SUMMARY OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10–19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10–14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15–19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10–14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85–2.09). In the age group 15–19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39–1.41)). Girls aged 10–14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53–1.75), and among those aged 15–19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35–2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence. OBJECTIVE METHODS crosssectional cross sectional System 1019 10 19 10–1 201 n=2,405,248, n2405248 n n=2,405,248 , 2 405 248 (n=2,405,248) groups G1 G primiparas G2 G3 RESULTS 1014 14 50 5 0 5. 47 4 7 4.7% 1519 15 15–1 278 27 8 27. 273 3 27.3% 96 p<0.001 p0001 p 001 (p<0.001 OR=1.96 OR196 OR 95 CI [CI 1.85–2.09. 185209 1.85–2.09 . 85 09 1.85–2.09) 40 OR=1.40 OR140 95CI 1.39–1.41. 139141 1.39–1.41 39 41 1.39–1.41)) of8 of< 64 OR=1.64 OR164 1.53–1.75, 153175 1.53–1.75 53 75 1.53–1.75) 137 OR=2.37 OR237 37 2.35–2.38. 235238 2.35–2.38 35 38 2.35–2.38) CONCLUSION 101 10– 20 n240524 n=2,405,24 24 (n=2,405,248 4.7 151 15– 27.3 9 p<0.00 p000 00 (p<0.00 OR=1.9 OR19 18520 1.85–2.0 OR=1.4 OR14 13914 1.39–1.4 1.39–1.41) 6 OR=1.6 OR16 15317 1.53–1.7 13 OR=2.3 OR23 23523 2.35–2.3 n24052 n=2,405,2 (n=2,405,24 4. p<0.0 p00 (p<0.0 OR=1. OR1 1852 1.85–2. 1391 1.39–1. 1531 1.53–1. OR=2. OR2 2352 2.35–2. n2405 n=2,405, (n=2,405,2 p<0. p0 (p<0. OR=1 185 1.85–2 139 1.39–1 153 1.53–1 OR=2 235 2.35–2 n240 n=2,405 (n=2,405, p<0 (p<0 OR= 18 1.85– 1.39– 1.53– 23 2.35– n24 n=2,40 (n=2,405 p< (p< 1.85 1.39 1.53 2.35 n2 n=2,4 (n=2,40 (p 1.8 1.3 1.5 2.3 n=2, (n=2,4 1. 2. n=2 (n=2, n= (n=2 (n= (n

SUMMARY OBJECTIVE: This study aimed to assess live birth frequency and age-specific fertility rates (ASFR) in the period 1996–2018 and the number of pregnancies at <14 years old in the period 2012–2018. METHODS: This was a cross-sectional study conducted by search on Live Births Data System (SINASC/DATASUS) database. RESULTS: There was a variation in ASFR in Brazil of 0.78‰ in 1996 to 0.87‰ in 2018 (+11.5%). In the north region, it increased from 1.28‰ to 1.66‰ in 2018. In the northeast region, it increased from 0.72‰ to 1.66‰ (+131%) in 1996–2011, but decreased to 1.31‰ in 2018 (-21% in relation to 2011). When comparing 1996 and 2018, in the southeast region, there was a 22% decrease; in the south region, it was 48.2%; and in the Center-West region, it was 34%; but in the north region, there was a 29.7% increase, and in the northeast region, it was 81.9%. When adding girls who became pregnant aged 13 years and gave birth at 14, there was a threefold increase in the rate. CONCLUSIONS: The increase of pregnancies in <14 years old in less developed regions of Brazil shows an association with socioeconomic factors and reveals the severe problem of rape of vulnerable persons in the country.

RESUMO OBJETIVO Comparar dados oficiais notificados de violência sexual contra meninas de 10 a 13 anos com dados sobre gravidez nessa mesma faixa etária entre 2012 e 2018. MÉTODOS estudo epidemiológico, descritivo, de corte transversal, com dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) sobre violência e gestação de meninas com idades entre 10 e 13 anos, dos anos de 2012 a 2018. Os dados sobre violência sexual foram acessados no Sistema de Informação de Agravos de Notificação (SINAN). Os dados sobre gravidez foram buscados em três Sistemas de Informação: o de Nascidos Vivos (SINASC), o de Mortalidade (SIM), para os óbitos fetais e o de Internações hospitalares (SIH), para os de aborto. RESULTADOS No período de 2012 a 2018 houve 136.387 gestações, sendo 120.185 nascimentos e 15.402 gestações interrompidas por aborto ou óbito fetal de mães que engravidaram com 13 anos ou menos. No mesmo período foram notificados ao SINAN 46.548 casos de abuso sexual de meninas com idades entre 10 e 13 anos. O número de meninas que engravidaram antes dos 14 anos, vítimas de estupro de vulnerável, foi 2,9 vezes maior do que o número de casos notificados ao SINAN. CONCLUSÃO A falta de registro adequado do estupro de vulnerável nas estatísticas oficiais no Brasil leva a subestimativa de sua magnitude.

