https://tede.unioeste.br/handle/tede/523 Thu, 06 Aug 2026 13:34:17 GMT 2026-08-06T13:34:17Z https://tede.unioeste.br/handle/tede/8566 Title: O nervo vago influencia o eixo hepcidina-ferro e a histologia do tecido esplênico em ratos Wistar obesos e não obesos induzidos à anemia hemolítica. Autor: Helene, Eveline Cristiane Batista Schmidt Primeiro orientador: Grassiolli, Sabrina Abstract: Introduction: The spleen plays a central role in immune responses and iron recycling through the reticuloendothelial system. Obesity exerts deleterious effects on splenic metabolic and immune activities, as well as on the regulation of endogenous iron, thereby favoring the development of anemia. In this context, the low-grade chronic inflammation characteristic of obesity has been associated with disruption of iron homeostasis, a process that appears to involve alterations in the secretion of hepcidin, the principal hormone regulating systemic iron flow. The parasympathetic branch of the autonomic nervous system, via Vagus Nerve (VN), exerts an anti-inflammatory effect that depends on splenic activity. However, whether this VN-spleen interface modulates iron homeostasis remains unclear. Objective: To evaluate the effects of VN absence on the splenic histology of obese and non-obese rodents induced to hemolytic anemia by phenylhydrazine. Methods: Male Wistar rats were rendered obese through hypothalamic injury induced by subcutaneous administration of monosodium glutamate (MSG; 4 g/kg) from postnatal day 2 to 10 (PND 2–10). Control rats (CTRL) received an equimolar saline solution. On PND 60, MSG (n=32) and CTRL (n=32) rats were randomly assigned into subgroups (n=16) according to the surgical procedures: subdiaphragmatic vagotomy (SV) or sham operation (SHAM). On PND 90, half of the animals in each group (n=8) were induced to hemolytic anemia by intraperitoneal administration of phenylhydrazine (PHZ; 40 mg/kg). On PND 120, animals were weighed and euthanized; whole blood was collected for plasma analysis, including iron and hepcidin quantification. Retroperitoneal white adipose tissue (rWAT) was excised and weighed. The spleen was harvested, weighed, and stored for histological analysis to assess area and morphological aspects of the White Pulp (WP), including the Lymphoid Nodule (LN) and Marginal Zone (MZ), as well as Red Pulp (RP) area. Results: MSG-treated animals developed obesity, associated with hypertriglyceridemia, insulin resistance (IR), and decreased circulating iron and hepcidin concentrations, along with reduced spleen weight, decreased WP and RP areas, and increased iron deposition compared to CTRL rats. In both CTRL and MSG groups, SV reduced body weight and adiposity and increased stomach weight. In the CTRLSV group, worsened TG and IR were observed, accompanied by reduced plasma hepcidin levels and increased hemosiderin deposits in splenic tissue. In CTRLPHZ animals, spleen weight was increased, with no significant histological changes, except for a reduced number of WP per field due to PHZ. However, in MSGSV animals, TG levels decreased, IR and fasting glycemia improved, and plasma hepcidin concentration increased – an effect enhanced in the MSGSV+PHZ group. The area and number of WP per field were greater in the MSGSV group. MSGPHZ rats exhibited splenomegaly and increased hemosiderin deposition, with a reduction in LN area and an increase in RP area. Conclusion: Rats with hypothalamic obesity present alterations in the hepcidin-iron axis, with greater splenic iron accumulation. The absence of vagal signaling increases iron deposition in splenic tissue and exerts opposite effects on hepcidin concentration in healthy and obese rats. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Dissertação Fri, 15 May 2026 00:00:00 GMT https://tede.unioeste.br/handle/tede/8566 2026-05-15T00:00:00Z https://tede.unioeste.br/handle/tede/8524 Title: Avaliação da Qualidade do Serviço de Triagem Auditiva Neonatal de uma Regional de Saúde do Paraná Autor: Taborda, Leonardo Pires Primeiro orientador: Rodrigues, Rosa Maria Abstract: Neonatal Hearing Screening Programs (NHSPs) are essential for the early detection of hearing loss (HL) and for ensuring timely diagnosis and intervention, thereby reducing adverse impacts on child development. Despite their importance, these programs face barriers that limit their effectiveness. This study aimed to evaluate the quality of the NHSP in a Health Region of Paraná, Brazil, considering the dimensions of structure, process, and outcomes according to Donabedian’s framework. The research consisted of an integrative review and an evaluative study. The review was conducted using PubMed, SciELO, and the Virtual Health Library databases, with study selection performed by two independent reviewers and synthesis of findings organized according to Donabedian’s framework. The evaluative study included documentary