ALEXANDRA VALERIA MARIA BRENTANI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
53 resultados
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bookPart Triagem das principais deficiências de micronutrientes na infância(2013) VALENTE, Maria Helena; GOMES, Filumena Maria da Silva; BRENTANI, Alexandra- The creation of the Global Scales for Early Development (GSED) for children aged 0-3 years: combining subject matter expert judgements with big data(2023) MCCRAY, Gareth; MCCOY, Dana; KARIGER, Patricia; JANUS, Magdalena; BLACK, Maureen M.; CHANG, Susan M.; TOFAIL, Fahmida; EEKHOUT, Iris; WALDMAN, Marcus; BUUREN, Stef van; KHANAM, Rasheda; SAZAWAL, Sunil; NIZAR, Ambreen; SCHOENBECK, Yvonne; ZONGO, Arsene; BRENTANI, Alexandra; ZHANG, Yunting; DUA, Tarun; CAVALLERA, Vanessa; RAIKES, Abbie; WEBER, Ann M.; BROMLEY, Kieran; BAQUI, Abdullah; DUTTA, Arunangshu; NISAR, Imran; DETMAR, Symone B.; ANAGO, Romuald; MERCADANTE, Pacifico; JIANG, Fan; KAUR, Raghbir; HEPWORTH, Katelyn; RUBIO-CODINA, Marta; KEMBOU, Samuel N.; AHMED, Salahuddin; LANCASTER, Gill A.; GLADSTONE, MelissaIntroductionWith the ratification of the Sustainable Development Goals, there is an increased emphasis on early childhood development (ECD) and well-being. The WHO led Global Scales for Early Development (GSED) project aims to provide population and programmatic level measures of ECD for 0-3 years that are valid, reliable and have psychometrically stable performance across geographical, cultural and language contexts. This paper reports on the creation of two measures: (1) the GSED Short Form (GSED-SF)-a caregiver reported measure for population-evaluation-self-administered with no training required and (2) the GSED Long Form (GSED-LF)-a directly administered/observed measure for programmatic evaluation-administered by a trained professional.MethodsWe selected 807 psychometrically best-performing items using a Rasch measurement model from an ECD measurement databank which comprised 66 075 children assessed on 2211 items from 18 ECD measures in 32 countries. From 766 of these items, in-depth subject matter expert judgements were gathered to inform final item selection. Specifically collected were data on (1) conceptual matches between pairs of items originating from different measures, (2) developmental domain(s) measured by each item and (3) perceptions of feasibility of administration of each item in diverse contexts. Prototypes were finalised through a combination of psychometric performance evaluation and expert consensus to optimally identify items.ResultsWe created the GSED-SF (139 items) and GSED-LF (157 items) for tablet-based and paper-based assessments, with an optimal set of items that fit the Rasch model, met subject matter expert criteria, avoided conceptual overlap, covered multiple domains of child development and were feasible to implement across diverse settings.ConclusionsState-of-the-art quantitative and qualitative procedures were used to select of theoretically relevant and globally feasible items representing child development for children aged 0-3 years. GSED-SF and GSED-LF will be piloted and validated in children across diverse cultural, demographic, social and language contexts for global use.
- 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- Kangaroo mother care for preterm infants and child development - evidence from Sao Paulo, Brazil(2022) ONYANGO, Silas; BRENTANI, Alexandra; FINK, GuntherGlobally, an estimated 15 million children are born prematurely each year, resulting in a high burden of under-five mortality and neurodevelopmental disability. Kangaroo Mother Care (KMC) is a key intervention to support the development of preterm infants. However, evidence on the impact of KMC in routine care settings remains limited. This paper examines the associations between maternal KMC efforts and child development among preterm infants using data from a prospective cohort study conducted in Sao Paulo, Brazil. Study outcomes were height-for-age z-scores (HAZ) and cognitive development at age 3 years. Practicing KMC was positively associated with HAZ (+0.91 SD, 95% CI [0.126, 1.695]), and cognition (+0.37 SD, [0.034, 0.806]) of preterm children. The results suggest that KMC can improve children's cognitive and physical development. New programmes to increase KMC uptake in the setting studied may be beneficial for both mothers and their preterm children.
