ALEXANDRA VALERIA MARIA BRENTANI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
22 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 22
- 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.
- 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.
- 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.
- Contextual design choices and partnerships for scaling early child development programmes(2019) MILNER, Kate M.; SALAZAR, Raquel Bernal; BHOPAL, Sunil; BRENTANI, Alexandra; BRITTO, Pia Rebello; DUA, Tarun; GLADSTONE, Melissa; GOH, Esther; HAMADANI, Jena; HUGHES, Rob; KIRKWOOD, Betty; KOHLI-LYNCH, Maya; MANJI, Karim; HARDY, Victoria Ponce; RADNER, James; RASHEED, Muneera Abdul; SHARMA, Sonia; SILVER, Karlee L.; TANN, Cally; LAWN, Joy E.Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains (R), Grand Challenges Canada (R) funded ECD portfolio across 23 low-and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.
- Associations between neighborhood violence during pregnancy and birth outcomes: evidence from Sao Paulo's Western Region Birth Cohort(2021) SANTOS, Angelica Carreira dos; BRENTANI, Alexandra; FINK, GuentherBackground Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied. Methods Using geocoded birth records from the ongoing Western Region Birth Cohort (Regiao Oeste Coorte - ROC-Cohort) of infants born between 2012 and 2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of the mother's residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy. Results Among the 5268 children included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile had higher odds of being born small-for-gestational-age (1.41[1.06-1.89]), preterm (1.35[1.01-1.80]), and low birth weight (1.42[1.03-1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and birth outcomes. Conclusions Higher exposure to violent crimes in the close vicinity of pregnant women's residence is associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can potentially contribute not only to the short-term wellbeing of populations but may also have large social, economic, and health benefits in the long term.
- Land use regression modelling of community noise in Sao Paulo, Brazil(2021) RAESS, Michelle; BRENTANI, Alexandra; CAMPOS, Bartolomeu Ledebur de Antas de; FLUCKIGER, Benjamin; HOOGH, Kees de; FINK, Gunther; ROOSLI, MartinNoise pollution has negative health consequences, which becomes increasingly relevant with rapid urbanization. In low- and middle-income countries research on health effects of noise is hampered by scarce exposure data and noise maps. In this study, we developed land use regression (LUR) models to assess spatial variability of community noise in the Western Region of Sao Paulo, Brazil.We measured outdoor noise levels continuously at 42 homes once or twice for one week in the summer and the winter season. These measurements were integrated with various geographic information system variables to develop LUR models for predicting average A-weighted (dB(A)) day-evening-night equivalent sound levels (L-den) and night sound levels (L-night). A supervised mixed linear regression analysis was conducted to test potential noise predictors for various buffer sizes and distances between home and noise source. Noise exposure levels in the study area were high with a site average L-den of 69.3 dB(A) ranging from 60.3 to 82.3 dB(A), and a site average Lnight of 59.9 dB(A) ranging from 50.7 to 76.6 dB(A). LUR models had a good fit with a R-2 of 0.56 for L-den and 0.63 for L-night in a leave-one-site-out cross validation. Main predictors of noise were the inverse distance to medium roads, count of educational facilities within a 400 m buffer, mean Normalized Difference Vegetation Index (NDVI) within a 100 m buffer, residential areas within a 50 m (L-den) or 25 m (L-night) buffer and slum areas within a 400 m buffer. Our study suggests that LUR modelling with geographic predictor data is a promising and efficient approach for noise exposure assessment in low- and middle-income countries, where noise maps are not available.
- 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.
- Caregiver depression is associated with hair cortisol in a low-income sample of preschool-aged children(2020) LIU, Cindy H.; FINK, Guenther; BRENTANI, Helena; BRENTANI, AlexandraBackground: Caregiver depression and child temperamental characteristics such as effortful control have been associated with child dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Hair cortisol concentrations (HCC) has been increasingly adopted as an integrated marker of HPA axis activity. This study examined the associations between caregiver depressive symptoms, caregiver social support, child effortful control, and child HCC in a sample of a high-risk, low-income preschool-aged children. Methods: 154 caregivers comprised mostly of mothers and their children (2-to-5 years) who were enrolled in a birth cohort study conducted in poor urban neighborhoods of Sao Paulo, Brazil. Through personal interviews at their homes, caregivers provided ratings of their psychosocial experiences and of their child's behavior. Hair was sampled from children with at least a 3-cm hair length. Results: In a multivariable regression analysis, an unadjusted model showed child age to be negatively associated with HCC (beta = -0.32, p < .001). The adjusted model, which accounted for child age and sex, showed a positive relationship between caregiver depressive symptoms and HCC (beta = 0.22, p < .01). Caregiver social support and child effortful control were not associated with HCC. Conclusions: The elevated HCC among children with caregivers reporting greater depression risk is consistent with prior findings showing elevated HCC among children exposed to persistent stress. Stabilization of child HCC may be occurring within preschool children given the negative association between HCC and age. Greater research is needed to determine whether the effects of caregiver social support and effortful control can be captured through HCC.
- Impact of COVID-19 on maternal health and child care behavior: Evidence from a quasi-experimental study of vulnerable communities in Boa Vista, Brazil(2022) LOSS, G.; FINK, G.; BESSA, L.; BRENTANI, A.Background: COVID-19 related distress has been shown to have negative associations with family well-being. Objectives: To determine the immediate impact of acute COVID-19 infection on maternal well-being and parenting practices among Brazilian families. Participants and setting: We studied 2′579 mothers (29′913 observations) of young children from vulnerable neighborhoods in Boa Vista, Brazil over 12 months. Methods: We monitored family health and caregiving behavior including the incidence of COVID-19 infections in the surveyed households through bi-weekly phone interviews over 50 weeks, from June 2020 to May 2021. Primary outcomes were home-based child stimulation, positive parenting behavior, and parenting stress. We used fixed effects panel regressions to estimate the impact of household COVID-19 infections on parenting outcomes. Results: Over the study period, 441 participants (17.1%; 831 (3.0%) observations) reported at least 1 positive COVID-19 infection in their household. Household COVID-19 infections significantly reduced home-based stimulation by 0.10 SDs (95%CI: −0.18, −0.01), positive parenting behaviors by 0.14 SDs (−0.21, −0.01), and increased parenting stress by 0.07 SDs (0.02, 0.12). The impact on home-based stimulation was most pronounced when the mother herself had a COVID-19 infection (−0.16; −0.29, −0.04). Parenting stress responded most strongly to mother or child COVID-19 infections. Effects were relatively short-lived, only children's infections' on parental stress was still detectable 2 weeks after initial infection. Conclusion: Our findings suggest that COVID-19 infections cause substantial disruptions in children's home environments - additional short-term support for families with acute infections could attenuate the negative impact on children's home environment during the pandemic. © 2022 The Authors
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