ALEXANDRA VALERIA MARIA BRENTANI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- 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.
- IDENTIFICATION OF O-LINKED N-ACETYLGLUCOSAMINE TRANSFERASE (OGT) EXPRESSION IN HUMAN PLACENTAS AS A POTENTIAL BIOMARKER OF PRENATAL STRESS EXPOSURE(2022) CAMILO, Caroline; VIEIRA, Luana Martos; TORREZAN, Arleti Caramori; SOUSA, Antonia Beatriz; GOUVEIA, Gisele Rodrigues; EUCLYDES, Veronica Luiza Vale; SILVA, Aloisio Souza Felipe da; BRENTANI, Alexandra; BRENTANI, Helena
- 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
- Analysis of the influence of the timing of enrollment in daycares on child development(2023) BATISTA, Christyann Lima Campos; BRENTANI, Alexandra Valeria MariaThis study aimed to analyze the relationship be-tween the age of enrollment into early childhood education (ECE) programs and child develop-ment. This is a cross-sectional study using data from the Birth Cohort of the Western Region of Sao Paulo, Brazil, with a 36-month follow-up of children born at the University Hospital of the University of Sao Paulo from 2012 to 2014, and their caregivers who participated in the 36-month follow-up conducted from 2015 to 2017. Child de-velopment was measured by the Engle Scale of the Regional Project on Child Development Indi-cators (PRIDI). ECE programs were evaluated in relation to their quality. The social characteristics of the children and their caregivers, as well as the characteristics of the economic and family context, were used as exposure variables. Our sample con-sisted of 472 children and their parents/caregivers. The enrollment into daycare from 13 and 29 months was the most frequent. When considered alone, a higher age of enrollment was associated with higher development score [beta = 0.21, 95%CI: 0.02; 0.40, p = 0.027]. After adjusting for con-founding variables in the regression models, it was observed that being enrolled in a private institu-tion, total time of breastfeeding, time spent by the main caregiver working outside home, and in-hibitory control were determinants in explaining the infant development at 36 months in the sam-ple. Older age of entry into ECE programs may have a positive effect on infant development at 36 months of age, but these findings must be carefully considered.
- 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.
- GeoHealth: A Georeferenced System for Health Data Analysis in Primary Care(2012) SA, J. H. G.; REBELO, M. S.; BRENTANI, A.; GRISI, S.; GUTIERREZ, M. A.The Primary Care Information System (SIAB) concentrates basic healthcare information from all different regions of Brazil. The information is collected by primary care teams on a paper-based procedure that degrades the quality of information provided to the healthcare authorities and slows down the process of decision making. To overcome these problems we propose a new data gathering application that uses a mobile device connected to a 3G network and a GPS to be used by the primary care teams for collecting the families' data. A prototype was developed in which a digital version of one SIAB form is made available at the mobile device. The prototype was tested in a basic healthcare unit located in a suburb of Sao Paulo. The results obtained so far have shown that the proposed process is a better alternative for data collecting at primary care, both in terms of data quality and lower deployment time to health care authorities.