ABSTRACT OBJECTIVE Compare official data on notifications of sexual violence against girls aged 10 to 13 years with data on pregnancy for the same age group between 2012 and 2018. METHODS This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on violence against and pregnancy of girls aged 10 to 13 years from 2012 to 2018. Data on sexual violence were accessed in the Health Information System (SINAN); on pregnancy, in the Live Births Information System (SINASC), on fetal deaths, in the Mortality Information System (SIM), and on abortions, in the Hospital Admission System (SIH). RESULTS Between 2012 and 2018, out of 136,387 pregnancies, there were 120,185 live births and 15,402 interrupted pregnancies by abortions or fetal deaths of mothers who became pregnant aged 13 years or younger. In the same period, SINAN received 46,548 notifications of sexual abuse against girls aged 10 to 13 years. The number of girls who became pregnant before the age of 14, victims of statutory rape, was 2.9 times higher than the number of cases notified to SINAN. CONCLUSION The lack of adequate notification of statutory rapes in Brazilian official statistics leads to the underestimation of its magnitude.

RESUMO OBJETIVO Comparar dados oficiais notificados de violência sexual contra meninas de 10 a 13 anos com dados sobre gravidez nessa mesma faixa etária entre 2012 e 2018. MÉTODOS estudo epidemiológico, descritivo, de corte transversal, com dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) sobre violência e gestação de meninas com idades entre 10 e 13 anos, dos anos de 2012 a 2018. Os dados sobre violência sexual foram acessados no Sistema de Informação de Agravos de Notificação (SINAN). Os dados sobre gravidez foram buscados em três Sistemas de Informação: o de Nascidos Vivos (SINASC), o de Mortalidade (SIM), para os óbitos fetais e o de Internações hospitalares (SIH), para os de aborto. RESULTADOS No período de 2012 a 2018 houve 136.387 gestações, sendo 120.185 nascimentos e 15.402 gestações interrompidas por aborto ou óbito fetal de mães que engravidaram com 13 anos ou menos. No mesmo período foram notificados ao SINAN 46.548 casos de abuso sexual de meninas com idades entre 10 e 13 anos. O número de meninas que engravidaram antes dos 14 anos, vítimas de estupro de vulnerável, foi 2,9 vezes maior do que o número de casos notificados ao SINAN. CONCLUSÃO A falta de registro adequado do estupro de vulnerável nas estatísticas oficiais no Brasil leva a subestimativa de sua magnitude.

ABSTRACT OBJECTIVE Compare official data on notifications of sexual violence against girls aged 10 to 13 years with data on pregnancy for the same age group between 2012 and 2018. METHODS This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on violence against and pregnancy of girls aged 10 to 13 years from 2012 to 2018. Data on sexual violence were accessed in the Health Information System (SINAN); on pregnancy, in the Live Births Information System (SINASC), on fetal deaths, in the Mortality Information System (SIM), and on abortions, in the Hospital Admission System (SIH). RESULTS Between 2012 and 2018, out of 136,387 pregnancies, there were 120,185 live births and 15,402 interrupted pregnancies by abortions or fetal deaths of mothers who became pregnant aged 13 years or younger. In the same period, SINAN received 46,548 notifications of sexual abuse against girls aged 10 to 13 years. The number of girls who became pregnant before the age of 14, victims of statutory rape, was 2.9 times higher than the number of cases notified to SINAN. CONCLUSION The lack of adequate notification of statutory rapes in Brazilian official statistics leads to the underestimation of its magnitude.

Resumo Objetivamos analisar a distribuição geográfica, a estrutura de atendimento e os recursos humanos das unidades do Sistema Único de Saúde (SUS) que prestam serviços em saúde sexual e reprodutiva (SSR) à população adolescente, na segunda maior cidade do Brasil. Realizamos estudo transversal com mapeamento geográfico e coleta de dados por meio de questionário aplicado aos coordenadores, em todas as 147 unidades ambulatoriais do Rio de Janeiro, dispostas ao atendimento em SSR. Verificamos que todas as Regiões Administrativas (RA) desse município dispõem de unidades de atendimento para adolescentes, entretanto, em mais de 90% delas, eles são atendidos juntamente com a população adulta, sem turnos ou salas específicas. Em mais de 10% dos serviços, a assistência só é dada na presença do responsável. Em casos de violência sexual a proporção mostrou-se ainda maior, chegando a atingir 34% dos casos. Em apenas 12,9% das unidades são realizadas atividades educativas direcionadas a adolescentes e constatou-se que menos de 1/3 dos médicos estava capacitado para lidar com a saúde do adolescente. Em conclusão, apesar da larga distribuição geográfica das unidades de saúde, a estrutura do atendimento e os recursos humanos não atendem a contento as especificidades do público adolescente.

