Abstract The present study aimed to investigate the socioeconomic and obstetric characteristics of adolescent mothers and the complications they cause to maternal and neonatal health. This baseline data analysis of the MINA-Brazil birth cohort was conducted in the municipality of Cruzeiro do Sul, state of Acre, Brazil. The chi-square test was used to compare characteristics of adolescent and adult postpartum women, and multiple Poisson regression models with robust variance were used to assess associated factors. Among the postpartum women, 26.2% (95%CI: 24.0-28.4) were adolescents. Factors associated with childbirth in adolescence included: nine years or less of schooling (adjPR:1.36; 95%CI: 1.14-1.61), belongs to the lowest quartiles of the wealth index (1st quartile: adjPR:1.40; 95%CI: 1.08-1.80) (2nd quartile: adjPR:1.37; 95%CI: 1.08-1.74), primigravidae (adjPR:3.69; 95%CI: 2.98-4.57), low pre-pregnancy BMI (adjPR:1.28; CI95%: 1.04-1.57), urinary tract infection during pregnancy (adjPR:1.25; CI95%: 1.07-1.46) and less than six prenatal consultations (adjPR:1.42; 95%CI: 1.21-1.66). Poverty, little schooling, primigravidae, low pre-pregnancy BMI, urinary tract infection during pregnancy and few prenatal consultations were associated with childbirth during adolescence in a municipality in the Northern region of Brazil.

Resumo O objetivo do estudo foi investigar as características socioeconômicas e obstétricas de parturientes adolescentes e suas complicações sobre a saúde materna e neonatal. Trata-se de uma análise de dados da linha de base da coorte de nascimentos MINA-Brasil conduzida no município de Cruzeiro do Sul, estado do Acre. Utilizou-se teste qui-quadrado para comparar características das puérperas adolescentes com as adultas e modelos múltiplos de regressão de Poisson com variância robusta para avaliar fatores associados. Entre as puérperas estudadas, 26,2% (IC95%: 24,0-28,4) eram adolescentes. Os fatores associados ao parto na adolescência foram ter nove anos ou menos de estudo (RPaj:1,36; IC95%: 1,14-1,61), pertencer aos menores quartis do índice de riqueza (1° quartil: RPaj:1,40; IC95%: 1,08-1,80) (2° quartil: RPaj:1,37; IC95%: 1,08-1,74), ser primigesta (RPaj:3,69; IC95%: 2,98-4,57), baixo IMC pré-gestacional (RPaj:1,28; IC95%: 1,04-1,57), infecção urinária na gravidez (RPaj:1,25; IC95%: 1,07-1,46) e menos de seis consultas de pré-natal (RPaj:1,42; IC95%: 1,21-1,66). Pobreza, baixa escolaridade, primigestação, baixo IMC pré-gestacional, infecção urinária na gestação e menor número de consultas de pré-natal foram associados ao parto na adolescência em município da região Norte do Brasil.

