Search Results (294)

Background/Objectives: Smoking is an established cofactor for cervical carcinogenesis, but evidence on how Smoking Pattern Changes around cohort entry relate to risk in Japan is limited. We quantified cervical cancer risk by baseline smoking status and by changes between two routine health checkups in a nationwide cohort. Methods: We used the Japan Medical Data Center claims–checkup database between January 2005 and July 2022. Women with ≥2 pre-index checkups were included; the index date was the second checkup. Self-reported smoking at each visit defined never, former (quit), new (initiated), and current (persistent) smokers; checkup pairs >36 months apart were excluded. Incident cervical cancer required ICD-10 C53 plus cancer-directed treatment (surgery, radiotherapy, or systemic antineoplastic therapy). Multivariable Cox models estimated hazard ratios (HRs) with 95% CIs, adjusting for age, BMI, alcohol, exercise, hypertension, diabetes, cerebrovascular and cardiovascular disease, and cholangitis. Results: Among 1,330,797 women, incidence rates (per 100,000 person-years) were 151.4 in never smokers and 244.9 in ever smokers. Ever versus never smoking was associated with higher risk (HR 1.53, 95% CI 1.43–1.62). A graded risk was observed across Smoking Pattern Change categories versus never: former HR 1.44 (1.15–1.79), new HR 1.51 (1.20–1.90), current HR 1.54 (1.44–1.64). By age, HRs were 1.58 (1.47–1.70) for <50 years and 1.35 (1.17–1.55) for 50–64 years; ≥65 years was not statistically significant (HR 0.69, 0.30–1.59). Conclusions: Smoking was associated with substantially higher cervical cancer risk, with a clear risk gradient from former to new to current smoking. The rapid elevation in new smokers and residual risk after quitting support integrating proactive cessation and initiation prevention into risk-stratified screening and routine health-check programs in Japan. Full article

Cancer survivors (CS) constitute an expanding population with underrecognized cardiometabolic risk. Despite substantial improvements in five-year survival rates, both childhood and adult survivors remain at high risk for premature morbidity and mortality. These risks are particularly pronounced following exposure to anthracyclines and/or chest radiotherapy, typically in a dose-dependent manner. In Chile, the establishment of the National Pediatric Antineoplastic Drug Program (PINDA) in 1998 marked a milestone in improving equitable access to high-quality pediatric oncology care through evidence-based treatment protocols across the public health system; the adult counterpart (PANDA) has developed diagnostic, treatment, and monitoring protocols for hematological neoplasms. Few prospective cohort or mechanistic studies have clarified risk stratification or surveillance strategies in survivor populations. The regulated, short-term activation of inflammation and innate immunity can be an adaptive and protective response to tissue injury, whereas persistent low-grade inflammation may trigger neutrophil extracellular traps formation (NETosis) and other maladaptive pathways that accelerate endothelial injury, thrombosis, and adverse cardiovascular remodeling. NETosis represents a putative immunomodulatory target for therapeutic immunomodulation in heart failure and maladaptive left ventricular remodeling in preclinical models. Concurrently, skeletal muscle-derived and hormonal mediators known as exerkines—together with increased NET activity—may modulate the pathophysiology of chronic cardiometabolic disease and contribute to cancer progression, particularly in the context of obesity, diabetes, and insulin resistance. Structured exercise is a promising non-pharmacological intervention that modulates inflammatory and metabolic pathways and may thereby help prevent non-communicable diseases, including cancer. We synthesize basic and clinical evidence to (1) define how cancer therapies promote low-grade inflammation and NETosis; (2) describe how exerkines and structured exercise influence cardiometabolic biology; and (3) evaluate exercise as a mechanistic and clinically pragmatic strategy to reduce long-term CVD risk in pediatric and adult CS. Full article

