http://hdl.handle.net/11624/150 2026-05-01T22:57:12Z http://hdl.handle.net/11624/4262 Title: Suplementação de creatina entre praticantes de exercícios físicos em academias e sua influência sobre marcadores antioxidantes e de dano ao DNA. Authors: Eisenhardt, Munithele Moraes Abstract: Introduction: The increase in gym membership has driven demand for sports supplements, particularly creatine. Scientific evidence shows that, in addition to its ergogenic benefits, creatine has antioxidant properties. However, the relationship between creatine supplementation and DNA damage still needs further investigation. General objective: To review and investigate creatine supplementation among gym-goers, exploring its relationship with demographic and behavioral variables, and to analyze its influence on antioxidant and DNA damage markers. Book Chapter: This chapter sought to identify the role of creatine supplementation as an ergogenic aid, capable of contributing to significant improvements in physical performance and muscle mass gain. In addition, it provided evidence suggesting that creatine supplementation may play an indirect antioxidant role, helping to combat oxidative stress during physical exercise, thus mitigating oxidative damage to cellular structures such as lipids, proteins, and DNA. Manuscript 1: A total of 358 gym users were evaluated and responded to an online questionnaire addressing demographic data, exercise habits, and creatine use. Of these, 48.6% used creatine, with a higher prevalence among females (57.5%; p<0.001), younger individuals (<30 years; 56.3%, p<0.001), and non-smokers (87.0%; p=0.037). Creatine users had a higher frequency of weekly training sessions (64.4%, >4 times per week; p<0.001), sessions lasting up to 60 minutes (60.9%; p=0.001), and motivation focused on muscle mass gain (85.1%; p<0.001). Differences according to gender were observed for the number of weekly sessions (>4 times per week, Women, 56.0% and Men 75.7%; p=0.027), training duration (≤60 minutes, Women, 69.0% and Men 50.0%; p=0.012), reasons for use, such as muscle mass gain (Women, 34.0% and Men 62.0%; p<0.0001), and motivation focused on muscle mass gain (Women, 34.0% and Men 62.0%; p<0.0001), reasons for use, such as muscle mass gain (Women, 34.0% and Men 62.0%; p<0.0001) and muscle recovery (Women, 34.0% and Men 9.5%; p<0.001), and recommendations for use by nutritionists (women, 50.0%, and men, 21.6%; p<0.001) or physical (women, 6.0%, and men, 0.0%; p=0.039). Supplementation also varied according to age group, with significant differences in training duration (<30 years: 54.1%, ≤60 minutes; 30–45 years: 77.0%, ≤60 minutes and >45 years: 60.0%, >60 minutes; p=0.003), reasons such as muscle mass gain (<30 years: 54.1%, 30–45 years: 34.4%, and >45 years: 60.0%; p=0.048) and health (>45 years: 40.0%; p=0.001), in addition to medical recommendation (>45 years: 20.0%; p=0.001). Manuscript 2: In total, 254 gym-goers were evaluated, with a mean age of 35.36 ± 13.60 years and a prevalence of females (65.0%). The prevalence of creatine use was 44.9%, and the individuals were divided into three supplementation groups: non-user (n=140), creatine use alone (n=33), and combined use of creatine with one or more supplements (n=81). Regarding DNA damage markers (damage index and frequency, micronuclei, and nuclear buds), analyses of variance did not indicate significant differences between the supplementation groups (p>0.05). However, adjusted linear regression revealed that participants using combined creatine maintained a significantly lower frequency of cells with micronuclei compared to those using isolated creatine (β=−2.19; p=0.023), even after controlling for covariates. The other associations between the form of supplementation and the other markers of DNA damage did not hold up after adjustment. Finally, for the antioxidant markers TEAC and TBARS, no significant differences were observed between the groups in the analysis of variance or in the linear regression (crude and adjusted), indicating that the form of creatine use did not significantly impact systemic antioxidant status (p>0.05). Creatine Supplementation Guide: The primer addresses the main aspects of creatine supplementation, highlighting its antioxidant benefits, the definition of creatine and its dietary sources, and its mechanism of action in the body. Other beneficial effects are also presented, such as improved muscle and energy performance, and information on safety of use, including recommended doses and supplementation protocols. Final considerations: The works described in this dissertation reinforce the relevance of creatine supplementation in the context of sports nutrition, highlighting its ergogenic and antioxidant effects. Also, the findings suggest a potential protective effect of combined creatine on DNA damage, with little influence of the supplementation method on the antioxidant markers analyzed. 2026-01-01T00:00:00Z http://hdl.handle.net/11624/4261 Title: Tuberculose ativa e latente na população privada de liberdade : prevalência, perfil epidemiológico e avaliação de tecnologias diagnósticas. Authors: Boeira, Eduarda Gassen Abstract: Introduction: Tuberculosis (TB) remains a major public health problem, especially in prisons, where incidence is more than 22 times higher than in the general population (GP). Active case finding has shown high effectiveness in increasing detection and reducing incidence. Overall objective: To estimate the prevalence of active and latent tuberculosis among people deprived of liberty (PDL), to characterize their sociodemographic and epidemiological profile, and to evaluate diagnostic technologies used in the prison context. Manuscript 1: Objective: To assess the occurrence of active tuberculosis and latent infection, as well as associated factors, in a male prison in southern Brazil using a systematic screening strategy. Methods: A cross-sectional study with mass screening was conducted, including symptom assessment, digital chest X-ray with automated interpretation using artificial intelligence (LunitTB), and molecular testing with GeneXpert MTB/RIF. Latent TB infection was evaluated using the interferon-gamma release assay (IGRA). Sociodemographic, clinical, and behavioral variables were analyzed. Results: Of the 677 eligible individuals, 652 (96.3%) completed screening, and 120 underwent IGRA testing. The prevalence of active TB was 4.7%, and 62% of those tested had latent infection. TB occurrence was associated with contact with a TB case within the same cell, problematic alcohol use, and symptoms such as weight loss, chest pain, and night sweats. Chest X-ray combined with artificial intelligence showed good performance in case identification. Conclusion: Findings reveal a high burden of TB and latent infection in the prison setting, reinforcing the importance of active screening. The integration of chest X-ray, artificial intelligence, and molecular testing proved effective in increasing case detection, including cases that would likely not be identified by symptom-based strategies alone. Manuscript 2 Objective: To evaluate the performance of diagnostic tests for TB in the general population (GP) and people deprived of liberty (PDL) across four Brazilian states. Methods: An ecological study was conducted using data from the Brazilian Notifiable Diseases Information System (SINAN), including new pulmonary TB cases reported between 2017 and 2023 in the states of São Paulo, Rio Grande do Sul, Espírito Santo, and Goiás. Variables included sociodemographic characteristics and the use of sputum smear microscopy, sputum culture, rapid molecular testing (RMT), and chest X-ray. Descriptive and inferential analyses were performed using Pearson’s chi-square test, with post-hoc analysis based on adjusted standardized residuals. Results: A total of 103,956 cases were analyzed, of which 82.1% were in the GP and 17.9% in the PDL. The PDL group had a higher proportion of young men, individuals of mixed race (brown), and lower educational levels. The GP showed higher use of sputum smear microscopy and chest X-ray, while the PDL had proportionally greater use of RMT and sputum culture. Despite the high TB incidence in the PDL, access to diagnostic technologies was similar to that of the GP. The mean time between diagnosis and treatment initiation was also similar between groups. Conclusion: Sociodemographic and territorial inequalities in TB diagnosis persist. Differences in the use of diagnostic tests between GP and PDL are small when considering the disproportionate disease burden in prisons, highlighting inequities in the organization of care and reinforcing the need for equity-oriented strategies in TB control. Overall conclusion: The adoption of an integrated screening strategy combining computer-aided digital chest X-ray and rapid molecular testing revealed a high hidden burden of TB in the prison system. These findings demonstrate that reactive, symptom-based models are insufficient, that structural inequalities affect access to diagnosis, and that systematic, equitable, and targeted expansion of diagnostic technologies is essential to interrupt transmission within prisons and reduce its impact on the broader community. 2026-01-01T00:00:00Z http://hdl.handle.net/11624/4258 Title: O perfil clínico e sociodemográfico de pessoas com histórico de tentativa de suicídio. Authors: Lasevitz, Jaime Abstract: Introduction: Suicide is an emerging public health issue, with an increasing incidence, especially among young and old people. In addition to previous suicide attempts, recognized as one of the main risk factors, there is evidence that other variables are correlated. The analysis of hospital records in the context of attempted suicide episodes requires further studies. This research focuses on a region that has an annual suicide and attempted suicide rate higher than the national average. The need for additional studies on the factors that contribute to this problem is highlighted. General