ANA PAULA SCOLEZE FERRER
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
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- Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions(2016) FERRER, Ana Paula Scoleze; GRISI, Sandra Josefina Ferraz ElleroIntroduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC) are considered an indicator of the effectiveness of primary health care (PHC). High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501) users (guardians/caregivers) and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil), while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services). Results: Sixty-five percent (65.2%) of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.
- 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.
- International Youth Day - pediatric rehabilitation from a global health perspective(2023) FERRER, Ana Paula Scoleze
- 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.
- Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseases of one tertiary referral hospital(2022) SIMON, Juliana R.; PEREIRA, Maria F. B.; MARQUES, Heloisa H.; ELIAS, Adriana M.; SAKITA, Neusa K.; FERREIRA, Juliana C. O. A.; PRECIOSO, Alexander Roberto; GRISI, Sandra J. F. E.; FERRER, Ana Paula S.; BAIN, Vera; SILVA, Clovis A.; CAMPOS, Lucia M. A.Objectives: To evaluate seroconverted asymptomatic COVID-19 in pediatric Autoimmune Rheumatic Diseases (ARDs) patients and to identify the risk factors related to contagion.Methods: A cross-sectional study was conducted in March 2021, before vaccination of children and adolescents in Brazil, including 77 pediatric ARDs patients, followed at a tertiary hospital and 45 healthy controls, all of them without a previous diagnosis of COVID-19. Data was obtained by a questionnaire with demographic data, symp-toms compatible with COVID-19 over the previous year, and contact with people with confirmed COVID-19. Patient's medical records were reviewed to access data regarding disease and current medications. A qualitative immunochromatographic SARS-CoV-2 test was performed on all participants.Results: Patients and controls were similar in terms of female gender (70.1% vs. 57.8%, p = 0.173), age (14 vs. 13 years, p = 0.269) and SARS-CoV-2 positive serology (22% vs. 15.5%, p = 0.481). 80.5% of rheumatic patients were in use of immunosuppressive drugs: 27.3% of them used corticosteroids (33.3% in high doses), and 7.8% on immunobiologicals. No statistical differences were found between positive (n = 17) and negative serol-ogy (n = 60) patients regarding demographic/socioeconomic data, contact with people with confirmed COVID-19, use and number of immunosuppressive drugs, use and dose of corticosteroids, use of hydroxychloroquine and immunobiological drugs (p > 0.05).Conclusions: Pediatric rheumatic disease patients were infected at the same rate as healthy ones. Neither the underlying pathology nor its immunosuppressive treatment seemed to interfere with contagion risk.
- Care coordination in pediatrics: Experience of the outpatient clinic for Children with Special Health Care Needs (CSHCN)(2022) FERRER, Ana Paula Scoleze; SCARAMUZZI, Daleth Rodrigues; BOURROUL, Maria Lucia M.; ZUCCOLOTTO, Sandra M. C.; GRISI, Sandra J. F. E.
- Glycemic control strategies and the occurrence of surgical site infection: a systematic review(2016) DOMINGOS, Caroline Maria Herrero; IIDA, Luciana Inaba Senyer; POVEDA, Vanessa de BritoObjective: To analyze the available evidence in the scientific literature on the relationship between glycemic control strategies performed and the occurrence of surgical site infection in adult patients undergoing surgery. Method: This is a systematic review, through the CINAHL, Medline, LILACS, Cochrane Database of Systematic Reviews, and EMBASE, which included 8 studies. Results: Despite the diversity of tested interventions, studies agree that glycemic control is essential to reduce surgical site infection rates and should be kept between 80 and 120 mg/dl during the perioperative period. Insulin continuous infusion during surgery was the most tested and seems to get better results in reducing surgical site infection rates and success in glycemic control compared to other strategies. Conclusion: Strict glycemic control during the perioperative benefits the recovery of surgical patients, especially for the successful implementation of the measure the performance of the nursing team.
- Rollout of community-based family health strategy (programa de saude de familia) is associated with large reductions in neonatal mortality in Sao Paulo, Brazil(2016) BRENTANI, Alexandra; GRISI, Sandra Josefina Ferraz Ellero; TANIGUCHI, Mauro T.; FERRER, Ana Paula Scoleze; BOURROUL, Maria Lucia de Moraes; FINK, GuntherRationale: Several recent studies suggest that Brazil's Estrategia Saude de Familia (Family Health Strategy-FHS) has contributed to declines in mortality at the national and regional level. Comparatively little is known whether this approach is effective in urban populations with relatively easy access to health services. Objectives: To use detailed medical data collected as part of Sao Paulo's Western Region project to examine whether the FHS program had an impact on child health in Sao Paulo, Brazil. Results: No associations were found between FHS and birth weight (OR 1.03, 95% CI 0.93-1.29), gestational length (OR 0.98, 95% CI 0.83-1.15) or stillbirth (OR 1.51, 95% CI 0.75-3.03). FHS eligibility was associated with a 42% reduction in the odds of child mortality (OR 0.58, 95% CI 0.34, 0.91), with largest effect sizes for the early neonatal period (OR 0.18, 95% CI 0.04-0.79). Conclusions: Community based health delivery platforms may be a highly effective way to reduce neonatal mortality in urban areas of low and middle income countries, even when access to general health services is almost universal. (C) 2016 The Authors.
- Developmental and Behavioral Pediatrics: an emerging subspecialty. Experience of the Instituto da Crianca e do Adolescente-ICr-HCFMUSP(2022) FERRER, Ana Paula Scoleze; GRISI, Sandra Josefina Ferraz Ellero
- 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.