The complex bidirectional relationship between diabetes mellitus (DM) and oral cancer (OC) denotes that metabolic dysfunction and malignancy intersect at molecular, cellular, and systemic levels. This state-of-the-art review analyzes the most recent literature data on the multiple interconnected pathways linking DM and OC, including hyperinsulinemia/IGF-1 signaling, chronic hyperglycemia-induced cellular damage, persistent inflammation, immune dysfunction, and oral microbiota dysbiosis. These mechanisms create a permissive environment for oral carcinogenesis while simultaneously impairing the body’s natural tumor surveillance systems. Key molecular networks explored include the PI3K/AKT/mTOR pathway, AGE-RAGE interactions, NF-κB signaling, the p53 tumor suppressor pathway, and HIF-mediated responses. Clinical evidence demonstrates that patients with diabetes have higher OC prevalence (250 per 100,000 patients) and significantly increased mortality (HR of 2.09) compared to non-diabetics. The review highlights metformin as the most promising anti-diabetic agent for OC management, showing anti-tumor effects through mTOR inhibition. Novel therapeutics, such as GLP-1 agonists, particularly semaglutide, may be helpful but require further clinical validation. Understanding the shared molecular pathways enables the development of integrated therapeutic strategies that target both conditions simultaneously, and it supports effective screening programs, personalized prevention strategies, and optimized multidisciplinary management approaches for this high-risk patient population. Full article

Background: The early detection of insulin resistance (IR) is critical for the prevention of type 2 diabetes and cardiometabolic diseases. The ECORE-BF index is a simple anthropometric tool for estimating body fat percentage and overweight. However, its potential utility as a predictor of IR risk has not been previously evaluated in large populations using validated IR indices. Methods: This cross-sectional study included 418,343 Spanish workers (172,282 women and 246,061 men) who underwent occupational health evaluations. The ECORE-BF index was calculated for all participants, and its association with four validated surrogate markers of IR was analyzed: the triglyceride–glucose index (TyG), TyG-BMI, METS-IR, and SPISE. Subjects were classified into normal or high-risk IR groups based on established cut-off values. We evaluated the mean ECORE-BF values across groups, the prevalence of ECORE-BF-defined obesity, and the diagnostic performance of ECORE-BF using receiver operating characteristic (ROC) curve analysis. Results: Participants with elevated IR index values had significantly higher mean ECORE-BF scores than those with normal values (p < 0.001). The prevalence of ECORE-BF-defined obesity was substantially higher in all high-risk IR groups, exceeding 99% for METS-IR and SPISE in both sexes. ROC analysis demonstrated the high diagnostic accuracy of ECORE-BF in predicting elevated IR risk, with area under the curve (AUC) values ranging from 0.698 (TyG in men) to 0.992 (METS-IR in women). Sensitivity and specificity were also high, particularly for TyG-BMI, SPISE, and METS-IR, with optimal Youden indices above 0.75. Conclusions: ECORE-BF demonstrated high accuracy as a non-invasive tool for identifying individuals at increased insulin resistance risk; however, due to the cross-sectional design, predictive value for incident disease cannot be inferred. Its simplicity, cost-effectiveness, and high diagnostic accuracy support its potential utility in large-scale screening programs for early detection of metabolic risk. Full article

Background: Prediabetes is a significant precursor to type 2 diabetes mellitus (T2DM) and its well-known complications. In Sudan, data on the epidemiology of prediabetes among adolescents are scarce, especially in the central region. Thus, this study aimed to determine the prevalence of and factors associated with prediabetes among adolescents in central Sudan. Methods: This community-based cross-sectional study was carried out in East Gezira, central Sudan, from April to June 2025 and included 379 adolescents. Sociodemographic characteristics, anthropometric data (body mass index and BMI-z-score), and clinical information were gathered. Prediabetes was defined as a glycated hemoglobin (HbA1c) level in the range of 5.7% to 6.4%. Multivariate binary analysis was applied to identify the factors associated with prediabetes. Results: The median (interquartile range, IQR) age and BMI-z-score of the 379 enrolled adolescents were 14 (12–16) years and −1.4 (−2.1–−0.39), respectively. Sixty-four (17.0%) adolescents had prediabetes. Univariate analysis did not reveal any significant associations between the investigated factors and prediabetes. However, multivariate binary analysis showed that being female was independently associated with prediabetes among adolescents (adjusted odds ratio, AOR = 1.80, 95% confidence interval, CI 1.01–3.18). Age, BMI z-score, parent education, and occupation were not associated with prediabetes. Conclusions: The prevalence of prediabetes among adolescents in central Sudan is substantial, highlighting a potential future surge in T2DM. The finding that female adolescents are at a higher risk underscores the need for targeted, gender-sensitive screening and preventive health programs to mitigate the progression from prediabetes to T2DM. Full article

