illiteracy were associated with treatment adherence. In the zero-inflated component, directly observed therapy, consultations per inhabitant, illiteracy, and the proportion of the population residing in rural areas increased the probability of a zero-interruption rate, whereas TB incidence, AIDS detection, municipal population, and household crowding decreased that probability. Conclusions: Tuberculosis treatment interruption in Brazil is shaped by socioeconomic, epidemiological, and health service factors, highlighting the need for integrated strategies that combine social protection with strengthened primary care to improve adherence and progress toward elimination goals.

Summary Background The growing discussion on teacher development focuses on diversified educational skills that promote knowledge and innovation in the teaching, learning and assessment process. With the Covid-19 scenario, this picture of necessary changes has become more evident, demonstrating the need for professional preparation to work in teacher development. The aim of the study was to analyze the effectiveness of teacher development programs for the training of university teachers in the health area, through a systematic review and meta-analysis. Methods The systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved searching five databases - PubMed-Medline, Education Resource Information Center (ERIC), SCOPUS, Embase and Web of Science. The review included randomized clinical trials and cohort studies that addressed the effectiveness of teaching professionalization in the health area for university professors. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain the distribution of effects between the studies, using Stata® software (version 11.0) and publication bias was examined by visual inspection of the graphs and Egger's test. Results We included 12 studies in the systematic review and 8 in the meta-analysis. These studies were published between 1984 and 2022 in 14 countries. Significant changes were reported in teachers' behavior to stimulate and encourage students, improvement in the quality of teaching and teaching staff, as well as improvement in skills such as leadership and self-evaluation. Furthermore, the result of the meta-analysis showed that there is evidence of the effectiveness of the positive effects of teacher development programs after their implementation, with this effect being 1.70% and an increase of 4.75 in the effect of these teacher development programs. Conclusion Our study shows that development programs have been implemented in different countries and contexts, all of which have proven to be effective in the short, medium and long term. We recommend that future research focus specifically on the different competencies that have been acquired following the implementation of these programs.

Background optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority. Methods we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox’s proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values. Results Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39–5.12), serum iron (HR = 8.396, 95% CI: 2.02–34.96), serum calcium (HR = 4.102, 95% CI: 1.35–12.46) and serum protein (HR = 4.630, 95% CI: 2.07–10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01–0.74), high ferritin values (HR = 0.392, 95% CI: 0.19–0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19–0.61) and serum albumin (HR = 0.230, 95% CI: 0.10–0.54) were less risk to die. Conclusion survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

•Non-nutrients are no-calorie substances able to modulate several metabolic pathways.•Non-nutrients have been demonstrated as an antioxidant and anti-inflammatory action.•Non-nutrients can reduce intestinal absorption of glucose and fat. Among the 10 leading causes of death in developed countries are chronic non-communicable diseases (NCDs). The effect of these multifactorial diseases on public health has stimulated considerable research aimed at investigating their primary risk factors (genetic factors, stress, food intake, and amount of physical exercise). Thus, healthful foods (e.g., fruits, vegetables, oils, grains, and seeds) are sources of bioactive compounds that promote good health and disease prevention. Among their components are non-caloric substances identified as non-nutrients (polyphenols, phytosterols, saponins, and phytates), which have been found to have a role in modulating metabolic pathways, maintaining health, and preventing NCDs. The aim of this study is to demonstrate and review the performance of some non-nutrients, such as their antioxidant and anti-inflammatory action, modulation of the antiatherogenic lipid profile (higher high-density lipoprotein cholesterol, lower oxidized low-density lipoprotein, and triacylglycerols), reduction of glucose and fat intestinal absorption, increase in insulin sensitivity, and stimulation of nitic oxide synthesis.

