http://hdl.handle.net/11624/150 2026-03-28T21:47:41Z http://hdl.handle.net/11624/4230 Title: Determinantes metabólicos, clínicos e psicossociais da perda de peso durante o processo da cirurgia bariátrica. Authors: Uebel, Gabriela Cristina Abstract: INTRODUCTION: Obesity is characterized as a multifactorial chronic condition involving metabolic, clinical, and psychosocial alterations. Although bariatric surgery is recognized as the most effective treatment for sustained weight loss, the mechanisms determining its outcomes include a complex interaction among metabolic biomarkers, lifestyle factors, and mental health. Investigating these determinants in an integrated manner is essential to understand the weight loss process in the surgical context. OBJECTIVE: To investigate the metabolic, clinical, and psychosocial factors related to weight loss in the early postoperative period of bariatric surgery, approximately four months of follow-up, considering the interaction between gut microbiota, bile acids, follistatin, lifestyle, and mental health. MANUSCRIPT 1: Introduction: Obesity is a multifactorial chronic condition associated with high morbidity and mortality and increased risk of cardiovascular and metabolic diseases. Bariatric surgery, particularly Roux-en-Y gastric bypass and sleeve gastrectomy, is the most effective intervention for sustained weight loss and metabolic improvement. Objective: To review the literature on the relationship between weight loss after bariatric surgery, gut microbiota, bile acids, and follistatin. Methodology: A literature search was conducted in PubMed, Scopus, Web of Science, LILACS, and SciELO databases, covering publications between 2019 and 2025, in Portuguese, English, and Spanish. Studies involving humans and animal models that evaluated weight loss and at least one biomarker of interest were included. Results: Twenty four articles were included. Findings indicate that bariatric surgery promotes increased bacterial diversity, qualitative and quantitative changes in bile acid metabolism, and early elevation of follistatin levels. These factors are associated with weight loss and improved insulin sensitivity. Conclusion: The interaction among gut microbiota, bile acids, and follistatin levels constitutes a central metabolic axis that contributes to successful weight loss and metabolic benefits following bariatric surgery. Keywords: Bariatric surgery; Gut microbiota; Bile acids; Follistatin; Weight loss. MANUSCRIPT 2: Introduction: Bariatric surgery promotes significant weight loss and rapid metabolic improvement. However, the role of bile acids in this process during the early postoperative period remains incompletely understood. Objective: To evaluate early anthropometric and metabolic changes, including hepatic markers and bile acids, after bariatric surgery and their association with weight loss at four months. Methods: Cross sectional observational with assessments in the preoperative period and four months after bariatric surgery. Total serum bile acids, lipid profile, glycemia, liver enzymes, C-reactive protein, and uric acid were analyzed. Weight loss was expressed as percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL). Physical activity was assessed using the short version of the International Physical Activity Questionnaire (IPAQ). Results: The sample consisted of eight women. A significant reduction in body weight and BMI was observed after four months, with %TWL of 20.2 ± 3.8% and %EWL of 60.8 ± 13.1% (p < 0.001). There was a significant decrease in LDL-cholesterol (p = 0.015) and gamma glutamyltransferase (p = 0.021), while total bile acids did not show significant changes. A positive correlation was identified between %TWL and reduction in uric acid (ρ = 0.786; p = 0.028). No associations were observed between weight loss and physical activity practice. Conclusion: Bariatric surgery promoted expressive weight loss and early metabolic improvement, whereas changes in total bile acid levels were not observed in the early period, suggesting a progressive adaptation of this metabolic axis. MANUSCRIPT 3: Introduction: Obesity is a multifactorial chronic condition associated with important psychosocial repercussions. Although bariatric surgery is effective for sustained weight loss, its effects on body image perception and mental health in the early postoperative period remain poorly understood. Objective: To evaluate changes in body image perception and mental health indicators in patients undergoing bariatric surgery during the early postoperative period. Methodology: Cross-sectional observational study conducted with 10 adult individuals followed in a specialized service. Body image perception was assessed using the Multidimensional Body-Self Relations Questionnaire – Appearance Scales (MBSRQ-AS), and mental health was evaluated using the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9), applied in the preoperative period and approximately four months after surgery. Results: A reduction in body weight and body mass index was observed in the early postoperative period, along with improvements in specific domains of body image perception and reduction of dysfunctional eating behaviors. Conversely, mental health indicators did not show relevant changes during the evaluated period. Conclusion: In the early postoperative period of bariatric surgery, improvements in body image perception and eating behavior are more evident than changes in mental health indicators, suggesting that psychological adaptation occurs gradually and reinforcing the importance of continuous psychosocial follow-up. 2026-01-01T00:00:00Z http://hdl.handle.net/11624/4227 Title: Relação entre o consumo de suplementos esportivos e biomarcadores renais, hepáticos, de genotoxicidade e de estresse oxidativo em praticantes de academia : uma análise correlacional e comparativa. Authors: Castilhos, Eduarda da Silva Limberger Abstract: Introduction: The increase in physical exercise practice has driven the consumption of sports supplements, especially in gym environments, stimulating the growth of the industry and the diversification of available products. The simultaneous intake of multiple