SANDRA JOSEFINA FERRAZ ELLERO GRISI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- No Association between Low Birth Weight and Cardiovascular Risk Factors in Early Adulthood: Evidence from Sao Paulo, Brazil(2013) GOMES, Filumena Maria; SUBRAMANIAN, S. V.; ESCOBAR, Ana Maria de Ulhoa; VALENTE, Maria Helena; GRISI, Sandra Josefina Ferraz Ellero; BRENTANI, Alexandra; FINK, GuentherBackground: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in Sao Paulo State, Brazil. Methods and Findings: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in Sao Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (beta = 22.0, 95% CI: 23.69, 20.27, p = 0.02), fasting glucose levels (beta = 21.9, 95% CI: 23.9, 20.07, p = 0.05), waist-hip ratio (beta = 20.03, 95% CI: 20.07, 20.01, p = 0.10), systolic blood pressure (beta = 23.32, 95% CI: 27.60, 0.96, p = 0.12), and total cholesterol levels (beta = 23.19, 95% CI: 216.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (beta = 0.79, 95% CI: 20.0455, 1.623, p = 0.064) and blood pressure (beta = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. Conclusions: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries.
bookPart Crescimento: influências fetais, a importância do catch-up do crescimento e a prevenção da obesidade(2013) GOMES, Filumena Maria da Silva; VALENTE, Maria Helena; ESCOBAR, Ana Maria de Ulhôa; BRENTANI, Alexandra; GRISI, Sandra Josefina Ferraz Ellero- PEDIATRICIANS AFTER RESIDENCY: A SURVEY OF PERSONAL/PROFESSIONAL DATA AND ISSUES(2021) SILVA, Clovis Artur; TRINDADE, Vitor Cavalcanti; ABEL, Roberta Capretz D’Oliveira; SILVA, Marcelo Oliveira; SANTOS, João Fernando Vecchi; KOCH, Vera Hermina Kalika; FERRER, Ana Paula Scoleze; BRENTANI, Alexandra; ODONE-FILHO, Vicente; TANNURI, Uenis; CARVALHO, Werther Brunow; CARNEIRO-SAMPAIO, Magda; GRISI, Sandra Josefina Ferraz ElleroABSTRACT Objective: To assess personal, professional, medical, and scientific educational characteristics and issues reported by pediatricians. Methods: Cross-sectional study based on an online survey including 614 pediatricians who graduated in the last 15 years at a University Pediatric Department in Brazil. Results: The response rate was 331/614(54%). The majority were females (82%), the median age was 33 years (27-40) and median years of pediatric practice was 5 (1-13). High workload (>60 hours/week) occurred in 25% and 47% earned ≥15 minimum wages/month. The most work-related issues reported were long working hours, poor social life and a sedentary lifestyle (>50%). Pediatricians were further divided into two groups, according to years of pediatric clinical practice: group 1 (≤5 years) and group 2 (>5 years). The median of overall satisfaction with pediatric residency [8(0-10) vs. 9 (4-10); p=0.002] was significantly reduced in group 1. The frequencies of workload >60 hours, work on pediatric ward and pediatric intensive care were significantly higher in the first group (p<0.05). Regarding main issues related to clinical practice in the last year, long working hours (73 vs. 53%; p<0.001), poor social life (75 vs. 62%; p=0.018) and harassment (23 vs. 4%; p=0.003) were significantly higher in the first group. Conclusions: Very early career pediatricians (≤5 years) reported higher workload, lower income, work-related issues and different location of pediatric practice compared to early career pediatricians (>5 years). The overall satisfaction with pediatric residency was good, however, reduced in very early career pediatricians.
