TESE DE DOUTORADO - PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA

URI Permanente para esta coleçãohttps://tedebc-teste.ufma.br/handle/tede/1009

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Navegando TESE DE DOUTORADO - PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA por Autor "ALMEIDA, Cecília Cláudia Costa Ribeiro de"

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    FATORES DOS PRIMEIROS 1000 DIAS DE VIDA ASSOCIADOS À SINTOMAS ASMA NA INFÂNCIA NA COORTE BRISA EM SÃO LUÍS E RIBEIRÃO PRETO, BRASIL.
    (Universidade Federal do Maranhão, 2018-02-05) NASCIMENTO, Joelma Ximenes Prado Teixeira; BATISTA, Rosângela Fernandes Lucena; 363.734.943-49; http://lattes.cnpq.br/3936205532436748; ALMEIDA, Cecília Cláudia Costa Ribeiro de; 507.669.963-87; ALMEIDA, Cecília Cláudia Costa Ribeiro de; 507.669.963-87; BATISTA, Rosângela Fernandes Lucena; 363.734.943-49; http://lattes.cnpq.br/3936205532436748; VIANNA, Elcio dos Santos Oliveira; http://lattes.cnpq.br/8733105749892750; BARBIERI, Marco Antonio; http://lattes.cnpq.br/0765555733544821; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430
    Asthma is a complex syndrome, of difficult diagnosis in children. The mechanisms involved in the etiopathogeny of the disease have not been completely elucidated. Environmental exposures during the first 1000 days of life (270 days of gestation plus the 365 days of the first year of life and 365 days of the second of life) appear to have a strong influence on epigenetic regulation, increasing predisposition to childhood asthma. The association between early exposures of the prenatal period, birth and the first years of life with asthma symptoms in children involves multicausality and temporality relationships between these variables that can be better studied by structural equation modeling (SEM). Chapter I of this thesis was the original article: The First 1000 Days of Life Factors Associated with “Childhood Asthma Symptoms”: Brisa Cohort, São Luís, Brazil, which aimed to analyze the associations between the environmental factors up to the first 1000 days of life and “Childhood Asthma Symptoms”. It is a prospective study involving three moments of the BRISA cohort in Sao Luis (n = 1140), where the outcome was the latent variable “Childhood Asthma Symptoms”, formed by four indicators with convergent loads: medical diagnosis of asthma, number of wheezing episodes, emergency care visit due to wheezing and medical diagnosis of rhinitis. A theoretical model that included prenatal factors, birth factors and of the second year of life, were analyzed in association with “Childhood Asthma Symptoms” using SEM. It was observed that the higher the pre-gestational BMI, high soft drink consumption in gestation, cesarean section without labor, chill in the first three months of life, carpeted floor and child´s exposure to tobacco were associated with higher values of “Childhood Asthma Symptoms”. In contrast, high birth weight, the age of the child and children exclusively breastfed for six months were associated with lower values of “Childhood Asthma Symptoms”. Chapter II of this thesis was the original article: Environmental factors linked microbiota hypothesis and “Childhood Asthma Symptoms”: BRISA cohort, Ribeirão Preto, Brazil, which aimed to analyze environmental factors linked to the microbiota hypothesis and “Childhood Asthma Symptoms”. It is a prospective study involving population-based sample of the BRISA birth cohort in Ribeirão Preto (n = 3694). Birth and second year life factors linked to the microbiota hypothesis were analyzed on a theoretical model having as outcome the latent variable “Childhood Asthma Symptoms” was formed by three indicators (medical diagnosis of asthma, number of wheezing episodes and emergency care visit due to wheezing) using SEM. It was observed that children with higher BMI values, belonging to the black race, with diarrhea and older presented higher values for “Childhood Asthma Symptoms”; while better economic situation, female gender and longer breastfeeding presented lower values for “Childhood Asthma Symptoms”. In the present thesis, the analyzes of the variable “Childhood Asthma Symptoms” as a continuous latent formed by clinical indicators of convergent loads reduced the error of measurement of this outcome difficult to diagnose in children. Our findings suggest that environmental exposures during the first 1000 days of life, such as: maternal and child overweight, consumption of soft drinks in gestation, cesarean delivery, would be involved in the early programming of asthma children, while breastfeeding would protect from this condition.
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    Fatores perinatais e níveis pressóricos de escolares em duas cidades brasileiras
    (Universidade Federal do Maranhão, 2017-07-06) SANTOS, Graciete Helena Nascimento dos; SIMÕES, Vanda Maria Ferreira; 094651893-91; http://lattes.cnpq.br/4024829764707677; SIMÕES, Vanda Maria Ferreira; 094651893-91; http://lattes.cnpq.br/4024829764707677; CARDOSO, Viviane Cunha; http://lattes.cnpq.br/9472547924584965; MARTINS, Marilia da Glória; http://lattes.cnpq.br/1876365333157244; ALMEIDA, Cecília Cláudia Costa Ribeiro de; http://lattes.cnpq.br/1783658679814263; BATISTA, Rosângela Fernandes Lucena; http://lattes.cnpq.br/3936205532436748
    Introduction: Changes in the gestational period and at the time of delivery can exert influence on blood pressure in adulthood, however it is still unknown if there is this effect in childhood and adolescence. Objective: The aim of this work was to assess the association of perinatal factors in the blood pressure levels of schoolchildren. Methods: Data from two birth cohorts in two Brazilian cities were evaluated. In the perinatal baseline, 2,858 mothers-babies binomials participated in Ribeirão Preto (RP) in 1994 and in São Luiz (SL) there was a participation of 2,443 mothers-babies in 1997/98. The follow-up in children during their school lives was done in the year of 2005; when 869 children (by the age of 10/11 years) were followed in RP and 805 (by the age of 7/9 years) in SL. The variables had gathered in the perinatal questionnaire were the following: sex, birthplace, mode of delivery, gestational age and birth weight. At the follow-up, further variables had collected: family income, maternal schooling, anthropometric measurements of the child and two measures of the child's blood pressure. An exploratory model using the perinatal period variables was analyzed in association with the outcome, systolic blood pressure (SBP). Multiple linear regression analysis of perinatal factors on the SBP levels was performed, adjusted to sociodemographic variables and anthropometric measurements of children. In the second article, the data from Ribeirão Preto cohort only were analyzed and the response variables, mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP), were standardized in a specific blood pressure z-score by age, sex and height. Multivariate analysis were performed by linear regression analysis to verify the association between the z-score of systolic and diastolic blood pressures and perinatal factors. Thus for analysis of the association between cesarean delivery and the z-scores of SBP e DBP, it was identified the minimum set of variables indicated by a Directed Acyclic Graph (DAG) for adjustment, which were maternal schooling at birth, maternal age, family income at birth and maternal smoking. For this adjusted analysis, two models were used: a multiple linear regression model (MLR) and a causal estimation model by the inverse of the probability weight (CEM). Results: In the first article, it was observed in RP an increase in mean SBP of 2.69 mmHg (95% CI = 0.86; 4.53) in those born by cesarean delivery and in SL, among preterm infants, an increase of 2.51 mmHg (95% CI = 0.81, 4.23). In the second article, in the analyzes adjusted in the two proposed models, there was statistical significance in the two methods between cesarean delivery and the SBP of students with a coefficient of 0.22 (p-value=0.01) in the MLR based on the DAG and coefficient of 0.25 (p-value=0.004) in CEM and the same was not observed with PAD. Conclusion: In the first article, it was drawn an association between cesarean delivery and blood pressure of schoolchildren from the city with the highest socioeconomic status, but not in those one from the poorest city. In the second article, this finding was reinforced and established a possible causality relationship between cesarean delivery and the future levels of SBP.