Educational strategies based on technological models that integrate the dimensions of prevention, screening, and treatment of diabetic foot ulcers are emerging as promising methods to improve nurses’ knowledge, skills, and clinical competencies in primary care. In this investigation, we evaluated the effectiveness of a digital education program, mediated by a virtual learning environment, in enhancing nurses’ clinical knowledge about diabetic foot ulcers. This quasi-experimental intervention study was conducted with 114 nurses, selected for convenience, from the five health districts that make up primary care in the municipality of Teresina, Brazil. Two stages, separated by the educational intervention, allowed us to measure their knowledge levels before and after the implementation of the digital technology. A characterization form and the Nurse Knowledge Assessment Questionnaire on Diabetic Foot were used to evaluate the outcomes. The McNemar test compared the pre- and post-intervention knowledge levels, while accuracy rate-based parameters allowed for the classification of results into performance categories. The intervention effect size was estimated using Cohen’s d test. Results showed substantial improvements in knowledge, particularly in domains related to definition (p = 0.002), risk factors (p < 0.001), associated complications (p < 0.001), signs and symptoms of neuropathies (p < 0.001), application of tests to assess protective sensation (p < 0.001) and foot biomechanics (p < 0.001), risk classification (p < 0.001), and prevention strategies (p < 0.001), with performance ratings predominantly “good” or “excellent” after the intervention. The effect size for paired samples was large (Cohen’s dz = 1.82), based on the total knowledge scores. Findings support the effectiveness signal of the virtual learning environment for knowledge improvement; however, without a control group, we cannot rule out testing effects. Controlled or stepped-wedge trials should confirm causality. Full article

(1) Background: Firefighters, exposed to diverse and unpredictable occupational environments, face cumulatively increased physical health risks. The purpose of this study was to assess the standardized prevalence ratios (SPRs) of occupational and chronic diseases in firefighters and the general population, categorized into pre-disease and disease stages; (2) Methods: This study was a community-based, retrospective, cross-sectional study. Data sources included the occupational health examination of 7024 firefighters and the National Health and Nutrition Examination Survey of 1485 general populations in 2019. Statistical analyses were performed using SAS version 9.4 SAS Institute Inc., Cary, NC, USA. SPRs of chronic and occupational diseases were calculated for each pre-disease and disease stage, and chi-square tests were performed; (3) Results: Data were analyzed from a cohort of 7024 firefighters who consented to the access and use of their occupational health examination results, 91.9% (n = 6456) were male, the average age was 43 years, the average number of years of service was 15.3 years. Among the five classifications of the occupational health examination results, 26.7% (n = 1877) were A, 19.2% (n = 1352) were C1, 42.4% (n = 2980) were C2, 1.5% (n = 108) were D1, and 10% (n = 705) were D2. As a result of calculating the SPRs compared to the general population, in the pre-disease stage, obesity SPR = 1.29 (95% confidence interval [CI] 1.23 to 1.34), hypertension SPR = 1.52 (95% CI 1.47 to 1.57), diabetes mellitus SPR = 1.07 (95% CI 1.02 to 1.11), and metabolic syndrome SPR = 1.62 (95% CI 1.57 to 1.66) were all higher in the firefighter group. On the other hand, in the disease stage, metabolic syndrome and complex pulmonary ventilation impairment were higher in SPRs than in the general population, but not statistically significant. However, at the disease stage, SPRs for obesity, hypertension, diabetes, and noise-induced hearing loss were higher and statistically significant in the general population; (4) Conclusions: The SPRs for firefighters produced in this study clearly demonstrate the healthy worker effect. The SPRs, derived from a cross-sectional study, highlight the need for future cohort building of firefighters to track and monitor health outcomes, as well as systematic and thorough health management interventions to prevent progression from pre-disease to disease. Therefore, this study can be utilized in the development of mid-to-long-term firefighter health promotion programs and health and safety plans to minimize firefighters’ physical health and occupational exposures. Full article