analysis of DATASUS data, collection of information from the Regional Health Department, and a field study conducted at the regional hearing healthcare referral service. The field study was carried out in two stages. In the first stage, a cross-sectional design was adopted, and an initial questionnaire was administered to parents and/or caregivers of children receiving care at the service in order to characterize aspects related to structure, process, and outcomes. Caregivers of children in institutional care were excluded. A total of 63 caregivers participated in this stage. The second stage employed a longitudinal qualitative design. Among the participants from the first stage, only caregivers of children who had received a “refer” result on neonatal hearing screening and were younger than six months of age at the time of the initial data collection were selected. These participants were followed for two months via WhatsApp. Follow-up questionnaires were administered after hearing related appointments, and a final questionnaire was applied to assess perceptions of the care pathway, characterizing a case study design. Two participants remained in the study until its completion. The results revealed weaknesses across all three Donabedian dimensions. Regarding structure, limited availability of screening sites, shortages of professionals, a high dependence on outsourced services, and the absence of an integrated information system were identified. In the outcomes dimension, estimated coverage rates were below recommended levels, and delays in completing neonatal hearing screening were observed. In the process dimension, inconsistencies in care referrals were identified, affecting the timing of diagnosis and intervention. Longitudinal follow-up revealed communication failures, diagnostic delays, and variations in family satisfaction throughout the care pathway. The findings were consistent with the results of the integrative review, which demonstrated that NHSPs worldwide present limitations in structure, process, and outcomes, as well as recurrent delays in audiological diagnosis. It is concluded that the evaluated NHSP demonstrates compromised quality resulting from interdependent weaknesses across structure, process, and outcomes. Structural limitations directly affect care processes, generating delays, coordination failures, and difficulties in continuity of care, resulting in indicators below recommended standards. These findings highlight the need to reorganize care pathways, strengthen regional management, improve information systems, and expand access in order to ensure timely diagnosis and intervention for children with suspected hearing loss. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Dissertação Wed, 11 Mar 2026 00:00:00 GMT https://tede.unioeste.br/handle/tede/8524 2026-03-11T00:00:00Z https://tede.unioeste.br/handle/tede/8522 Title: Avaliação do comportamento alimentar de crianças com transtorno do espectro autista (TEA) e a atitude dos cuidadores no momento das refeições Autor: Klauck, Caroline Maliska Primeiro orientador: Toso, Beatriz Rosana Gonçalves de Oliveira Abstract: Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent impairments in communication and social interaction, associated with restricted and repetitive patterns of behavior, interests, or activities. Among the difficulties presented by autistic children, eating difficulties stand out. Objective: To evaluate the eating behavior of children with Autism Spectrum Disorder (ASD), as well as the attitude adopted by caregivers in response to this behavior at mealtimes. Methods: This is a cross-sectional study with a qualitative-quantitative approach. Data collection took place in the municipality of Capanema-Pr, with family members of children with ASD, linked to the Association of Parents of Children with ASD and/or who attended municipal schools and early childhood education centers. Sociodemographic, clinical, and child feeding data were collected using a structured questionnaire, validated and translated into Portuguese, called the Brief Record of Eating Behavior (BRCA-TEA). The qualitative stage consisted of two open-ended guiding questions about caregivers' strategies at mealtimes. Quantitative data were analyzed using descriptive statistics with the aid of SPSS, while qualitative data were analyzed manually with the aid of Microsoft Excel software. Results: The sample consisted mainly of mothers, and the children were predominantly male, with support level 2, frequent use of medication, and the presence of comorbidities, especially attention deficit hyperactivity disorder (ADHD). It was observed that 63.6% of children had eating behavior problems, mainly characterized by selectivity, food refusal, and low acceptance of new foods. There was a significant association between the level of support and sociodemographic