- A home visit-based early childhood stimulation programme in Brazil-a randomized controlled trial(2021) BRENTANI, Alexandra; WALKER, Susan; CHANG-LOPEZ, Susan; GRISI, Sandra; POWELL, Christine; FINK, GuentherHome visiting programmes are increasingly recognized as one of the most effective interventions to improve child health and development in low-income settings. However, the best platforms to deliver such programmes remain unclear. We conducted a randomized controlled trial to test the relative effectiveness of child development agents (CDAs) and community health workers (CHWs) as two possible delivery platforms for early childhood development (ECD) focused home visiting intervention in SAo Paulo, Brazil. A total of 900 children aged 9-15months were screened for potential study inclusion between January and March 2015. Children who did not attend creches at enrolment were included in the trial. Children were randomly assigned to control or to receive biweekly home visits either through a CHW in the areas covered by the Brazilian Family Health Strategy (FHS) or by a newly hired cadre of CDAs in the areas not covered by the FHS. The primary study outcome was children's development (cognition, motor, language and social emotional skills) assessed after 12months of intervention with the PRIDI and Caregiver-Reported Early Development Instruments tools. A total of 826 mother-child dyads were enrolled in the trial. In intention-to-treat analysis, neither intervention arm improved study outcomes. In per-protocol (PP) analysis, the CDA programme resulted in a 0.22 standard deviation increase in children's development (95% confidence interval [0.01-0.43]). The results presented in this study suggest that home visiting programmes have the potential to improve child development among poor urban families in Brazil. However, delivering home visiting interventions through already active CHWs may not be feasible in the Brazilian context and coordination across sectors is essential to effective ECD policies.
- Overall and Sex-Specific Associations Between Fetal Adversity and Child Development at Age 1 Year: Evidence From Brazil(2018) FINK, Guenther; ANDREWS, Kathryn G.; BRENTANI, Helena; GRISI, Sandra; FERRER, Ana Paula Scoleze; BRENTANI, AlexandraA growing body of epigenetic research suggests that in-utero adaptations to environmental changes display important sex-specific variation. We tested this heterogeneous adaptation hypothesis using data from 900 children born at the University Hospital in Sao Paulo, Brazil, between October 2013 and April 2014. Crude and adjusting linear models were used to quantify the associations between prematurity, being small for gestational age, and children's physical and mental development at 12 months of age. Prematurity was negatively associated with neuropsychological development in final models (z score difference, -0.42, 95% confidence intervals: -0.71, -0.14), but associations did not vary significantly by sex. For being small for gestational age, associations with height-for-age, weight-for-age, and neuropsychological development were also negative, but they were systematically larger for male than for female infants (P < 0.05 for all). These results suggest that male fetuses may be more vulnerable to intrauterine adversity than female fetuses. Further research will be needed to better understand the mechanisms underlying these sex-specific associations.
- Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study(2021) SOUSA, Braian Lucas Aguiar; BRENTANI, Alexandra; RIBEIRO, Cecilia Claudia Costa; DOLHNIKOFF, Marisa; GRISI, Sandra Josefina Ferraz Ellero; FERRER, Ana Paula Scoleze; FERRARO, Alexandre ArchanjoObjectives To analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents. Design Cross-sectional observational study using publicly available data from the Brazilian Ministry of Health. Setting Nationwide. Participants 5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020. Main outcome measure We used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development. Results Individually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North-OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities-OR 0.26, 95% CI 0.17 to 0.38) Conclusions Besides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.
bookPart Atenção à criança sob risco biopsicossocial(2013) BRENTANI, Alexandra; VALENTE, Maria Helena; GOMES, Filumena Maria da Silva; ESCOBAR, Ana Maria de Ulhôa; GRISI, Sandra Josefina Ferraz Ellero- Gestational age acceleration is associated with epigenetic biomarkers of prenatal physiologic stress exposure(2022) EUCLYDES, Veronica; GOMES, Catarina; GOUVEIA, Gisele; GASTALDI, Vinicius Daguano; FELTRIN, Arthur Sant'Anna; CAMILO, Caroline; VIEIRA, Rossana Pulcineli; FELIPE-SILVA, Aloisio; GRISI, Sandra; FINK, Gunther; BRENTANI, Alexandra; BRENTANI, HelenaBackground Physiological maternal stress response, such as imbalance in the glucocorticoid pathway and immune system seems to be mediated by DNA methylation (DNAm) and might translate intrauterine stress exposures into phenotypic changes in a sex-specific manner. DNAm in specific sites can also predict newborn gestational age and gestational age acceleration (GAA). GAA occurs when the predicted biological age is higher than the chronological age. In adults, poor health outcomes related to this deviance are well documented and raise questions for the interpretation and prediction in early stages of life. Boys seem to be more vulnerable to intrauterine stress exposure than girls; however, the mechanisms of adaptive sex-specific responses are still unclear. We hypothesize that intrauterine stress exposure is associated with GAA and could be different in boys and girls if inflammatory or glucocorticoid pathways exposure is considered. Results Using the Western Region Birth Cohort (ROC-Sao Paulo, Brazil) (n = 83), we calculated DNAm age and GAA from cord blood samples. Two epigenetic risk scores were calculated as an indirect proxy for low-grade inflammation (i-ePGS) and for glucocorticoid exposure (GES). Multivariate linear regression models were applied to investigate associations of GAA with prenatal exposures. The i-ePGS and GES were included in different models with the same co-variates considering sex interactions. The first multivariate model investigating inflammatory exposure (adj. R-2 = 0.31, p = < 0.001) showed that GAA was positively associated with i-ePGS (CI, 0.26-113.87, p = 0.049) and negative pregnancy-related feelings (CI, 0.04-0.48 p = 0.019). No sex interaction was observed. The second model investigating glucocorticoid exposure (adj. R-2 = 0.32, p = < 0.001) showed that the higher was the GAA was associated with a lower the lower was the GES in girls (CI, 0.04-2.55, p = 0.044). In both models, maternal self-reported mental disorder was negatively associated with GAA. Conclusion Prenatal epigenetic score of exposure to low-grade inflammatory was a predictor of GAA for both sexes. Glucocorticoid epigenetic score seems to be more important to GAA in girls. This study supports the evidence of sex-specificity in stress response, suggesting the glucocorticoid as a possible pathway adopted by girls to accelerate the maturation in an adverse condition.
- Cohort Profile: Sao Paulo Western Region Birth Cohort (ROC)(2020) BRENTANI, Alexandra; FERRER, Ana Paula Scoleze; BRENTANI, Helena; LIU, Cindy H.; GRISI, Sandra J. F. E.; VALENTE, Maria Helena; GOMES, Filumena; ESCOBAR, Ana Maria de Ulhoa; FINK, Gunther
- Breastfeeding, Physical Growth, and Cognitive Development(2021) WALLENBORN, Jordyn T.; LEVINE, Gillian A.; SANTOS, Angelica Carreira dos; GRISI, Sandra; BRENTANI, Alexandra; FINK, GuntherBACKGROUND AND OBJECTIVES: Breastfeeding is an evidence-based recommendation for all countries, but breastfeeding rates have been declining in many middle-income settings. One reason behind this decline is the perception that breastfeeding may not be necessary in modern urban settings, where clean water is available and alternative foods are abundant. We investigate the importance of breastfeeding for early childhood development in the modern urban context of Sao Paulo, Brazil. METHODS: In our study, we used data from the ongoing prospective Western Region Birth cohort in Sao Paulo, Brazil. Children were recruited at birth and managed for 3 years. Durations of exclusive and mixed breastfeeding were our primary independent variables. Our secondary independent variable was an indicator for compliance with World Health Organization (WHO) breastfeeding recommendations. Our primary outcomes of interest were indicators of children's physical, cognitive, language, and social-emotional development at 3 years of age. Adjusted estimates and 95% confidence intervals were calculated by using linear and logistic regression. RESULTS: Complying with WHO recommendations to exclusively breastfeed for 6 months followed by complementary feeding until 2 years of age was associated with a 0.4-SD increase in overall child development (beta: .38; confidence limit = 0.23 to 0.53), a 0.6-SD increase in height-for-age z score (beta: .55; confidence limit = 0.31 to 0.79), and a 67% decrease in the odds of stunting (odds ratio = 0.33; 95% confidence interval = 0.20 to 0.54). CONCLUSIONS: Our results suggest that even in settings with easy access to complementary foods, complying with WHO breastfeeding recommendations is important for healthy physical growth and cognitive development.