- Protocol for validation of the Global Scales for Early Development (GSED) for children under 3 years of age in seven countries(2023) CAVALLERA, Vanessa; LANCASTER, Gillian; GLADSTONE, Melissa; BLACK, Maureen M.; MCCRAY, Gareth; NIZAR, Ambreen; AHMED, Salahuddin; DUTTA, Arup; ANAGO, Romuald Kouadio E.; BRENTANI, Alexandra; JIANG, Fan; SCHOENBECK, Yvonne; MCCOY, Dana C.; KARIGER, Patricia; WEBER, Ann M.; RAIKES, Abbie; WALDMAN, Marcus; BUUREN, Stef van; KAUR, Raghbir; MAILLARD, Michelle Perez; NISAR, Muhammad Imran; KHANAM, Rasheda; SAZAWAL, Sunil; ZONGO, Arsene; MERCADANTE, Mariana Pacifico; ZHANG, Yunting; ROY, Arunangshu D.; HEPWORTH, Katelyn; FINK, Guenther; RUBIO-CODINA, Marta; TOFAIL, Fahmida; EEKHOUT, Iris; SEIDEN, Jonathan; NORTON, Rebecca; BAQUI, Abdullah H.; ALI, Jamila Khalfan; ZHAO, Jin; HOLZINGER, Andreas; DETMAR, Symone; KEMBOU, Samuel Nzale; BEGUM, Farzana; ALI, Said Mohammed; JEHAN, Fyezah; DUA, Tarun; JANUS, MagdalenaIntroduction Children's early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to monitor children's early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Early Development (GSED) to measure children's early development up to 3 years of age. The GSED includes three measures for population and programmatic level measurement: (1) short form (SF) (caregiver report), (2) long form (LF) (direct administration) and (3) psychosocial form (PF) (caregiver report). The primary aim of this protocol is to validate the GSED SF and LF. Secondary aims are to create preliminary reference scores for the GSED SF and LF, validate an adaptive testing algorithm and assess the feasibility and preliminary validity of the GSED PF. Methods and analysis We will conduct the validation in seven countries (Bangladesh, Brazil, Cote d'Ivoire, Pakistan, The Netherlands, People's Republic of China, United Republic of Tanzania), varying in geography, language, culture and income through a 1-year prospective design, combining cross-sectional and longitudinal methods with 1248 children per site, stratified by age and sex. The GSED generates an innovative common metric (Developmental Score: D-score) using the Rasch model and a Development for Age Z-score (DAZ). We will evaluate six psychometric properties of the GSED SF and LF: concurrent validity, predictive validity at 6months, convergent and discriminant validity, and test-retest and inter-rater reliability. We will evaluate measurement invariance by comparing differential item functioning and differential test functioning across sites. Ethics and dissemination This study has received ethical approval from the WHO (protocol GSED validation 004583 20.04.2020) and approval in each site. Study results will be disseminated through webinars and publications from WHO, international organisations, academic journals and conference proceedings. Registration details Open Science Framework https://osf.io/ on 19 November 2021 (DOI 10.17605/OSF.IO/KX5T7; identifier: osf-registrations-kx5t7-v1).
- A Remote Parenting Program and Parent and Staff Perspectives: A Randomized Trial(2023) SMITH, Joanne A.; CHANG, Susan M.; BRENTANI, Alexandra; FINK, Gunther; LOPEZ-BOO, Florencia; TORINO, Belen Michel; CODINA, Marta Rubio; WALKER, Susan P.OBJECTIVES: To assess impact and implementation of remote delivery of a parenting program following suspension of in-person visits during the coronavirus disease 2019 pandemic. METHODS: Impact of remote delivery of the Reach Up parenting program on parenting practices was evaluated by randomized trial in Jamaica. Mothers with children aged 5 to 24 months who met 1 of 7 at-risk criteria were enrolled at health centers. Participants were randomly assigned to intervention or control using random number tables generated by a statistician. Intervention comprised a manual for parents with illustrated play activities, phone calls, and short message service messages. The control group received usual care. Parent practices were measured using an adapted Family Care Indicators telephone-administered questionnaire by interviewers unaware of group assignment. Qualitative interviews were conducted with staff and parents in Jamaica and Brazil and staff in Ecuador to identify facilitators and barriers to remote delivery of Reach Up. RESULTS: Two hundred forty-seven participants were assessed at endline (control n = 130; intervention n = 117). Intervention increased parent activities that support child development, effect size 0.34 SD (95% confidence interval 0.03-0.53), and use of praise, odds 2 times higher with intervention. There were no benefits to interactive language or play materials. Qualitative results showed parents appreciated program continuation and felt motivated to help their child, and methods were acceptable to staff. Barriers included poor mobile phone access, difficulty contacting parents, and feedback limitations without in-person contact. CONCLUSIONS: Remote delivery methods have potential to contribute to scaling of parenting programs.