Abstract The present study aimed to investigate the socioeconomic and obstetric characteristics of adolescent mothers and the complications they cause to maternal and neonatal health. This baseline data analysis of the MINA-Brazil birth cohort was conducted in the municipality of Cruzeiro do Sul, state of Acre, Brazil. The chi-square test was used to compare characteristics of adolescent and adult postpartum women, and multiple Poisson regression models with robust variance were used to assess associated factors. Among the postpartum women, 26.2% (95%CI: 24.0-28.4) were adolescents. Factors associated with childbirth in adolescence included: nine years or less of schooling (adjPR:1.36; 95%CI: 1.14-1.61), belongs to the lowest quartiles of the wealth index (1st quartile: adjPR:1.40; 95%CI: 1.08-1.80) (2nd quartile: adjPR:1.37; 95%CI: 1.08-1.74), primigravidae (adjPR:3.69; 95%CI: 2.98-4.57), low pre-pregnancy BMI (adjPR:1.28; CI95%: 1.04-1.57), urinary tract infection during pregnancy (adjPR:1.25; CI95%: 1.07-1.46) and less than six prenatal consultations (adjPR:1.42; 95%CI: 1.21-1.66). Poverty, little schooling, primigravidae, low pre-pregnancy BMI, urinary tract infection during pregnancy and few prenatal consultations were associated with childbirth during adolescence in a municipality in the Northern region of Brazil. health MINABrazil MINA Brazil Sul Acre chisquare chi square women factors 262 26 2 26.2 95%CI 95CI CI 95 (95%CI 24.028.4 240284 24.0 28.4 24 0 28 4 24.0-28.4 adolescents included adjPR1.36 adjPR136 adjPR 1.36 1 36 (adjPR:1.36 1.141.61, 114161 1.14 1.61 , 14 61 1.14-1.61) 1st st quartile adjPR1.40 adjPR140 1.40 40 adjPR:1.40 1.081.80 108180 1.08 1.80 08 80 1.08-1.80 2nd nd adjPR1.37 adjPR137 1.37 37 adjPR:1.37 1.081.74, 108174 1.74 74 1.08-1.74) adjPR3.69 adjPR369 3.69 3 69 (adjPR:3.69 2.984.57, 298457 2.98 4.57 98 57 2.98-4.57) prepregnancy pre adjPR1.28 adjPR128 1.28 (adjPR:1.28 CI95% CI95 1.041.57, 104157 1.04 1.57 04 1.04-1.57) adjPR1.25 adjPR125 1.25 25 (adjPR:1.25 1.071.46 107146 1.07 1.46 07 46 1.07-1.46 adjPR1.42 adjPR142 1.42 42 (adjPR:1.42 1.211.66. 121166 1.21 1.66 . 21 66 1.21-1.66) Poverty 26. 9 028 24.028. 24028 240 24. 284 28. 24.0-28. adjPR1 adjPR1.3 adjPR13 136 1.3 (adjPR:1.3 141 1.141.61 11416 114 1.1 161 1.6 6 1.14-1.61 adjPR1.4 adjPR14 140 1.4 adjPR:1.4 081 1.081.8 10818 108 1.0 180 1.8 8 1.08-1.8 137 adjPR:1.3 1.081.74 10817 174 1.7 7 1.08-1.74 adjPR3 adjPR3.6 adjPR36 369 3.6 (adjPR:3.6 984 2.984.57 29845 298 2.9 457 4.5 5 2.98-4.57 adjPR1.2 adjPR12 128 1.2 (adjPR:1.2 CI9 041 1.041.57 10415 104 157 1.5 1.04-1.57 125 071 1.071.4 10714 107 146 1.07-1.4 142 (adjPR:1.4 211 1.211.66 12116 121 166 1.21-1.66 02 24.028 2402 24.0-28 adjPR1. 13 1. (adjPR:1. 1.141.6 1141 11 16 1.14-1.6 adjPR:1. 1.081. 1081 10 18 1.08-1. 1.081.7 17 1.08-1.7 adjPR3. 3. (adjPR:3. 2.984.5 2984 29 2. 45 4. 2.98-4.5 12 1.041.5 1041 15 1.04-1.5 1.071. 1071 1.07-1. 1.211.6 1211 1.21-1.6 24.02 24.0-2 (adjPR:1 1.141. 1.14-1. adjPR:1 1.081 1.08-1 (adjPR:3 2.984. 2.98-4. 1.041. 1.04-1. 1.071 1.07-1 1.211. 1.21-1. 24.0- (adjPR: 1.141 1.14-1 adjPR: 1.08- 2.984 2.98-4 1.041 1.04-1 1.07- 1.211 1.21-1 (adjPR 1.14- 2.98- 1.04- 1.21-