supplements raises concerns regarding metabolic safety, with possible impacts on hepatic, renal, genotoxicity, and oxidative stress biomarkers. General objective: To investigate the relationship between dietary supplement consumption and renal, hepatic, genotoxicity, and oxidative stress biomarkers in gym-goers through correlational and comparative analyses. Manuscript 1: A total of 355 individuals engaged in physical activities at gyms were evaluated, of whom 59.4% reported the use of nutritional supplements. The concurrent consumption of two products was the most frequent practice among users (26.5%). Statistical analysis revealed significant, although low-magnitude, correlations between the number of supplements used and serum levels of creatinine (Spearman r = 0.198; p < 0.001), urea (Spearman r = 0.107; p = 0.047), ALT (Spearman r = 0.193; p < 0.001), and ALP (Spearman r = 0.123; p = 0.023). However, after adjustment for potential confounding variables, only the association between the number of supplements and ALT levels remained statistically significant (r = 0.148; p = 0.006), indicating a possible hepatic influence related to multi-supplementation practices. Furthermore, no significant differences (p > 0.05) were observed between groups regarding genotoxicity markers (Visual score and frequency, micronuclei, and nuclear buds) or oxidative stress bio Manuscript 2: In this study, gym-goers were classified into three groups according to their pattern of dietary supplement consumption: non-use (n = 160), single-supplement use (n = 84), and multi-supplement use (n = 111). Comparative analysis between the groups revealed statistically significant differences in renal and hepatic biomarkers, with higher levels of creatinine, ALT, and ALP observed among participants who concomitantly used multiple supplements (Kruskal-Wallis: creatinine, p = 0.001; ALT, p = 0.002). However, after adjusting for confounding variables such as age, sex, body mass index, and physical activity level, these associations lost statistical significance (p > 0.05), indicating that the initially observed effects may be related to other factors, mainly sex and age. Moreover, no significant differences (p > 0.05) were detected between groups regarding genotoxicity markers (frequency of DNA damage, micronuclei, and nuclear buds) or oxidative stress biomarkers (TBARS and TEAC), suggesting that. Final considerations: The results demonstrate that the use of multiple supplements may lead to subtle alterations in renal and hepatic biomarkers, but these changes are mainly modulated by individual factors such as age and sex. Additionally, no significant effects were observed on genotoxicity or oxidative stress markers, indicating the safety of concurrent supplement consumption in healthy individuals. These findings reinforce the importance of professional monitoring and individualized assessment in supplement prescription, contributing to safer and evidence-based supplementation practices. 2025-01-01T00:00:00Z http://hdl.handle.net/11624/4221 Title: Sífilis congênita como desafio de saúde pública : análise temporal de óbitos no Brasil e experiências de mulheres com sífilis na gestação. Authors: Figueiredo, Thaysi Carnet Abstract: Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum, which can also be transmitted from mother to baby during pregnancy, causing serious complications such as miscarriage, premature birth, stillbirth, and congenital sequelae. Even with control measures in place for over a century, the disease continues to be prevalent in Brazil and worldwide, and is considered a serious public health problem. The infection can go unnoticed in its early stages because it is often asymptomatic. However, if left untreated, it can progress to severe forms, affecting the nervous system and the heart. Given this, diagnostic tests must be performed even without symptoms, especially during prenatal care. Primary health care plays an essential role in combating syphilis, being responsible for early detection, adequate treatment, and follow-up of cases, using technical knowledge and available resources to reduce vulnerability to sexually transmitted infections. GENERAL OBJECTIVE: To investigate knowledge, information, and experiences related to syphilis in women treated in the SUS, linking these experiences with the monitoring of congenital syphilis and with the national and municipal epidemiological panorama of the disease. MANUSCRIPT 1: Objective: To analyze the temporal trend of deaths from congenital syphilis in Brazil from 1996 to 2019. Method: This is an ecological trend study. Data obtained by the Department of Informatics of the Unified Health System were used, extracted from the International Classification of Diseases, version 10, code A50. For the analysis of temporal trends, joinpoint regressions were performed, considering the annual percentage change in the number of cases and their respective 95% confidence intervals (95% CI) for national data and data from each region of the country. Results: From 1996 to 2019, Brazil recorded a total of 3,013 deaths from congenital syphilis. The southeast region had the highest number of deaths recorded during the period (n=1,314). The Northeast region recorded 938 deaths, the North region 325, and the South region 296. The Midwest region recorded the lowest number of deaths in the period (n=140). Conclusion: Brazil experienced a period of decline in deaths from congenital syphilis between 1996 and 2008, while between 2008 and 2015, there was an increase. However, since 2015, the country has seen a stabilization in the number of deaths. MANUSCRIPT 2: Objective: This study aims to investigate the knowledge/information and experiences of women who presented with syphilis in a SUS (Brazilian Unified Health System) service in a municipality in Rio Grande do Sul, Brazil. Method: This is a descriptive study with a qualitative approach, using open interviews conducted between May and November 2024 with 23 women whose children were exposed to syphilis or presented with congenital syphilis. The data were analyzed using Bardin's content analysis. Results: The majority of participants (12) reported having