- Relation between Birth Weight, Growth, and Subclinical Atherosclerosis in Adulthood(2015) VALENTE, Maria Helena; GOMES, Filumena Maria da Silva; BENSENOR, Isabela Judith Martins; BRENTANI, Alexandra Valeria Maria; ESCOBAR, Ana Maria de Ulhoa; GRISI, Sandra J. F. E.Background and Objectives. Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. Methods. 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. Results. Birthweight <2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to -0.323, 95% CI [-0.571, -0.075] P < 0.05; (b) diastolic blood pressure (RC = -4.744, 95% CI [-9.017, -0.470] P < 0.05); (c) low HDL-cholesterol (RC = -0.272, 95% CI [-0.516, -0.029] P < 0.05); (d) frequency of intima-media thickness (IMT) of left carotid >75th percentile (RC = -0.242, 95% CI [-0.476, -0.008] P < 0.05). Birthweight >3,500 g was associated with (a) BMI >25.0 kg/m(2), (RC = 0.317, 95% CI [0.782, 0.557] P < 0.05); (b) increased waist circumference (RC = 0.284, 95% CI [0.054, 0.513] P < 0.05); (c) elevated WHR (RC = 0.280, 95% CI [0.054, 0.505] P < 0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC = 4.354, 95% CI [0.821, 7.888] P < 0.05); (e) maximum SAT (RC = 7.095, 95% CI [0.608, 13.583] P < 0.05); (f) right lobe of the liver side (RC = 6.896, 95% CI [1.946, 11.847] P < 0.001); (g) frequency's right lobe of the liver >75th percentile (RC = 0.361, 95% CI [0.169, 0.552] P < 0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC = -0.046, 95% CI [-0.086, -0.006] P < 0.05; (b) frequency IMT of left carotid > 75th percentile (RC = -0.253, 95% CI [-0.487, -0.018] P < 0.05); (c) mean IMT (RC = -0.038, 95% CI [0.073, -0.002] P < 0.05); (d) the frequency of the mean IMT > 75th percentile (RC = -0.241, 95% CI [-0.442, -0.041] P < 0.05). Conclusions. Adults birthweight <2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.
- Association between community noise and children's cognitive and behavioral development: A prospective cohort study(2022) RAESS, Michelle; BRENTANI, Alexandra Valeria Maria; FLUCKIGER, Benjamin; CAMPOS, Bartolomeu Ledebur de Antas de; FINK, Gunther; ROOSLI, MartinBackground: Noise exposure has been associated with adverse cognitive and behavioral outcomes in children, but evidence on longitudinal associations between community noise and child development in low- and middle-income countries is rare. We investigated associations between community noise and behavioral and cognitive development in preschool children in Sao Paulo. Methods: We linked child development data from the Sao Paulo Western Region Birth Cohort with average (Lden) and night-time (Lnight) community noise exposure at children's home, estimated by means of a land use regression model using various predictors (roads, schools, greenness, residential and informal settlements). Outcomes were the Strengths and Difficulties Questionnaire (SDQ) and Regional Project on Child Development Indicators (PRIDI) at 3 years of age and the Child Behavior Checklist (CBCL) and International Development and Early Learning Assessment (IDELA) at 6 years of age. We investigated the relationship between noise exposure and development using cross-sectional and longitudinal regression models. Results: Data from 3385 children at 3 years of age and 1546 children at 6 years of age were analysed. Mean Lden and Lnight levels were 70.3 dB and 61.2 dB, respectively. In cross-sectional analyses a 10 dB increase of Lden above 70 dB was associated with a 32% increase in the odds of borderline or abnormal SDQ total difficulties score (OR = 1.32, 95% CI: 1.04; 1.68) and 0.72 standard deviation (SD) increase in the CBCL total problems zscore (95% CI: 0.55; 0.88). No cross-sectional association was found for cognitive development. In longitudinal analyses, each 10 dB increase was associated with a 0.52 SD increase in behavioral problems (95% CI: 0.28; 0.77) and a 0.27 SD decrease in cognition (95%-CI: 0.55; 0.00). Results for Lnight above 60 dB were similar. Discussion: Our findings suggest that community noise exposure above Lden of 70 dB and Lnight of 60 dB may impair behavioral and cognitive development of preschool children.
bookPart Triagem do comportamento seguro(2013) GOMES, Filumena Maria da Silva; ESCOBAR, Ana Maria de Ulhôa; WAKSMAN, Renata Dejtiar; BRENTANI, Alexandra; SILVA, Alexandre Funcia de Azeredo- 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.
- The Intergenerational Effects on Birth Weight and Its Relations to Maternal Conditions, Sao Paulo, Brazil(2015) SILVA, Leide Irislayne Macena da Costa e; GOMES, Filumena Maria da Silva; VALENTE, Maria Helena; ESCOBAR, AnaMaria de Ulhoa; BRENTANI, Alexandra Valeria Maria; GRISI, Sandra J. F. E.Background and Objectives. Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. Methods. 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and >= 3,500 grams (g)). The length at birth was also studied in children <= 47.5 cm (lower quartile). Chi(2) test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. Results. The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman's Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi(2) sig 0.323; with Spearman's Rho 0.036; OR 1.5 and OR lower 0.7). The child's low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman's Rho 0.080; OR 4.9 and OR lower 1.0). The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi(2) sig 0.002; Spearman's Rho 0.113; OR 3.2 and OR lower 1.5). The child's weight at birth >= 3,500 g showed strong correlation with maternal weight at birth >= 3,500 g (Chi(2) sig 0; Spearman's Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight >= 3,500 g ((maternal prepregnancy BMI > 25.0 with Chi(2) sig 0.013; Spearman's Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI > 30.0 with Chi(2) sig 0 Spearman's Rho 0.137; OR 2.58 and OR upper 4.26)). The child's length at birth in the lower quartile (<= 47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi(2) sig 0.004; Spearman's Rho 0.105; OR 4.3 and OR lower 1.5). Conclusions. The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures.