TEDE Collection:

Influência da Fissura Labiopalatina no Desenvolvimento Motor em Crianças na Região Oeste do Paraná - Brasil

2026-04-15T12:55:39Z

Title: Influência da Fissura Labiopalatina no Desenvolvimento Motor em Crianças na Região Oeste do Paraná - Brasil Autor: BERTOLDO, Maria Goreti Weiand Primeiro orientador: Costa, Rose Meire Abstract: Cleft lip and palate (CLP) is the most prevalent congenital craniofacial anomaly worldwide; its correction must begin early and requires multiple procedures and prolonged treatment periods, often leading to various complications that may affect infant motor development (MD). Since the literature on this topic is still incipient, this research was conducted in two stages. The first consisted of an integrative review to identify a possible relationship between CLP and delays in MD, and the second investigated the impact of this condition on the motor performance of infants up to 18 months of age. For the review, primary and secondary studies published between 1990 and 2020 were analyzed with no language restrictions. Of the 360 articles extracted using defined criteria from relevant databases, 8 studies were included. The results indicate significant delays in children with CLP, especially in language and fine motor skills, as well as impairments in cognitive, social, and personal domains. The severity and anatomical type of the cleft appeared to be potential modulators of the profile and intensity of delays, although this association was not consistently observed across studies. The observational research with a cross sectional design was conducted at a specialized craniofacial anomaly center in a public hospital in the western macroregion of Paraná, Brazil. Data collection took place between 2020 and 2025, during which 204 infants were assessed, and the type of cleft was classified using the Spina scale, and MD was measured using the Alberta Infant Motor Scale (AIMS). Analyses were performed in R software (version 4.5.1), and homogeneity between categories was assessed using Pearson’s chi square test. Differences in performance between postures in each trimester were analyzed using one-way ANOVA, followed by Tukey’s test (p < 0.05). The results showed that most children with clefts were male (53,4%), with an equivalent distribution among cleft types (pre-foramen 33,3%, , post-foramen 31.0%, trans foramen 37.1%) and a predominance of unilateral clefts (56.0%). It was found that 50.2% of the children scored below the 50th percentile on the AIMS, indicating risk or clear motor delay. The analysis revealed that the supine posture showed early stabilization, whereas the other postures exhibited gradual progression and greater variability, reflecting an increase in biomechanical complexity and postural control demands. Moreover, the study validates the use of the AIMS for this population, providing a useful tool to quantify deficits and support early interventions aimed at ensuring the full motor development of children with clefts. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese

A HOMEOSTASE FÉRRICA EM ADULTOS COM EXCESSO DE PESO E SUA RELAÇÃO COM COMPLICAÇÕES METABÓLICAS E HEPÁTICAS

2026-02-27T17:36:17Z

Title: A HOMEOSTASE FÉRRICA EM ADULTOS COM EXCESSO DE PESO E SUA RELAÇÃO COM COMPLICAÇÕES METABÓLICAS E HEPÁTICAS Autor: Zanuzo, Késia Primeiro orientador: Grassiolli, Sabrina Abstract: Introduction: Alterations in iron homeostasis, evidenced by elevated serum ferritin (SF) levels, are present in individuals with excess weight and negatively affect insulin sensitivity as well as glucose and lipid homeostasis. These imbalances increase the risk of Metabolic Syndrome (MetS) and Metabolic-Associated Steatotic Liver Disease (MASLD). Factors such as adiposity, sex, diet, and metabolic parameters influence both SF concentrations and the severity of MASLD. However, the relationship among these factors remains poorly understood in the adult population of Paraná, Brazil. Objective: To evaluate the association between SF concentrations and changes in adiposity, nutritional status, metabolic status, and hepatic complications in adult residents of Paraná. Methods: This was a quantitative, descriptive, cross-sectional study with non-probabilistic consecutive sampling, approved by an institutional Research Ethics Committee. Data were collected at a Nutrition outpatient clinic in Southwestern Paraná between 2023 and 2024. A total of 163 adults were evaluated, with collection of socioeconomic data (age, sex, education, income), lifestyle factors (physical activity, alcohol consumption, smoking), anthropometric measurements (weight, height, and adiposity), laboratory tests (glucose, lipid profile, hepatic parameters, SF, complete blood count, inflammatory markers), and dietary information (food frequency questionnaire and 24-hour dietary recall). The prevalence of MetS, the Hepatic Steatosis Index (HSI), and the Fibrosis-4 Index (FIB-4) were also calculated. Results: In the first stage, 79 adults were analyzed, with a median age of 34 (25–44) years. Among them, 67.09% were overweight, which was associated with greater visceral adiposity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance, resulting in a higher prevalence of MetS (30.39%) and increased cardiovascular risk (54.43%) compared to individuals without excess weight (p<0.05). Significant hematological alterations were also identified (p<0.05), including increased hemoglobin, erythrocytes, hematocrit, leukocytes, and platelets, as well as reduced mean corpuscular volume and mean corpuscular hemoglobin. Principal component analysis showed a significant association between visceral adiposity, metabolic and hematological alterations, and elevated SF concentrations in overweight individuals (p<0.05). In the second stage, 113 adults (>18 years) were evaluated and categorized into normal SF and high SF groups. Individuals with high SF were predominantly male (47.4%), married or in a stable union (65.7%), had lower educational attainment (42.1%), higher obesity prevalence (55.3%), and alterations in glycemic, lipid, and blood pressure parameters (p<0.05). Hepatic findings showed that adults with high SF had increased alanine aminotransferase (21.6%), uric acid (29%), and HSI (67.6%) (p<0.05). Logistic regression indicated a higher likelihood of elevated SF among men (OR=16.82) and individuals with high adiposity (OR=7.5). Diet did not influence SF concentrations. PERMANOVA analysis confirmed that adults with high SF present a distinct sociodemographic profile, greater adiposity, and more metabolic and hepatic complications, with no dietary impact. Conclusions: Adults from Paraná with excess weight, high visceral adiposity, and metabolic complications exhibited higher SF concentrations, particularly men. SF appears to be a potential marker of health status and risk of hepatic complications. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese

PERFIL EPIDEMIOLÓGICO DOS ÓBITOS POR CÂNCER DO COLO DO ÚTERO NO PARANÁ E O PROCESSO NO PROGRAMA NACIONAL DE CONTROLE

2026-02-27T17:25:26Z

Title: PERFIL EPIDEMIOLÓGICO DOS ÓBITOS POR CÂNCER DO COLO DO ÚTERO NO PARANÁ E O PROCESSO NO PROGRAMA NACIONAL DE CONTROLE Autor: Plewka, Jacqueline Primeiro orientador: Simão, Rita de Cássia Garcia Abstract: Introduction: Cervical cancer is the fourth leading cause of death among women in Brazil, affecting women of working age. Despite the National Cervical Cancer Control Program, implemented by the Ministry of Health and provided through the Unified Health System, mortality remains high, indicating gaps in early detection and clinical follow-up. Objective: To characterize the care process of women who died from cervical cancer in the state of Paraná, Brazil, between 2014 and 2023, within the scope of the National Cervical Cancer Control Program, based on records from the Ministry of Health information systems. Methods: This study employed two complementary approaches: an ecological time-series investigation using records from the Mortality Information System of Paraná, and a retrospective analysis of cytopathological, colposcopic, and histopathological examinations recorded in the Cancer Information System. Sociodemographic variables, mortality rates by place of residence and place of death, projections through 2030, years of potential life lost, frequency of examinations, and clinical follow-up of precursor lesions and cancer were analyzed using descriptive statistics, chi-square tests, generalized linear models with Poisson distribution for temporal trends, and spatial analysis with mean rates and heat maps. Projections were performed using the Holt–Winters method, adopting a 5% significance level. Results: A total of 3,508 deaths were analyzed, predominantly among White women with low educational attainment and employment in repair and maintenance services. The highest mortality rates occurred among women aged over 65 years; however, a substantial number of deaths were observed among those aged 40–59 years, indicating a relevant socioeconomic impact, with a mean of 14.41 years of potential life lost. Higher mortality by place of residence was observed in the 9th Health Region, located in the tri-border area, indicating greater regional vulnerability, while higher mortality by place of death occurred in the 10th Health Region, possibly related to the greater availability of specialized health services. Temporal projections indicated a 27.69% increase in mortality by 2030, rising from 0.65 to 0.83 deaths per 100,000 women. Among 812 women analyzed in the Cancer Information System, 53.4% underwent only cytopathological examinations, 18.2% underwent colposcopic and histopathological examinations, and 28.4% completed the full diagnostic triad. Predominantly negative results were observed, with absence of squamocolumnar junction representation and screening indication. Inadequate clinical follow-up was identified in 25.8% of women with precursor lesions or cancer. The correlation between cytology and histology within the diagnostic triad reached 86.1%, highlighting the relevance of cytopathological examination, whereas isolated colposcopy showed low sensitivity.Conclusions: The study characterized the epidemiological profile, mortality rates, and care flow of women who died from cervical cancer in Paraná between 2014 and 2023. Weaknesses were identified in follow-up and screening stages within the National Cervical Cancer Control Program, indicating that, despite the reliability of cytopathological screening, the opportunistic model of the Unified Health System contributes to the persistence of high mortality rates in the state. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese

Programa de intervenção padronizada para estímulo do desempenho motor de prematuros hospitalizados e autoeficácia materna para cuidado

2026-02-27T17:09:05Z

Title: Programa de intervenção padronizada para estímulo do desempenho motor de prematuros hospitalizados e autoeficácia materna para cuidado Autor: Ruedell, Aneline Maria Primeiro orientador: Viera, Claudia Silveira Abstract: The objective of this study is to examine the influence of an educational motor intervention program offered to mothers on the motor performance of hospitalized premature infants and on maternal self-efficacy perceptions regarding care. This is a quasi-experimental pilot study developed in two stages: 1. cross-cultural validation of the Maternal Education Program Manual, based on The Norwegian Physiotherapy Study Preterm Infants, which proposes maternal training for motor stimulation of hospitalized premature infants. 2. application of the program to mothers of premature newborns hospitalized in the Neonatal Intensive Care Unit. The study sites were the Neonatal Intensive Care Unit and the Outpatient Clinic for follow-up of at-risk newborns at the University Hospital of Western Paraná. Eighteen preterm newborns with a gestational age greater than 28 weeks and less than or equal to 32 weeks and their mothers participated in the study, excluding those with malformations and/or a diagnosis of neurological injury; adolescent mothers; illiterate mothers or those who did not speak Portuguese fluently; mothers who had a diagnosis of a mental disorder or used psychotropic medication. The preterm newborns were randomly divided into two groups: Comparison Group, nine premature newborns who received only the standard routine guidelines of the sector, and Intervention Group, whose nine mothers, in addition to the usual guidelines of the unit, participated in the Maternal Education Program developed by the physical therapist, author of this thesis. The standardized intervention program consisted of meetings between mothers and the physical therapist during their child's hospitalization, three times in the first week, twice in the second week, and once in the third week. In addition, the mothers performed motor stimulation for three weeks, with two daily sessions of 10 minutes each. Participants in both groups were evaluated at three points in time: 1. hospitalization, when the newborns reached 34 weeks; 2. at 37 weeks of gestational age, during hospitalization; 3. at three months of age after conception, at the premature infant follow-up clinic. Motor development was assessed using the Test of Infant Motor Performance. Maternal self efficacy in neonatal care was measured using two specific instruments: Perception of Maternal Parenting Self-Efficacy, applied during hospitalization, and the Preterm Parenting & Self-Efficacy Checklist – Brazilian version, at the follow-up clinic. The data were analyzed using descriptive statistics to characterize the sample and compare the groups, using Student's t-test, Wilcoxon-Mann-Whitney test, and Fisher's exact test, considering the small sample size. The significance level adopted in all analyses was 5% (α=0.05). The motor performance of the intervention group was higher after the motor intervention (p=0.001). There was no statistical difference in the third assessment, after hospital discharge (p=0.117). In maternal self-efficacy, assessed by the Preterm Parenting & Self-Efficacy Checklist in relation to motor performance, a positive correlation was also observed, with a tendency toward statistical significance (p=0.078; 95% CI: 0.05 to 0.74). It was concluded that the motor intervention performed by the mothers had a positive effect immediately after the end of the intervention, but this was not sufficient to maintain the evolution of motor performance at three months. Mothers with greater self efficacy tended to have children with better motor performance. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese