ANA PAULA SCOLEZE FERRER
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
bookPart Crescimento e desenvolvimento(2022) ESCOBAR, Ana Maria de Ulhoa; FERRER, Ana Paula Scoleze; GRISI, Sandra- 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.
bookPart Avaliação do desenvolvimento(2022) FERRER, Ana Paula Scoleze; ESCOBAR, Ana Maria de Ulhoa; GRISI, Sandra- Survive and Thrive in Brazil: The Boa Vista Early Childhood Program: study protocol of a stepped-wedge, randomized controlled trial(2020) BRENTANI, Alexandra; FERRER, Ana Paula Scolezze; BESSA, Luana; CHANG, Susan; WALKER, Susan; POWELL, Christine; HAMADANI, Jena; GRISI, Sandra; FINK, GuentherBackgroundA growing body of evidence suggests that early life health and developmental outcomes can be improved through parental support programs. The objective of this project was to test the feasibility, impact, and relative cost-effectiveness of an adapted ""Reach Up and Learn"" program delivered through home-visiting programs as well as through center-based parenting groups on child health and development in the municipality of Boa Vista, Brazil.MethodsA randomized, stepped-wedge design was used to roll out and evaluate the two parenting platforms in Boa Vista municipality. A total of 39 neighborhoods with a high Neighborhood Vulnerability Index were selected for the study. For the first phase of the program, nine neighborhoods were randomly selected for home visits, and two were randomly selected for the center-based parenting groups. In the second phase of the program, 10 neighborhoods were added to the home-visiting program, and eight were added to the center-based program. In the final phase of the program, the remaining 10 control areas will also be assigned to treatment. Study eligibility will be assessed through a baseline survey completed by all pregnant women in the 39 study areas. Pregnant women will be eligible to participate in the study if they are either classified as poor, were under age 20 years when they became pregnant, or if they indicate to have been exposed to domestic or sexual violence. To assess program impact, an endline survey will be conducted when children reach age 2 years. The primary study outcome is child development at age 2 years as measured by the PRIDI instrument. Secondary outcome will be infant mortality, which will be assessed linking municipal vital registration systems to the program rollout.DiscussionThis trial will assess the feasibility and impact of parenting programs rolled out at medium scale. The results from the trial should create evidence urgently needed for guiding Brazil's national Crianca Feliz program as well as similar efforts in other countries.Trial registrationClinicalTrials.gov, ID: NCT03386747. Registered on 13 December 2017. All items of the World Health Organization Trial Registration Data Set are available in this record.
- Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in Sao Paulo State, Brazil(2017) ANDREWS, Kathryn; BOURROUL, Maria Lucia Moraes; FINK, Gunther; GRISI, Sandra; FERRER, Paula Scoleze; DINIZ, Edna Maria de Albuquerque; BRENTANI, AlexandraBackground Differential trends in mortality suggest that stillbirths may dominate neonatal mortality in the medium to long run. Brazil has made major efforts to improve data collection on health indicators at granular geographic levels, and provides an ideal environment to test this hypothesis. Our goals were to examine levels and trends in stillbirths and neonatal deaths and the extent to which the mortality burden caused by stillbirths dominates neonatal mortality at the municipality-and state-level. Methods We used data from the Brazilian Ministry of Health's repository on births, fetal, and neonatal deaths (2010 +/- 2014) to calculate stillbirth and neonatal mortality rates for Sao Paulo state's 645 municipalities. Results At the state level, 7.9 per 1000 pregnancies ended in stillbirth (fetal death >22 weeks gestation or fetal weight >500g), but this varied from 0.0 to 28.4 per 1000 across municipalities. 7.9 per 1000 live births also died within the first 28 days. 42% of municipalities had a higher stillbirth rate than neonatal mortality rate, and in 61% of areas with low neonatal mortality (<8.0 per 1000), stillbirth rates exceeded neonatal mortality rates. Conclusions This analysis suggests large variability and inequality in mortality outcomes at the sub-national level. The results also imply that stillbirth mortality may exceed neonatal mortality in Brazil and similar settings in the next few decades, which suggests a need for a shift in policy. This work further underscores the importance of continued research into causes and prevention of stillbirth.
- Inactivated trivalent influenza vaccination is associated with lower mortality among patients with COVID-19 in Brazil(2021) FINK, Guenther; ORLOVA-FINK, Nina; SCHINDLER, Tobias; GRISI, Sandra; FERRER, Ana Paula S.; DAUBENBERGER, Claudia; BRENTANI, AlexandraObjective To estimate associations between trivalent influenza vaccination and COVID-19 mortality as well as severe clinical outcomes among hospitalised patients. Design Retrospective observational study. Setting This study was conducted among hospitalised patients with COVID-19 in Brazil. Participants We analysed all hospitalised patients with COVID-19 with available vaccination information captured in Brazil's national electronic respiratory infection data system between 1 January 2020 and 23 June 2020. Main outcome measures The primary outcomes were age-specific mortality rates of hospitalised patients with COVID-19 with and without recent inactivated trivalent influenza vaccination. Results A total of 53 752 clinically confirmed COVID-19 cases were analysed. Controlling for health facility of treatment, comorbidities as well as an extensive range of sociodemographic factors, patients who received a recent influenza vaccine experienced on average 7% lower odds of needing intensive care treatment (95% CI 0.87 to 0.98), 17% lower odds of requiring invasive respiratory support (95% CI 0.77 to 0.88) and 16% lower odds of death (95% CI 0.78 to 0.90). Protective effects were larger when the vaccine was administered after onset of symptoms as well as among younger patients. Conclusion Patients with COVID-19 with recent inactivated influenza vaccination experience significantly better health outcomes than non-vaccinated patients in Brazil. Beneficial off-target effects of influenza vaccination through trained innate immune responses seem plausible and need to be further explored. Large-scale promotion of influenza vaccines seems advisable, especially in populations at high risk for severe COVID-19 disease progression.