objective of the dissertation: To analyze epidemiological data of people who attempted suicide treated at a Central hospital, Vale do Rio Pardo in Rio Grande do Sul. Manuscript summary 1: This manuscript aims to analyze the profile of individuals treated at a general hospital who attempted suicide between January 2020 and March 2021. This is an epidemiological, descriptive, and quantitative study carried out in a referral hospital in Vale do Rio Pardo, Rio Grande do Sul. Hospital records were analyzed using the International Classification of Diseases (ICD-10), selecting diagnoses of intentional self harm and mental and behavioral disorders. In the second stage, cases of attempted suicide and the following variables were identified: age, sex, method used in the suicide attempt, diagnoses and monthly frequency of cases, origin, and referrals. The results showed a high prevalence of mood disorders, with a predominance of suicide attempts among women, mainly due to exogenous intoxication. Most cases came from urban areas. Young people had a higher rate of suicide attempts than other age groups. Most of the cases were referred to the public health system. There was an increase in cases during the summer, especially in January. It was concluded that the vulnerability profile of women and young people, especially those associated with mood disorders and exogenous intoxication. The increase in cases during the summer in the region under study may be an indicator of risk of suicide attempts in the future, but more research is needed in this regard. Final considerations of the dissertation: There is a need to intensify suicide prevention actions, especially among young people, through the implementation of educational and psychological support programs involving their families. The scientific literature still lacks more in-depth studies on the causes of seasonality in suicide attempts and their regional variations. In addition to biological causes, investigation of cultural and social specificities of each location is necessary. Access to medicines must be controlled from their supply to the care of family members at home, since medicine poisoning is the most common means of attempted suicide. 2025-01-01T00:00:00Z http://hdl.handle.net/11624/4255 Title: Tendências temporais de agravos à saúde antes e após a catástrofe climática do ano de 2024 no estado do Rio Grande do Sul. Authors: Guterres, Francine Xavier Abstract: General Introduction: Extreme weather events have intensified in recent decades, producing significant impacts on public health. In Rio Grande do Sul, the floods of May 2024 constituted the largest climate catastrophe in the state's recent history, with substantial health repercussions. General Objective: To analyze the influence of the 2024 climate catastrophe on the temporal distribution of notifiable health conditions in the municipality of Campo Bom (RS). Manuscript I. Effects of the 2024 climate catastrophe on health conditions reported in a municipality in the state of Rio Grande do Sul: a study using interrupted time series. Introduction: Extreme weather events have become more frequent with significant repercussions on disease patterns. The May 2024 floods in Rio Grande do Sul affected hundreds of municipalities, including Campo Bom, historically vulnerable to flooding. Objective: To examine the temporal behavior of notifiable health conditions in the municipality of Campo Bom between 2014 and 2024, with emphasis on changes associated with the hydrometeorological catastrophe of May 2024. Methods: A retrospective ecological study using data from the Notifiable Health Conditions Information System (SINAN) to compose monthly time series analysis of viral hepatitis, venomous animal accidents, leptospirosis, human anti-rabies care, dengue, Coronavirus Disease 2019 – Covid-19, and severe acute respiratory syndrome (SARS). Negative binomial regression, Zero-Inflated Negative Binomial (ZINB) models, and interrupted time series were applied, with May 2024 as the interruption point. Results: Leptospirosis showed a 45-fold increase in incidence immediately after the floods (IRR= 45.0; p= 0.002) and human anti-rabies care almost doubled (IRR= 1.96; p= 0.002). Viral hepatitis, dengue, and SARS showed no significant changes. The increase in venomous animal accidents resulted from a pre-existing upward trend. Covid-19 showed a 99% decline (IRR= 0.01; p<0.001), reflecting the decline of an epidemic wave prior to the disaster. Conclusion: The 2024 climate catastrophe primarily impacted leptospirosis and anti-rabies care, while other conditions maintained their patterns, reinforcing the importance of sensitive and technically structured epidemiological surveillance to guide rapid responses in future climate disasters. Manuscript II. Epidemiological behavior of dengue in Rio Grande do Sul: temporal and spatial analysis in the context of the 2024 climate catastrophe. Objective: To analyze the epidemiological behavior of dengue in the state of Rio Grande