ALEXANDRA VALERIA MARIA BRENTANI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
8 resultados
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- Relationship between birth weight and total cholesterol concentration in adulthood: A meta-analysis(2017) CHEN, Lian-Hui; CHEN, Shan-Shan; LIANG, Li; WANG, Chun-Lin; FALL, Caroline; OSMOND, Clive; VEENA, Sargoor R.; BRETANI, AlexandraBackground: Although a substantial number of studies have investigated the relationship between birth weight and serum cholesterol later in life, the results vary extensively. The aim of this study was to explore the relationship between birth weight and total cholesterol concentration in adulthood. Methods: We considered the results of several published observational studies that reported the association between birth weight and total cholesterol concentration in adulthood. The associations were assessed by linear regression coefficients. Summary regression coefficients with 95% confidence intervals (CI) were computed using random-effects models. Subgroup and sensitivity analyses were also conducted to explore possible explanations for heterogeneity among the studies. Results: A total of 20 studies with 26,122 participants were identified. After adjustment for adult body mass index, the summary regression coefficient for an increment in birth weight of 1 kg was -0.09 mmol/L (95% CI: -0.13, -0.05) for men without heterogeneity (I-2 = 17.2%) and -0.08 mmol/L (95% Cl: -0.13, -0.03) for women with low heterogeneity (I-2 = 34.0%). Stratified and sensitivity analyses generally confirmed the robustness of the findings in men. However, subgroup analyses by age indicated that the association of birth weight with total cholesterol was statistically significant only in women aged <50 years. There was no evidence of publication bias in these studies. Conclusion: Based on our results, lower birth weight was found to be associated with higher concentrations of total cholesterol in men aged >18 years and in women aged <50 years.
- Association between maternal lifestyle and preschool nutrition(2016) NOBRE, Erica Bezerra; BRENTANI, Alexandra Valeria Maria; FERRARO, Alexandre ArchanjoIntroduction: Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition. Objective: To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children. Method: From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern Sao Paulo. A proportional stratified random sample was selected using two layers (""schools"" and ""children""). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression. Results: Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting ""sedentary behavior"" and the habit of eating ""ultra-processed foods"" had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the ""consumerist"" cluster. Conclusion: Mothers living a consumerist lifestyle can promote negative influences on child nutrition.
- 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.
- Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital(2021) MARQUES, Heloisa Helena de Sousa; PEREIRA, Maria Fernanda Badue; SANTOS, Angelica Carreira dos; FINK, Thais Toledo; PAULA, Camila Sanson Yoshino de; LITVINOV, Nadia; SCHVARTSMAN, Claudio; DELGADO, Artur Figueiredo; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHOL, Werther Brunow de; ODONE FILHO, Vicente; TANNURI, Uenis; CARNEIRO-SAMPAIO, Magda; GRISI, Sandra; DUARTE, Alberto Jose da Silva; ANTONANGELO, Leila; FRANCISCO, Rossana Pucineli Vieira; OKAY, Thelma Suely; BATISTTELLA, Linamara Rizzo; CARVALHO, Carlos Roberto Ribeiro de; BRENTANI, Alexandra Valeria Maria; SILVA, Clovis ArturOBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p < 0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p <0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
- 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).
- Maternal depression and child development: Evidence from Sao Paulo's Western Region Cohort Study(2016) BRENTANI, Alexandra; FINK, GuntherIntroduction: While a growing body of evidence has investigated the relationship between maternal mental health and child development, evidence on children's early life outcomes remains mixed. We analyze the empirical relationship between maternal depression and children's development at age one using data from the Sao Paulo Western Region Cohort project. Method: Seven hundred and ninety-eight (798) mother-child dyads living in the Butanta-Jaguare region of Sao Paulo were assessed through a home visit between January and March 2015. Maternal mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers were classified as ""possibly depressed"" if their EPDS score was between 10 and 13 and as ""likely depressed"" if their EPDS score was >13. The child outcomes analyzed were height, weight, and overall development as assessed by the Ages and Stages Questionnaire (ASQ). Height and weight were age-normalized using WHO growth standards. Stunting was defined as height-for-age z-score (HAZ) < -2. Obesity was defined as body mass index z-score (BMIZ) > 2. Adjusted and unadjusted linear regression models were used to assess the associations between Edinburgh scores and child outcomes. Results: No association was found between maternal depression variables and children's height, weight, stunting, and obesity. Positive associations were found between possible depression and ASQ (delta = 0.33; 95CI 0.11-0.54; p-value< 0.01); no associations were found between likely depression and any of the outcomes analyzed. Conclusion: The results from this study suggest that symptoms of maternal depression are not associated with delays in child development in the study setting analyzed. Further research will be needed to understand this lack of association: while it is possible that caregivers' mental health did not affect caregiving behavior, it is possible that the effect of maternal depression can vary according to timing, persistence, and intensity. It is also possible that the EPDS instrument may fail to identify mothers with clinical depression, or that children with depressed mothers get increased support from other family members or public early childhood focused programs.
- Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation(2020) KOHLI-LYNCH, Maya; HARDY, Victoria Ponce; SALAZAR, Raquel Bernal; BHOPAL, Sunil S.; BRENTANI, Alexandra; CAVALLERA, Vanessa; GOH, Esther; HAMADANI, Jena D.; HUGHES, Rob; MANJI, Karim; MILNER, Kate M.; RADNER, James; SHARMA, Sonia; SILVER, Karlee L.; LAWN, Joy E.; TANN, Cally J.Objective The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals' vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio. Setting We evaluated 32 RCEL projects across 17 LMICs on four continents. Participants Overall, 2165 workers delivered ECD interventions to 25 909 families. Intervention Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security. Primary and secondary outcomes We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review. Results Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions. Conclusions This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.
- 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.