Resumo O objetivo do estudo foi investigar as características socioeconômicas e obstétricas de parturientes adolescentes e suas complicações sobre a saúde materna e neonatal. Trata-se de uma análise de dados da linha de base da coorte de nascimentos MINA-Brasil conduzida no município de Cruzeiro do Sul, estado do Acre. Utilizou-se teste qui-quadrado para comparar características das puérperas adolescentes com as adultas e modelos múltiplos de regressão de Poisson com variância robusta para avaliar fatores associados. Entre as puérperas estudadas, 26,2% (IC95%: 24,0-28,4) eram adolescentes. Os fatores associados ao parto na adolescência foram ter nove anos ou menos de estudo (RPaj:1,36; IC95%: 1,14-1,61), pertencer aos menores quartis do índice de riqueza (1° quartil: RPaj:1,40; IC95%: 1,08-1,80) (2° quartil: RPaj:1,37; IC95%: 1,08-1,74), ser primigesta (RPaj:3,69; IC95%: 2,98-4,57), baixo IMC pré-gestacional (RPaj:1,28; IC95%: 1,04-1,57), infecção urinária na gravidez (RPaj:1,25; IC95%: 1,07-1,46) e menos de seis consultas de pré-natal (RPaj:1,42; IC95%: 1,21-1,66). Pobreza, baixa escolaridade, primigestação, baixo IMC pré-gestacional, infecção urinária na gestação e menor número de consultas de pré-natal foram associados ao parto na adolescência em município da região Norte do Brasil. neonatal Tratase Trata se MINABrasil MINA Brasil Sul Acre Utilizouse Utilizou quiquadrado qui quadrado estudadas 262 26 2 26,2 IC95% IC95 IC (IC95% 24,028,4 240284 24,0 28,4 24 0 28 4 24,0-28,4 RPaj1,36 RPaj136 RPaj 1,36 1 36 (RPaj:1,36 1,141,61, 114161 1,14 1,61 , 14 61 1,14-1,61) 1° (1 quartil RPaj1,40 RPaj140 1,40 40 RPaj:1,40 1,081,80 108180 1,08 1,80 08 80 1,08-1,80 2° (2 RPaj1,37 RPaj137 1,37 37 RPaj:1,37 1,081,74, 108174 1,74 74 1,08-1,74) RPaj3,69 RPaj369 3,69 3 69 (RPaj:3,69 2,984,57, 298457 2,98 4,57 98 57 2,98-4,57) prégestacional pré gestacional RPaj1,28 RPaj128 1,28 (RPaj:1,28 1,041,57, 104157 1,04 1,57 04 1,04-1,57) RPaj1,25 RPaj125 1,25 25 (RPaj:1,25 1,071,46 107146 1,07 1,46 07 46 1,07-1,46 prénatal natal RPaj1,42 RPaj142 1,42 42 (RPaj:1,42 1,211,66. 121166 1,21 1,66 . 21 66 1,21-1,66) Pobreza escolaridade primigestação prégestacional, gestacional, 26, IC9 (IC95 028 24,028, 24028 240 24, 284 28, 24,0-28, RPaj1 RPaj1,3 RPaj13 136 1,3 (RPaj:1,3 141 1,141,61 11416 114 1,1 161 1,6 6 1,14-1,61 ( RPaj1,4 RPaj14 140 1,4 RPaj:1,4 081 1,081,8 10818 108 1,0 180 1,8 8 1,08-1,8 137 RPaj:1,3 1,081,74 10817 174 1,7 7 1,08-1,74 RPaj3 RPaj3,6 RPaj36 369 3,6 (RPaj:3,6 984 2,984,57 29845 298 2,9 457 4,5 9 5 2,98-4,57 RPaj1,2 RPaj12 128 1,2 (RPaj:1,2 041 1,041,57 10415 104 157 1,5 1,04-1,57 125 071 1,071,4 10714 107 146 1,07-1,4 142 (RPaj:1,4 211 1,211,66 12116 121 166 1,21-1,66 (IC9 02 24,028 2402 24,0-28 RPaj1, 13 1, (RPaj:1, 1,141,6 1141 11 16 1,14-1,6 RPaj:1, 1,081, 1081 10 18 1,08-1, 1,081,7 17 1,08-1,7 RPaj3, 3, (RPaj:3, 2,984,5 2984 29 2, 45 4, 2,98-4,5 12 1,041,5 1041 15 1,04-1,5 1,071, 1071 1,07-1, 1,211,6 1211 1,21-1,6 (IC 24,02 24,0-2 (RPaj:1 1,141, 1,14-1, RPaj:1 1,081 1,08-1 (RPaj:3 2,984, 2,98-4, 1,041, 1,04-1, 1,071 1,07-1 1,211, 1,21-1, 24,0- (RPaj: 1,141 1,14-1 RPaj: 1,08- 2,984 2,98-4 1,041 1,04-1 1,07- 1,211 1,21-1 (RPaj 1,14- 2,98- 1,04- 1,21-

