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Electrospinning emerged as a promising technique to produce scaffolds for cultivated meat in function of its simplicity, versatility, cost-effectiveness, and scalability. Cellulose acetate (CA) is a biocompatible and low-cost material that support cell adhesion and proliferation. Here we investigated CA nanofibers, associated or not with a bioactive annatto extract (CA@A), a food-dye, as potential scaffolds for cultivated meat and muscle tissue engineering. The obtained CA nanofibers were evaluated concerning its physicochemical, morphological, mechanical and biological traits. UV-vis spectroscopy and contact angle measurements confirmed the annatto extract incorporation into the CA nanofibers and the surface wettability of both scaffolds, respectively. SEM images revealed that the scaffolds are porous, containing fibers with no specific alignment. Compared with the pure CA nanofibers, CA@A nanofibers showed increased fiber diameter (420 ± 212 nm vs. 284 ± 130 nm). Mechanical properties revealed that the annatto extract induces a reduction of the stiffness of the scaffold. Molecular analyses revealed that while CA scaffold favored C2C12 myoblast differentiation, the annatto-loaded CA scaffold favored a proliferative state of these cells. These results suggest that the combination of cellulose acetate fibers loaded with annatto extract may be an interesting economical alternative for support long-term muscle cells culture with potential application as scaffold for cultivated meat and muscle tissue engineering.

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.

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.

To identify the associations between MetS and its components and chronic kidney disease (CKD) in a population with arterial hypertension (AH), or diabetes mellitus (DM) accompanied by the Primary Health Care (PHC). A cross-sectional study with 788 individuals diagnosed with AH and/or DM followed by PHC of Viçosa, Brazil. Anthropometric, biochemical and clinical measures were performed for the diagnosis of MetS and CKD. MetS was identified using the NCEP-ATPIII criteria. CKD was identified by estimating the glomerular filtration rate using the CKD-EPI equation. Logistic regression models were used to estimate the chances of CKD associated with MetS and its components and specific combinations of components. The prevalence of MetS reported in the population was 65.4%, that of hidden CKD was 15.4%. The prevalence of CKD among participants with MetS was 75.2%. The most prevalent component of MetS in the population was AH (96.7%). Elevated fasting blood glucose, central obesity, and reduced HDL-c were significantly associated with an increased chance of CKD (OR = 2.80, 95% CI 1.76-4.45, OR = 1.68, 95% CI, 05-2.71, OR = 1.61, CI 95% 1.03-2.50, respectively). For the multivariate adjustment, the participants with MetS were 2 times more likely to have CKD than those without MetS (OR = 2.07; 95% CI, 1.25-3.44). The combination of three components of MetS high blood pressure, abdominal obesity and elevated fasting blood glucose and the combination of four components of MetS high blood pressure, reduced HDL-c, high fasting blood glucose and abdominal obesity were associated with increased odds of CKD (OR = 2.67, CI 95% 1.70-4.20, OR = 2.50, CI 95% 1.55-4.02, respectively). MetS, as well as its individual or combined components were independently associated with CKD in the population with AH and/or DM accompanied by PHC.

Introduction Diabetes Mellitus and Hypertension are some of the main Chronic Noncommunicable Diseases, representing a big challenge for global health. In this context, Telehealth programs are presented as a tool with exciting potential to complement and support health care. This paper aimed to analyze the effectiveness of the use of Telehealth programs in the care of individuals with Hypertension and/or Diabetes Mellitus . Methods A systematic review with meta-analysis was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol methodology. The following databases were used: PubMed, EMBASE, SciELO, ScienceDirect and Cochrane Library. Papers were included if they addressed the use of technologies that allow two-way communication at a distance between health professionals and patients affected by Hypertension and/or Diabetes Mellitus , type 1 or type 2. Experimental, cross-sectional, case–control, cohort, and clinical trials were included in the review. Results We included 164 papers in the review and 45 in the meta-analysis final synthesis. The systematic review results showed a prevalence of telemonitoring as the main form of Telehealth. The study showed a reduction in expenses with the use of Telehealth, both for the users and for the health systems providers, followed by greater satisfaction. Our meta-analysis showed that Telehealth is an effective tool in the care of diabetic patients, providing a 0.353% reduction in HbA1c compared to traditional care. No studies on Hypertension that met our eligibility criteria for inclusion in the meta-analysis were found. Conclusions Telehealth is an effective tool for the care of people with Diabetes Mellitus and/or Hypertension.

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: 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.

Background The study evaluates children in schools that participate in the School Health Program in the Northern region of Brazil with the objective of assessing whether their schools interfered in the development of overweight/obesity and how individual and school environment variables behave according to contextual analysis. Methods The analyses were carried out with 1036 children from 25 municipal public schools in Northern Brazil that participated in the School Health Program. We evaluated both individual characteristics and scholar environment through univariate and multivariate logistic regressions to identify which of these factors were related to overweight/obesity as well as the effect of varying such associations. Results The considered individuals had an median age of 8 years, being 54.9% female and 27.8% presenting overweight/obesity. In multivariate logistic regression, the overweight/obesity variance in schools was 0.386 (individual variables) and 0.102 (individual and school variables), explaining 23.7% of the variation, reduction of ICC and MOR. The Akaike Information Criterion between the models was reduced and the likelihood ratio indicated better adequacy of the latter model. The investigated children had a greater chance of developing overweight/obesity when they performed 2+ sedentary activities/day, depending on school location as well as whether or not candies were sold in the school surroundings. On the other hand, a lower chance of developing overweight/obesity was identified in children that ate 5+ meals/day and practiced dance at school. Conclusion We observed that the variables inherent to both individuals and schools favored the development of overweight/obesity in children. It is relevant that scholar curriculums incorporate healthy eating interventions and encourage body practices associated with policies that restrain the sale of ultra-processed food in schools as well as the development of intersectoral actions between education and health to control childhood obesity.

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 ).