Background: Type 2 diabetes (T2D) is no longer a standalone clinical condition—it has become a syndemic shaped by food insecurity, social inequality, and digital marginalization in emerging economies. This convergence calls for a reimagining of public health through intersectoral, digitally enabled, and culturally grounded approaches. This study explores how intersectoral strategies, supported by digital innovation and rooted in food sovereignty, can help prevent and manage T2D in emerging countries. Methods: A narrative review was conducted using the PubMed, Scopus, and Web of Science databases. Studies published between 2014 and 2025 were included if they addressed T2D and food security in emerging contexts, focusing on intersectoral or multisectoral strategies. Studies on T1D, non-human subjects, and high-income settings were excluded from the study. Thirty-nine studies were critically synthesized. Results: Food insecurity acts as both a biological stressor and a sociopolitical condition that worsens poor glycemic control. Promising but underutilized intersectoral strategies include agroecological food systems, school-based nutrition programs, and community health worker networks. Digital tools, such as AI-driven diagnostics, blockchain food traceability, and mobile health platforms, offer scalable solutions but face challenges in infrastructure, digital literacy, and ethical governance. Conclusions: A digitally inclusive, ethically reflexive intersectoral paradigm is needed that recognizes food and digital access as human rights. Full article

Background: Obesity is a well-established risk factor for numerous chronic diseases, including heart disease and type 2 diabetes, and its impact is particularly acute among Black/African American men. According to the Centers for Disease Control and Prevention (CDC), 70.9% of Black men aged 20 and older are overweight or obese. Despite this alarming prevalence, there remains a limited number of studies that specifically investigate the root causes of obesity in this population. Addressing this gap is critical to developing culturally relevant interventions that promote health equity. The purpose of this study was to assess dietary patterns, that are associated with overweight/obesity, in Black men aged 18–65 across the United States of America, to gain an in-depth understanding of variables influencing BMI in Black men. Methods: This study utilized a quantitative approach to collect information from participants. A survey questionnaire was developed and administered via Qualtrics to participants using a web link. The survey collected information across 18 dietary variables. Data was exported to Microsoft Excel for statistical analysis. A simple linear regression was used to determine dietary variables correlation strength and significance with BMI. A significance level of p < 0.05 was used to determine if a variable was statistically significant. Variables were then organized based on significance vs. non significance and correlation strength. Result: The study sample consisted of 466 Black men aged 18 to 65 years. The mean BMI was 30.21. Approximately 19% (n = 87) had a BMI within the healthy range (18.5–24.9), 41% (n = 190) were categorized as overweight (BMI 25.0–29.9), and another 41% (n = 189) were classified as obese (BMI ≥ 30.0). The findings revealed that fruit and vegetable consumption and whole grain cereal consumption were significantly and positively correlated with BMI. Other variables, such as fried foods, processed foods, and sugary drinks, though historically associated with obesity, did not show statistical significance in this population. Conclusions: Results suggest that while multiple dietary factors influence BMI, fruit, vegetable, and whole grain consumption are significantly correlated with BMI in Black men living in America. The findings from this study serve as a foundational step for designing targeted, culturally sensitive interventions aimed at reducing obesity-related health disparities. Future research should further explore how tailored public health messaging and community-based programming can address the specific needs of this population. Full article

Background: Vision loss due to chronic eye diseases remains a significant public health challenge. Early detection through screening programs may reduce the burden of vision loss. This study aimed to assess the detection rate of eye diseases (glaucoma, AMD, and diabetic retinopathy), including those newly detected during opportunistic screening and ophthalmological consultations within the local government health policy program “Good Vision for Mazovians” in Mazovia, Poland. Material and methods: This study is a retrospective analysis of medical data from the registry of the Ophthalmology Department of the Międzylesie Specialist Hospital in Warsaw, which implemented the local government preventive program “Good Vision for Mazovians. Data from 1812 individuals (aged 18–92 years) participating in the “Good Vision for Mazovians” preventive program were analyzed. Results: Most participants were female (59.7%), aged over 60, and took medications regularly (62.7%). Excluding subjects with prior diagnosis of eye conditions, the detection rate was 38 suspected cases (3.8%) of glaucoma cases, 84 suspected cases of AMD (4.6%), and 21 suspected cases of diabetic retinopathy (1.2%). Most participants had not visited an ophthalmologist in the past two years (58.6%), reported low or average knowledge of eye health, had difficulty accessing ophthalmology services in their region (57%), and identified long waiting times for appointments as the main barrier to care (83.5%). Conclusions: Opportunistic screening for eye diseases in populations with limited access to eye care should be considered as a method for detecting common causes of irreversible visual impairment, particularly AMD. Older adults and individuals without higher education appear to face the greatest barriers to accessing ophthalmology services and may benefit the most from targeted opportunistic screening initiatives. Full article