ABSTRACT OBJECTIVE The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals’ health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes. METHODS A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling. RESULTS The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = −0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency. CONCLUSION The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic. COVID19 COVID 19 COVID-1 individuals lifestyle populationbased population based Pelotas Brazil prepandemic pre T1, T (T1 November2019 November 2019 November-201 March2020 March 2020 March-2020 peripandemic peri T2, (T2 August2021 August 2021 August-202 December2021 December December-2021 inperson person n 1,949. 1949 1,949 . 1 949 1,949) days SJL, , (SJL) MCTQ. MCTQ (MCTQ) Sociodemographic, Sociodemographic Socio demographic, demographic Socio-demographic prepandemic, pandemic, pandemicrelated analyzed modeling M 0334 0 334 0.334 0.001, 0001 0.001 001 0029 029 0.029 0.002, 0002 0.002 002 0.002) 0021 021 0.021 0.034, 0034 0.034 034 0.034) 0758 758 −0.758 Selfevaluated Self evaluated However selfreported self reported COVID1 COVID- (T November201 201 November-20 March202 202 March-202 August202 August-20 December202 December-202 194 1,94 94 (SJL (MCTQ 033 33 0.33 000 0.00 00 02 0.02 003 0.03 03 075 75 −0.75 November20 20 November-2 March20 March-20 August20 August-2 December20 December-20 1,9 9 3 0.3 0.0 07 7 −0.7 November2 2 November- March2 March-2 August2 August- December2 December-2 1, 0. −0. March- December- −0 −

ABSTRACT OBJECTIVE The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals’ health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes. METHODS A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling. RESULTS The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = −0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency. CONCLUSION The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic.

Objective: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. Methods: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. Results: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). Conclusion: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed. Objective attentionrelated related EFs (EFs 1 Methods populationbased population based 200 n=3,582 n3582 n 3 582 (n=3,582 n=1,950 n1950 950 (n=1,950 analyzed TEACh. TEACh TEA Ch . (TEA-Ch) CANTAB. CANTAB (CANTAB) impairment Results OR 3.04 304 04 95CI CI 95 2.094.43, 209443 2.09 4.43 , 2 09 4 43 2.09-4.43) 2.21 221 21 1.583.09. 158309 1.58 3.09 58 1.58-3.09) income color parity prematurity weight siblings Breastfeeding duration 0.38 038 0 38 0.220.65. 022065 0.22 0.65 22 65 0.22-0.65) Conclusion development populations needed 20 n=3,58 n358 (n=3,58 n=1,95 n195 (n=1,95 (TEA-Ch (CANTAB 3.0 30 9 094 2.094.43 20944 209 2.0 443 4.4 2.09-4.43 2.2 583 1.583.09 15830 158 1.5 309 5 1.58-3.09 0.3 03 220 0.220.65 02206 022 0.2 065 0.6 6 0.22-0.65 n=3,5 n35 (n=3,5 n=1,9 n19 (n=1,9 3. 2.094.4 2094 2. 44 4. 2.09-4.4 1.583.0 1583 1. 1.58-3.0 0. 0.220.6 0220 02 06 0.22-0.6 n=3, n3 (n=3, n=1, n1 (n=1, 2.094. 2.09-4. 1.583. 1.58-3. 0.220. 0.22-0. n=3 (n=3 n=1 (n=1 2.094 2.09-4 1.583 1.58-3 0.220 0.22-0 n= (n= 2.09- 1.58- 0.22- (n

Objectives: There is growing interest in examining the impacts of the coronavirus disease 2019 (COVID-19) pandemic on adolescent socioemotional development. This study aimed to examine changes in adolescent emotion regulation (ER), self-esteem (SE), and locus of control (LoC) from before to during the pandemic in a Brazilian birth cohort, and to investigate the variables associated with changes in those socioemotional competences. Methods: 1,949 adolescents from the 2004 Pelotas Birth Cohort were assessed before (T1, November 2019 to March 2020) and during (T2, August to December 2021) the COVID-19 pandemic (mean ages [SD] = 15.69 [0.19] and 17.41 [0.26], respectively). Adolescents’ socioemotional competences were assessed, including ER, SE, and LoC. Sociodemographic, pre-pandemic, and pandemic-related correlates were examined as predictors of change. Multivariate latent change score models were used in the analyses. Results: There were significant mean increases in adolescents’ ER and SE (mean ER = 1.918, p < 0.001; mean SE = 1.561, p = 0.001) and a significant mean decrease (towards internalization) in LoC levels (MLoC = -0.497, p < 0.01) during the pandemic. Factors that predicted a lower competency increase included family conflicts, harsh parenting, and maternal depressive symptoms during the pandemic. Conclusion: Despite the stress imposed by the COVID-19 pandemic, the adolescents of this cohort showed positive development in their socioemotional competences. Family-related factors emerged as important predictors of adolescent socioemotional adjustment during the study period. Objectives 201 COVID19 COVID 19 (COVID-19 , (ER) selfesteem self esteem (SE) (LoC Methods 1949 1 949 1,94 200 T1, T1 T (T1 2020 T2, T2 (T2 2021 COVID-1 SD [SD 1569 15 69 15.6 0.19 019 0 [0.19 1741 17 41 17.4 0.26, 026 0.26 26 [0.26] respectively. respectively . respectively) Adolescents Sociodemographic prepandemic, prepandemic pre pre-pandemic pandemicrelated related analyses Results 1918 918 1.918 0.001 0001 001 1561 561 1.561 towards internalization MLoC 0.497, 0497 497 -0.497 0.01 01 conflicts parenting Conclusion Familyrelated Family period 20 COVID1 (COVID-1 (ER (SE 194 94 1,9 (T 202 COVID- 156 6 15. 0.1 [0.1 174 4 17. 02 0.2 2 [0.26 191 91 1.91 0.00 000 00 56 1.56 0.497 049 49 -0.49 0.0 (COVID- 9 1, 0. [0. [0.2 1.9 5 1.5 0.49 04 -0.4 (COVID [0 1. 0.4 -0. [ -0 -