Context The need for curricular innovation, especially in university education, is incorporated into the agenda of universities for undergraduate health courses, whether through the models adopted in educational institutions, referenced by their curricula, or through traditional practices that still prevail in the 21st century as a form of teaching, to the detriment of innovative practices. With high retention and dropout rates in university courses, the contemporary scenario calls for the development of strategies to reorganize curricula that meet the new demands of student training, implementing new projects, programs, and/or tools that stimulate new teaching and learning processes. Therefore, the objective of this study was to analyze the evidence of the effectiveness of projects, programs, and/or strategies for curricular innovation in undergraduate health courses through a systematic review and meta-analysis. Methods The systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and were carried out in two stages: (a) search and selection and (b) analysis and evaluation. Eight databases were used: Cochrane Library; Education Resource Information Center (ERIC); Embase; Latin American and Caribbean Health Sciences Literature (LILACS); PubMed-Medline; SCOPUS; Scientific Electronic Library Online (SciELO); and Web of Science. The review included qualitative research, cohort studies, cross-sectional and quasi-experimental analytical studies that addressed evidence of the effectiveness of projects, programs, and/or strategies for curricular innovation in undergraduate health courses. The quality of the selected studies was assessed based on the Joanna Briggs Institute evaluation criteria. The meta-analysis was based on data on student satisfaction prevalence, self-efficacy, and academic performance. Publication bias was investigated by visual inspection of funnel plots and Egger’s test. Results Ninety-nine studies were included in the systematic review and 23 in the meta-analysis, covering publications from 1995 to 2024 in 19 countries, with a time span of almost three decades of studies on curricular innovations and evaluations in the health field, which provided an overview of the advances in this area. The interventions were classified into seven thematic areas: clinical simulation, interprofessional training, diversity and equity, assessment and feedback, educational leadership, humanistic education, and digital teaching. The studies analyzed highlighted that curricular innovations promote the improvement of critical skills, such as critical thinking, clinical reasoning, and interprofessional teamwork, in addition to increasing student satisfaction and engagement. Advances were also observed in the development of humanistic skills, cultural sensitivity, and adaptation to digital technologies and online education. These interventions positively impacted health education, strengthening technical competencies and clinical skills, while transforming institutional culture by valuing collaborative teaching practices. Students exposed to early practical experiences reported greater motivation, confidence, and satisfaction with the course, reflecting more robust preparation for professional challenges. In addition, the results of the meta-analysis showed a weighted prevalence of 82% (76%-88%) for student satisfaction, 67% (49%-86%) for self-efficacy, and 70% (64%-75%) for academic performance after the implementation of curricular interventions. Furthermore, it was observed that most studies showed significant positive effects on outcomes after the adoption of these interventions. Conclusion The findings suggest that curricular interventions have the potential to positively impact the training of health professionals. Thus, we conclude that curricular innovation strategies in health courses are promising, based on improvements in self-efficacy, academic performance, and student satisfaction, promoting indicators of teaching quality in the contexts in which they were carried out. We recommend the development of longitudinal and multicenter studies that investigate the effects of these innovations on professional practice and the quality of health care, considering different cultural and institutional contexts.

Background Recent studies have shown that the serum uric acid/creatinine ratio (SUA/SCr) is a better predictor of chronic kidney disease (CKD) than serum uric acid (SUA) isolated. The aim of the present study was to evaluate the association of isolated SUA and the SUA/SCr with CKD in hypertensive patients. Methods Cross-sectional study conducted with hypertensive patients followed-up by the Primary Health Care Service (PHC). Sociodemographic, economic, lifestyle, clinical, anthropometric, and biochemical variables were evaluated. The association between SUA parameters (quartiles of SUA and quartiles of SUA/SCr) and CKD was evaluated by bivariate and multivariate logistic regression. The association between SUA parameters (SUA and SUA/SCr) and estimated glomerular filtration rate (eGFR) was evaluated by linear regression. The analyses were performed considering four adjustment models. SUA and SUA/SCr were compared by receiver operating characteristic (ROC) curve. Results In the fully adjusted model, SUA was positively associated with the presence of CKD (OR = 6.72 [95 % CI 1.96–22.96]) and inversely associated with eGFR (β Coef. = -2.41 [95 % CI -3.44; -1.39]). SUA/SCr was positively associated with eGFR (β Coef. = 2.39 [1.42; 3.36]). According to the ROC curve, the SUA is a better predictor of CKD than the SUA/SCr. Conclusions Elevated levels of isolated SUA were associated with CKD and eGFR. However, the SUA/SCr was not associated with CKD. We do not recommend using the SUA/SCr to predict CKD in hypertensive patients.

The objective was to estimate the prevalence of excessive iodine intake in pregnant women and to investigate the consequences for maternal–fetal health. The systematic review was based on PRISMA. The search was conducted in September 2021 in LILACS, PubMed/MEDLINE, Science Direct, and SCOPUS databases. Observational studies that assessed excessive nutritional iodine status in pregnancy diagnosed by urinary iodine concentration and associated it with biomarkers of thyroid health function were included. Study selection, data extraction, and risk of biased evaluation were performed independently. Meta-analysis was calculated using a fixed and random effect model, and heterogeneity was assessed by the chi-square test. Meta-regressions were performed to identify the causes of heterogeneity using the Knapp and Hartung test. Nine studies were included in the systematic review, and eight in the meta-analysis. The prevalence of excessive iodine intake in 10,736 pregnant women in different regions of the world was 52%. The main implications for pregnant women were hypothyroxinemia, hypothyroidism, and hyperthyroidism. For the newborn, macrosomia and thyroid dysfunction. In addition, drinking water with high iodine intake contributed to excessive iodine intake. Therefore, the prevalence of iodine excess was 52%, with high heterogeneity among studies, explained by trimester of gestation and FT4 level; therefore, the farther the trimester of gestation and the lower the FT4, the higher the prevalence of iodine excess. PROSPERO Registration: CRD420206467 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206467 ).