Background/Objectives: Diabetic retinopathy (DR) develops from the interplay of vascular, inflammatory, and neurodegenerative processes. Citicoline, a natural compound essential for cell membranes, enhances neurotransmitter levels, has a neuroprotective effect, reduces oxidative stress by increasing glutathione, and decreases glutamate toxicity. Studies suggest that a citicoline liposomal formulation (eye drops) may prevent diabetes-induced retinal neurodegeneration. This study aimed to evaluate the impact of citicoline eye drops on the clinical signs of DR in clinical settings. Methods: More than 100 patients with nonproliferative DR (NPDR) were selected consecutively from the DR screening program and included in this real-life prospective observational clinical study. Each patient underwent color-fundus photography of two fields (macular field and disk/nasal field) in both eyes using a standard 45° fundus camera. Patients were prescribed citicoline eye drops and followed for a period of one year or longer. Results: In 4 patients with NPDR and macular hard exudates, the application of citicoline (Omk1^®) eye drops three times a day for at least six months to a year resulted in a reduction or complete disappearance of hard exudates. Conclusions: Our study, to the best of our knowledge, is the first one that establishes a clinically positive effect of citicoline eye drops on hard exudates in DR. However, to support the potential value of citicoline in the treatment of DR, the conclusions of this study still need to be confirmed by statistical analysis of a larger sample size and prospective studies with longer follow-up periods. Full article

Obesity is a multifactorial chronic disease resulting from complex genetic, molecular, environmental, and behavioral interactions. Its prevalence rises worldwide, affecting cardiovascular, metabolic, oncological, hepatic, respiratory, and skeletal health. Beyond caloric excess, genetic predisposition, epigenetic modifications, gut microbiota dysbiosis, endocrine-disrupting agents, circadian misalignment, and intergenerational and prenatal influences are critical determinants of obesity risk. Core pathophysiological mechanisms include insulin resistance, dyslipidemia, chronic low-grade inflammation, and neuroendocrine dysregulation of appetite and energy balance. These processes are linked to comorbidities such as type 2 diabetes, hypertension, atherosclerosis, fatty liver disease, sleep apnea, osteoporosis, and cancer. Advances in molecular profiling, metabolic phenotyping, and body composition analysis are refining obesity classification and enabling precise risk stratification. Current therapeutic strategies include behavioral interventions addressing stress-related mechanisms, pharmacological therapies such as GLP-1 receptor agonists, emerging gene therapy approaches, and bariatric surgery. Gut-derived hormones (leptin, ghrelin, GLP-1, PYY, CCK) are recognized as pivotal regulators of appetite and weight. Preventive strategies increasingly emphasize circadian alignment, while epigenetic inheritance and prenatal exposures such as maternal obesity or smoking highlight early-life programming in future metabolic health. Additionally, artificial intelligence-based platforms and personalized nutrition provide innovative opportunities for individualized prevention and management. This review synthesizes contemporary evidence on the biological basis, systemic consequences, preventive strategies, and evolving therapeutic modalities of obesity, affirming its recognition as a complex chronic disease requiring personalized, multidisciplinary care. Full article

Diabetes mellitus constitutes a significant global public health problem. It is a chronic disease characterized by persistent hyperglycemia, which is a consequence of inadequate insulin secretion, deficient insulin action, or a combination of both factors. A crucial component in the effective management of this pathology is therapeutic adherence, as it helps prevent complications, improve patient quality of life, reduce associated mortality, and decrease the need for hospitalization. In this context, it is crucial to implement a comprehensive care model that offers continuous support and a multidisciplinary approach. Primary care should be central, coordinating the entire care process. Understanding the clinical and social characteristics of people with diabetes is key to guiding more effective interventions. Objective: The objective of this study was to describe the sociodemographic and anthropometric characteristics, degree of metabolic control, and treatment adherence in patients with diabetes mellitus enrolled in primary care programs in Ceuta. Materials and Methods: This was a descriptive, observational, and cross-sectional study conducted during the second half of 2024. The study population included individuals enrolled in the primary care diabetes program in Ceuta. We analyzed sociodemographic variables with a self-administered questionnaire, the level of therapeutic adherence using the MMAS-8 scale, and glycemic control through glycosylated hemoglobin (HbA1c) values. Results: The sample consisted of 370 individuals, with 50.3% being men. The average age was 62.82 years (SD = 13.46). A significant portion of participants, 61.07%, had no formal education or had only received primary education. Additionally, 84.9% of the participants had at least one other associated chronic pathology. Regarding adherence, 36.8% of the patients showed a high level, and for all patients, the mean HbA1c value was 7.5% (SD = 1.55). Furthermore, our analysis revealed statistically significant associations between cultural background and both therapeutic adherence (weak positive correlation: r = 0.213, p ≤ 0.001; multivariate significance: sig: <0.001; Exp(B) = 2.448) and glycemic control (multivariate significance: sig: <0.001; Exp(B) = 2.686). Conclusions: We observed high treatment adherence in the study population, with HbA1c values within the limits recommended by the World Health Organization for older adults. Furthermore, a relationship between cultural background and both treatment adherence and glycemic control was identified. This suggests a need for further research into these and other social determinants, like study level or monthly income, in future studies. Full article

