Campinas Health Infant Survey A Birth Cohort in Brazil I4C 2013 Workshop - Lyon Silvia Brandalise, MD Celso Stephan, Epidemiologist Maria Vedovato, Epidemiologist

Campinas 800 km 2 one million inhabitants (2,5 million metropolitan region – 29 municipalities) predominantly industrial economy near petrochemical pole (Paulínia) HDI: 0.85 (Brazil 0.74) GDP / capita: USD 13,500

Boldrini Children´s Hospital one of the most important children’s cancer hospital in Latin America Develops clinical researches Non profit institution About 70% of patients are healed 80% of patients from public health system (SUS)

Ronald McDonald Pediatric Institute Structure delineated to I4C Programs: 504 m 2 10 rooms of ambulatory care 5 multidisciplinary rooms 4 ultrasound equipments biobank

Ronald McDonald’s Pediatric Institute Activities: Infant’s screening for retinoblastoma (retinal mapping by ophthalmologists). Routine examination should be guaranteed by Municipal Law for two times, in the first 18 months of age Abdominal ultrasound for recrutted normal babies cohort recruitment and interviews cohort headquarter

CHIS project partners Boldrini Children´s Hospital State University of Campinas – UNICAMP Public Health Department CIPOI - Children´s Hematology and Oncology Research Center. Neonatal Screening Program epiGeo - Epidemiologic Data Spatial Analisys Lab Municipal Health Department

Study Design prospective birth cohort n = 100,000 children Previous exposures and during pregnancy questionnaires (same from DNBC) – 3 rd and 7 th months of pregnancy – 6 th and 18 th months of children’s age bioespecimens: mother’s blood and umbilical cord blood and Guthrie Card’s samples

Study Design Clinical outcomes Childhood cancers and also: congenital malformations myelodysplasias cytopenias aplastic anemia Other chronic and noncommunicable diseases (diabetes, obesity, etc) follow-up: 18 years

Births in Campinas 14,000 / year 80% - National Public Health System (SUS) 20% - Private Health System Demand for different recruitment and follow-up strategies

Public (SUS) Strategy for CHIS 62 Basic Health Units (UBS) SUS id Card prenatal exams (Sinasc-Campinas, 2010): 4-6: 13% 7+:82%

Private Health Strategy for CHIS medical associations medical syndicate media campaings home interviews

CHIS Geographic Information System geographic distribution of exposures – water and energy supply, eletromagnetic radiation sources, chemical contaminants etc environmental data geolocation of cohort participants geographic statistical association

Sanitary landfills Geographic Information System Chemical poluents Eletromagnetic sources Water supply map Cohort Cases (x) and Controls (o) x x x x x x x x x o o o o o o o o o o o o o o

Electronic data acquisition 4 questionnaires from DNBC were translated, adapted, validated and converted to electronic versions for use on Android devices more efficiency sending data “direct” to DB no paper (except signed consent term form) no extra typing costs electronic data consistency

Financial support (Fiscal Year 2013) Ronald McDonald’s Institute - Funds approved US$ 208,000 (Required for the 1st year recruitments and interviews) Boldrini’s Center - Personnel US$ 480,000/yr - Undirect costs US$ 84,000/yr FAPESP – São Paulo Research Foundation - Funds US$ 170,000 (under analysis) ( For the Biobank equipments and lab materials) Estimated public reimbursements US$ 60,000/yr

Insertion of Campinas’s Health Department implement the CHIS project as a public health policy – To provide the ultrasound services for the pregnant – monitoring the health care of the mothers and babies To promote a real interface w/ Medical educational institutions There is a need for the approval by the Municipal Health Council Additional costs for 2014: US$ 528,000/yr (Personnel + Biobank maintenance) Estimated public reimbursements US$ 360,000/yr

Next steps Training interviewers: November, 2013 Starting recruitment: January, 2014 Incorporate young investigators to the Progra m To go fast, you go alone. To go far, you go together