Abstract We aimed to analyze the geographic distribution, the structure of healthcare services and the human resources of all units of the Sistema Único de Saúde (SUS - the Unified Health System) that provide sexual and reproductive health (SRH) services to the adolescent population in the second largest city in Brazil. We conducted a cross-sectional study with geographical mapping and data collection through a questionnaire applied in person with coordinators of the units or their representatives in 147 outpatient clinics in Rio de Janeiro that have SSR services. We found that in over 90% of the units, adolescents are treated together with the adult population, without particular shifts or rooms for this age group. In more than 10% of services, treatment is only provided with the presence of the guardian. In cases of sexual violence, this proportion is 34%. Specific educational activities for this age group are only carried out in 12.9% of units and less than one third of doctors had received some kind of training to deal with adolescent health. In conclusion, despite the wide geographic distribution of health facilities, the structure of care and the human resources do not meet the specific needs of adolescents.

Resumo Objetivamos analisar a distribuição geográfica, a estrutura de atendimento e os recursos humanos das unidades do Sistema Único de Saúde (SUS) que prestam serviços em saúde sexual e reprodutiva (SSR) à população adolescente, na segunda maior cidade do Brasil. Realizamos estudo transversal com mapeamento geográfico e coleta de dados por meio de questionário aplicado aos coordenadores, em todas as 147 unidades ambulatoriais do Rio de Janeiro, dispostas ao atendimento em SSR. Verificamos que todas as Regiões Administrativas (RA) desse município dispõem de unidades de atendimento para adolescentes, entretanto, em mais de 90% delas, eles são atendidos juntamente com a população adulta, sem turnos ou salas específicas. Em mais de 10% dos serviços, a assistência só é dada na presença do responsável. Em casos de violência sexual a proporção mostrou-se ainda maior, chegando a atingir 34% dos casos. Em apenas 12,9% das unidades são realizadas atividades educativas direcionadas a adolescentes e constatou-se que menos de 1/3 dos médicos estava capacitado para lidar com a saúde do adolescente. Em conclusão, apesar da larga distribuição geográfica das unidades de saúde, a estrutura do atendimento e os recursos humanos não atendem a contento as especificidades do público adolescente.

Abstract We aimed to analyze the geographic distribution, the structure of healthcare services and the human resources of all units of the Sistema Único de Saúde (SUS - the Unified Health System) that provide sexual and reproductive health (SRH) services to the adolescent population in the second largest city in Brazil. We conducted a cross-sectional study with geographical mapping and data collection through a questionnaire applied in person with coordinators of the units or their representatives in 147 outpatient clinics in Rio de Janeiro that have SSR services. We found that in over 90% of the units, adolescents are treated together with the adult population, without particular shifts or rooms for this age group. In more than 10% of services, treatment is only provided with the presence of the guardian. In cases of sexual violence, this proportion is 34%. Specific educational activities for this age group are only carried out in 12.9% of units and less than one third of doctors had received some kind of training to deal with adolescent health. In conclusion, despite the wide geographic distribution of health facilities, the structure of care and the human resources do not meet the specific needs of adolescents.

With the increasing popularity of web-based map browsers, remotely obtaining a high quality depiction of cartographic information has become commonplace. Most web mapping systems, however, rely on high-capacity servers transmitting pre-rendered tiled maps in raster format. That approach is capable of producing good quality renderings on the client side while using limited bandwidth and exploiting the browser's image cache. These goals are harder to achieve for maps in vector format. In this work, we present an alternative client-server architecture capable of progressively transmitting vector maps in levels-of-detail (LOD) by using techniques such as polygonal line simplification, spatial data structures and, most importantly, a customized memory management algorithm. A multiplatform implementation of this system is described, where the client application is written entirely in JavaScript and processed within the web browser, avoiding the need of external applications or plug-ins. Results of experiments aimed at gauging both the performance and the display quality obtained with the system are presented and explained. Extensions to the system are also discussed, including issues such as level-of-detail versus visual importance tradeoffs and the handling of closed polygonal lines.