Objectives: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. Methods: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. Results: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. Conclusions: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls. Objectives behavior position 1 Methods 3491 3 491 3,49 11yearolds yearolds year olds 1949 949 1,94 15yearolds 200 Cohort variables Results girls Conclusions 349 49 3,4 194 94 1,9 20 34 4 3, 19 9 1, 2

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted. reemergence re emergence vaccinepreventable preventable (VC countries 201 2021 COVID19 COVID 19 COVID-1 trend spacetime space distribution dose 1, 1 , 1) spatiotemporal spatio disposition 2015 2020 regions Northeast indicators inequality Strategy municipalities circulation however care hesitancy highlighted 20 202 COVID1 COVID- 2

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal. (CV países 201 2021 COVID19, COVID19 COVID 19, 19 COVID-19 espaçotemporal espaço Tratase Trata se dose 1, 1 , 1) espaçotemporal, 2015 observase observa acentuandose acentuando 202 regiões Nordeste humano Família desiguais vírus básica vacina vacinal 20 COVID1 COVID-1 2 COVID-

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS). VC, , (VC) poliomyelitis concern 1 201 2021 Brazil COVID19 COVID 19 COVID-1 STI (STI analysis NeweyWest Newey West Index index Covid19 Covid Covid-1 2019 SUS. SUS . (SUS) (VC 20 202 COVID1 COVID- Covid1 Covid- (SUS 2

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde. (CV infância sanitária 1 201 2021 COVID19, COVID19 COVID 19, 19 COVID-19 Brasil STI (STI espacial Imunização NeweyWest, NeweyWest Newey West, West Newey-West Brasileiro local Saúde Observase Observa país social 20 202 COVID1 COVID-1 2 COVID-

Objective: To test the efficacy of smartphone-assisted online brief cognitive behavioral therapy (b-CBT) to treat maternal depression compared to online brief CBT plus an active control app. Methods: A randomized controlled trial was conducted. Assessments were performed at baseline (T0), midpoint (T1, week 4-5), post-treatment (T2, week 8), and follow-up (T3, 2-month postnatal follow-up) by blinded interviewers. The primary outcome was depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at T2. We also assessed anxiety, stress, sleep quality, well-being, physical activity, treatment response, and offspring child behavior problems. Results: Eighty-one participants were randomized to the intervention (n=37) or active control (n=44) groups. Seventy-one participants completed the post-treatment assessment or reported primary outcome data. No differences were found between the intervention and active control groups regarding maternal depression or other mental health outcomes. Overall, we found large within-group effect sizes, with 80% of the total sample responding to treatment. Conclusions: Our data showed no difference between the groups, suggesting that adding apps to psychotherapy treatment may not enhance treatment effects on prenatal depression. A within-groups analysis showed that most participants with depression responded to treatment; however, future studies are needed to confirm whether this effect is related to factors other than the intervention. Objective smartphoneassisted smartphone assisted bCBT b (b-CBT app Methods conducted T0, T0 T , (T0) T1, T1 (T1 45, 45 4 5 4-5) posttreatment post T2, T2 (T2 8, 8 8) followup follow up T3, T3 (T3 2month month 2 interviewers EPDS (EPDS anxiety stress quality wellbeing, wellbeing well being, being well-being activity response problems Results Eightyone Eighty one n=37 n37 n 37 (n=37 n=44 n44 44 (n=44 Seventyone Seventy outcomes Overall withingroup within group sizes 80 Conclusions withingroups however (T0 (T 4-5 n=3 n3 3 (n=3 n=4 n4 (n=4 4- n= (n= (n