no prior knowledge about syphilis, allowing for a greater impact due to a lack of knowledge about the disease. In contrast, other participants (11) stated that they had prior knowledge, demonstrating female empowerment regarding information related to the disease. This suggests that investments in health, education, networking, professional qualifications, and other strategies adopted by the SUS have a positive impact. The guidance received was generally brief, and partner adherence to treatment remained a challenge. Strategies focused on welcoming patients, health education, and humanization proved to be crucial for therapeutic adherence. Conclusion: The study highlights the need for public policies and care practices that promote partner engagement, health education, and comprehensive care for pregnant women, aiming at the prevention of congenital syphilis and the promotion of maternal and child health. FINAL CONSIDERATIONS OF THE DISSERTATION: The study revealed that in a municipality in the valley’s region of Rio Grande do Sul, although there have been advances in the screening and treatment of gestational syphilis, important issues persist regarding care, clinical follow-up, and communication between professionals and users. Approximately Half of the women interviewed reported having prior knowledge about the disease and its treatment, demonstrating the commitment of the municipal health network to ensure access to quality healthcare, maintaining focus and work within the guidelines of the Brazilian Unified Health System (SUS). Adherence to treatment was satisfactory, but partner engagement remains low, compromising the prevention of vertical transmission. The findings reinforce the need for health education, team training, active case finding, male inclusion in care, and improvement of surveillance flows. 2025-01-01T00:00:00Z http://hdl.handle.net/11624/4203 Title: Análise da prevalência das doenças infecciosas na população em situação de rua : desafios das equipes do consultório na rua no acesso ao cuidado à saúde. Authors: Lamb, Iama Verdi Abstract: Healthcare is a social right, but the homeless population (PSR) faces access barriers, stigma, and high rates of diseases such as HIV (human immunodeficiency virus), hepatitis, syphilis, and tuberculosis (TB). The overall objective of my dissertation was to analyze the prevalence of emerging infectious diseases among the homeless and the challenges faced by street clinic teams in ensuring access to healthcare. Manuscript 1: This study aimed to map the literature on the prevalence, stigma, and barriers to treatment of infectious diseases such as HIV, syphilis, hepatitis, and tuberculosis among the homeless population (PSR), and the public policies needed to mitigate their impacts with health interventions targeted at this vulnerable group. This is an integrative literature review, with searches in PubMed, Springer Link, Taylor & Francis Online, Google Scholar, Scielo, and Wiley Online Library. A high prevalence of these diseases was found in individuals over 18 years of age, women, drug users, transgender individuals, and individuals with a history of incarceration. Homeless people face barriers to combating infectious diseases due to housing instability, drug use, and limited access to health services. Public policies such as housing stability strategies, targeted vaccination, screening, and early treatment can improve access to health care and reduce inequalities. It is concluded that targeted interventions and inclusive public health policies are essential to address these issues and promote equitable health outcomes. Manuscript 2: Homeless people face extreme poverty, homelessness, serious health problems, difficulties in accessing medical care, and discrimination. This study aimed to analyze the prevalence of infectious diseases, symptoms, risk behaviors, working conditions, and access to health services among homeless people, considering their history of deprivation of liberty, in a municipality in Rio Grande do Sul, Brazil. This is a cross-sectional, exploratory, and descriptive study conducted with homeless people from September to October 2024. Data collection took place at the Street Clinic Program to analyze infectious diseases and staff challenges, using in-person and confidential approaches. The data show that the homeless people analyzed have low age variability, a high prevalence of substance use, and challenges in accessing documents and work. Infectious diseases such as HIV (14.9%; p < 0.001) and syphilis (46%; p = 0.548) were identified. The BCG scar and tuberculosis treatment showed no statistical association with symptoms of cough, shortness of breath, weight loss, decreased appetite, fever, or spitting up blood. Cough was more common among those deprived of liberty (p = 0.004). Homeless people are highly vulnerable, with a high prevalence of HIV and syphilis. The data reinforce the importance of the Street Clinic in providing comprehensive care and access to healthcare. Manuscript 3: This study aimed to map the literature on the strategies and challenges faced by Street Outreach teams in Brazil. This is an integrative literature review, with research in the Scielo and Google Scholar databases, covering papers published within a five-year period (2019-2024). Street Outreach teams face challenges such as low educational levels and chemical dependency among the individuals they serve, which complicate reintegration and treatment. Lack of resources and inadequate infrastructure compromise continuity of care, while resistance to treatment and difficulty maintaining adherence are recurring problems. Social outreach and inclusion strategies range from basic support and socio-educational activities to education and prevention, with some teams utilizing technologies and adapting to local conditions. The study revealed that, although there have been advances in assisting the homeless population, significant challenges persist, such as lack of resources, social stigma, and logistical difficulties. It highlights the need for integrated approaches and more effective public policies to ensure more inclusive and equitable care. 2025-01-01T00:00:00Z