do Sul in 2024, a year marked by a significant climate catastrophe, and to describe its temporal and spatial distribution and demographic profile compared to the 2017–2023 period. Methods: A descriptive ecological study using data from the Notifiable Health Conditions Information System (SINAN) for the period 2017–2024. Temporal analysis was performed using cubic spline smoothing and Prais-Winsten regression for estimating annual percentage change. Spatial distribution was analyzed by municipality, comparing 2024 to the historical average of 2017–2023. Local spatial autocorrelation analysis (LISA) was applied with a queen contiguity matrix, permutations with α= 0.05, and adjustment by the False Discovery Rate method. The sociodemographic profile was characterized by sex, age group, and race/ethnicity. Results: A total of 209,668 confirmed cases were recorded between 2017 and 2024, with concentration in 2024. Temporal analysis revealed an epidemic outbreak between March and May 2024, peaking in April and exceeding the historical median fivefold. Annual percentage variation ranged from 270 to 308% (p<0.001), being highest in the ≥60 years age group (308%). Spatial distribution showed strong concentration in the Northwest/Missões region, with 39 municipalities identified in a High-High pattern (hotspots), notably Tenente Portela (27,260 cases/100,000 inhabitants). Low-transmission areas (coldspots) were identified in Serra Gaúcha and Campanha/Southern Coast. The sociodemographic profile revealed female predominance (54.8%), a shift toward older age groups (relative increase in ≥50 years), and proportional growth in the Black population. Conclusion: The year 2024 presented an atypical dengue pattern in the state of Rio Grande do Sul, with intensified transmission, spatial heterogeneity, and changes in the profile of the affected population. The temporal coincidence between the climate disaster and epidemic intensification suggests an interface between extreme hydrometeorological events and the dynamics of arbovirus transmission. Stratification of control actions by municipal risk level and integration between epidemiological surveillance and civil defense for response to climate emergencies is recommended. E-book Chapter. Climate catastrophe in the state of Rio Grande do Sul: when health conditions advance. Objective: To address the subject of climate catastrophes in accessible language to support the training of health professionals, continuing education, and scientific dissemination on the impacts of climate catastrophes on public health. Structure: The chapter is organized into four sections: (1) historical contextualization of extreme weather events in Rio Grande do Sul from the 1941 floods to the 2024 events; (2) presentation of climate-sensitive notifiable health conditions analyzed in the dissertation; (3) synthesis of the main empirical findings, highlighting heterogeneity in impacts by type of condition, spatial distribution, and territorial characteristics; and (4) discussion of implications for public health policies, epidemiological surveillance systems, and preparedness for future climate disasters. Contribution: Documents in a systematic and accessible manner the impact of the 2024 extreme climate events on morbidity patterns in Rio Grande do Sul and provides input for the critical training of health professionals and the enrichment of public debates on climate justice and socioenvironmental health inequalities. Dashboard RADAR-CB – Registry and Analysis of Data on Health Conditions Related to the Municipality of Campo Bom. Objective: To develop an interactive web tool for descriptive exploration of time series of health conditions in Campo Bom from 2014 to 2024, supporting municipal epidemiological surveillance. Platform and functionalities: Application developed in R language with the Shiny framework, hosted on ShinyApps.io, containing time series charts with interactive filters by health condition and period, boxplots for seasonality visualization, basic epidemiological indicators, and a responsive interface accessible via computer, tablet, and smartphone. Contribution: Translates complex statistical analyses presented in Manuscript I into easy-to-understand graphical representations, brings scientific production closer to municipal epidemiological surveillance routines, functions as a tool to support evidence-based decision-making, and presents potential for replication in other municipalities with similar technological resources. General Conclusion: The 2024 climate catastrophe impacted the analyzed health conditions heterogeneously, evidencing the sensitivity of certain diseases to abrupt environmental changes. The technical products developed (e-book chapter and RADAR-CB dashboard) demonstrate the feasibility of translating scientific knowledge into applied practice, contributing to professional training, management support, and the strengthening of integrated and territorialized surveillance strategies. 2026-01-01T00:00:00Z