variables, such as the child's age, education and age of caregivers, and maternal occupation, with no associations identified with clinical or nutritional variables. Qualitative analysis revealed seven themes and 19 subthemes, highlighting the diversity of strategies used by caregivers, including encouragement, routine organization, interaction, emotional support, games, distractions, and behavioral management, in addition to the challenges, feelings, and perceptions involved in feeding care. Conclusion: Food selectivity in children with ASD is a multifactorial phenomenon influenced by sensory, behavioral, emotional, and family aspects. Eating difficulties have a significant impact on families' daily lives and require interdisciplinary approaches that consider both the child's eating behavior and the family context, strengthening support for caregivers and the implementation of evidence-based strategies. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Dissertação Fri, 27 Feb 2026 00:00:00 GMT https://tede.unioeste.br/handle/tede/8522 2026-02-27T00:00:00Z https://tede.unioeste.br/handle/tede/8520 Title: Adaptação transcultural e validação psicométrica do instrumento “abbreviated profile of hearing aid benefit - aphab” para o português do Brasil Autor: Rosario, Ana Elisabete Fontana de Paula Primeiro orientador: Carvalho, Ariana Rodrigues da Silva Abstract: Introduction: In an attempt to minimize the undesirable effects of hearing loss, amplification through hearing aids is widely recommended. To measure the benefits provided by these aids, instruments such as questionnaires and scales are used. In this context, the use of validated instruments becomes essential to ensure greater reliability in the assessment of hearing aid benefit. Objective: To carry out the cross cultural adaptation and psychometric validation of the instrument Abbreviated Profile of Hearing Aid Benefit (APHAB) into Brazilian Portuguese, involving users of Personal Sound Amplification Devices (PSADs). Methods: This is a methodological study, with a quantitative analysis, aimed at validating the APHAB instrument, involving PSAD users who seek care at specialized private clinics in the municipality of Cascavel, Paraná. For its validation, the following sequence was used: (1) analysis of the synthesized version by a committee of judges, to compose the final version of the instrument, (2) semantic analysis, (3) structural evaluation. Considering the pre existence of a translation of the instrument from the source language into the target language, this step was not necessary in the present study. Results: The evaluation by the committee of judges resulted in suggestions related to the adjustment of verb tenses, substitution of pronouns, and revision of cultural expressions specific to the source language, aiming to ensure relevance, comprehensiveness, and clarity for the target population. Regarding general impressions, 47.5% of participants considered the instrument “very good” and another 47.5% rated it as “good.” The majority considered the questions easy to understand (87.5%), did not report difficulties with the response categories (85%), and found the questions very relevant to their health condition (77.5%). The reliability of the instrument was confirmed by Cronbach’s alpha coefficient (α = 0.84) and by Guttman’s Lambda 6 (G6 = 0.90), indicating a significant correlation among the items. Confirmatory Factor Analysis did not demonstrate structural validity, since the expected relationships between factors and indicators were not consistent with the observed data, even after adjustments. On the other hand, Exploratory Factor Analysis indicated the exclusion of items Q2, Q9, Q11, Q13, and Q24, resulting in an instrument with four subscales and 19 items. Conclusions: It is concluded that the version adapted into Brazilian Portuguese proved to be equivalent to the original version of the APHAB and presented satisfactory evidence of content validity. Despite the evidence of validity and reliability of the APHAB, the study has limitations, as it has a small sample composed of participants from a single location, which highlights the need to verify the evidence of validity and reliability with a larger audience and different locations. It is important to highlight that new studies need to be conducted with the version adapted into Brazilian Portuguese, with participants who preferably have sociodemographic and clinical characteristics different from those of this study, due to the different socioeconomic and cultural realities of Brazil. In general, the results allowed us to demonstrate that the cross-cultural adaptation, validity, and reliability of the APHAB in the PSAD user population was effective. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Dissertação Thu, 13 Mar 2025 00:00:00 GMT https://tede.unioeste.br/handle/tede/8520 2025-03-13T00:00:00Z