Background and Objectives: Type 2 diabetes mellitus (T2DM) remains a significant public health problem across Gulf Cooperation Council (GCC) nations because of advancements in urbanization alongside behavioural lifestyle changes and genetic predispositions. Specific self-management methods are fundamental in T2DM management because they provide better glycaemic control and decrease complications. Achieving a synthesis of updated evidence about self-management strategies and patient perception within GCC nations represents the primary objective of this narrative review. Materials and Methods: The studies included in the present review were retrieved from the Web of Science, Scopus, Medline, Saudi Digital Library, and Embase. We included peer-reviewed studies that were published from January 2020 to March 2025. The selected studies measured the self-management practices of adult T2DM patients by examining medication adherence, dietary patterns, blood glucose monitoring, and treatment barriers. Results: Research data indicate that patients demonstrate different levels of self-care management behaviours, where medication compliance is fair, but dietary patterns and physical activities remain areas of concern. High levels of knowledge deficits, cultural elements, and economic background substantially impact patients’ self-management practices. Patients indicate their need for enhanced and personalized care, better connections with healthcare providers, and interventions that consider their cultural backgrounds. Conclusions: Patients throughout the GCC region encounter ongoing difficulties that prevent them from performing their best at self-management, even though advanced healthcare facilities exist in this region. Therefore, it is critical to develop culturally sensitive patient-centered care, individualized educational programs, and adopt supportive digital solutions to enhance diabetes-related self-care management. Full article

Objectives: To analyze, across the periods before, during, and after the implementation of Social Isolation and Distancing Measures (IMDIS): (a) changes in the prevalence of non-communicable chronic diseases (NCDs), stratified by age group in the Brazilian population; and (b) the association between physical inactivity (PI), insufficient moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) with the occurrence of these conditions. This cross-sectional study used data from VIGITEL (Brazil’s Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey), an annual population-based telephone survey conducted across the country. Data were collected in 2019, 2021, and 2023, with a total sample size of 101,226 participants. Arterial hypertension (AH) and diabetes mellitus (DM) were self-reported, and obesity (OB) was diagnosed using body mass index. PI, insufficient MVPA, and SB were identified via VIGITEL indicators. Chi-square tests assessed differences in prevalence overall and by age group. Logistic regression models estimated odds ratios (ORs) for associations between demographic variables, behavioral factors, and the studied periods. The prevalence of AH and DM was highest among individuals over 60 years, reaching 61% after IMDIS, a period when OB also peaked across all age groups. Individuals aged 30–59 and those over 60 had higher odds of AH, DM, and OB across all periods. Female participants had higher ORs for AH and DM both before and after IMDIS. PI and insufficient MVPA were associated with increased odds of AH, DM, and OB in all periods, while SB significantly elevated the OR for OB at all time points. After IMDIS, there was an increase in the prevalence of AH, DM, and OB among older adults and younger individuals. PI, insufficient MVPA, SB, and advanced age were all associated with a greater likelihood of NCDs at every stage of the study. The high post-IMDIS rates of AH, DM, and OB highlight the need for urgent public health strategies. Low-cost programs, such as live videos and online group sessions, should be included in national physical activity guidelines. These initiatives are affordable, aligned with WHO goals, and reduce PI in IMDIS scenarios. Incorporating them into Academia da Saúde and Agita Brasil strengthens NCD prevention and increases the resilience of the health system for future health crises. Full article