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

ABSTRACT OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015–June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2–36.0) and 10.8% (95%CI: 8.9–12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19–1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23–2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44–2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15–2.52). Continued BF frequency was 67.9% (95%CI: 64.9–70.8), 29.3% (95%CI: 26.4–32.4), and 1.7% (95%CI: 0.9–2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01–1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99–7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64–4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.

RESUMO OBJETIVO: Descrever a prevalência e os fatores associados às práticas de aleitamento materno exclusivo (AME) e continuado (AM) entre crianças amazônicas. MÉTODOS: Foram utilizados dados de 1.143 pares mãe-filho registrados na coorte de nascimento Materno-Infantil no Acre (MINA-Brasil). As informações sobre AME e AM foram coletadas após o parto (julho de 2015–junho de 2016) e durante as consultas de acompanhamento com 1 e 6 meses pós-parto e com 1, 2 e 5 anos de idade. A análise longitudinal considerou a duração do AME e AM como desfechos. A probabilidade das práticas de aleitamento materno foi estimada pela análise de sobrevida de Kaplan-Meier. As associações entre as variáveis preditoras basais e os desfechos entre crianças nascidas a termo foram avaliadas por modelos de regressão de Cox estendidos. RESULTADOS: As frequências de AME (intervalo de confiança de 95% [IC95%]) aos 3 e 6 meses de idade foram de 33% (IC95%: 30,2–36,0) e 10,8% (IC95%: 8,9–12,9), respectivamente. A razão de risco ajustada para preditores de interrupção precoce do AME foi: ser primípara = 1,47 (IC95%: 1,19–1,80), alimentar recém-nascidos com pré-lácteos = 1,70 (IC95%: 1,23–2,36), usar chupeta na primeira semana de vida = 1,79 (IC95%: 1,44–2,23) e apresentar diarreia nas duas primeiras semanas de vida = 1,70 (IC95%: 1,15–2,52). A frequência do AM continuado foi de 67,9% (IC95%: 64,9–70,8), 29,3% (IC95%: 26,4–32,4) e 1,7% (IC95%: 0,9–2,8) aos 1, 2 e 5 anos de idade, respectivamente. A razão de risco ajustada para preditores de cessação precoce do AM foi: sexo masculino = 1,23 (IC95%: 1,01–1,49), uso de chupeta na primeira semana de vida = 4,66 (IC95%: 2,99–7,26) e AME menor que 3 meses = 2,76 (IC95%: 1,64–4,66). CONCLUSÕES: A duração do AME e do AM continuado entre crianças amazônicas é consideravelmente menor do que as recomendações da Organização Mundial da Saúde. Preditores significativos das práticas de aleitamento materno devem ser considerados na avaliação das estratégias locais para alcançar práticas ideais de aleitamento materno.

ABSTRACT OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0–21.0%), 42.6% (38.0–47.2%), and 8.7% (6.3–11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7–45.8%) of the study children were anemic, 38.4% (34.6–42.3%) were iron-deficient, and 26.3 (23.0–29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6–15.2%), 18.1% (15.5–21.1%), and 4.1% (2.8–5.7%), respectively; at five years of age (n = 655), 5.2% (3.6–7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84–2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14–2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17–2.39), malaria since birth (2.25; 1.30–3.87), and iron deficiency (2.15; 1.47–3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.

RESUMO OBJETIVO: O objetivo deste estudo foi descrever a prevalência e os preditores de anemia na infância em um estudo de coorte de nascimentos de base populacional amazônica. MÉTODOS: Estimou-se a prevalência de anemia materna no parto (concentração de hemoglobina [Hb] < 110 g/L) em mulheres participantes do estudo de coorte de nascimentos MINA-Brasil e em seus filhos, examinados nas idades um, dois (Hb < 110 g/L) e cinco anos (Hb < 115 g/L). Além disso, as concentrações de ferritina, receptor solúvel de transferrina e proteína C reativa foram medidas em mães no parto e em seus filhos de 1 e 2 anos de idade para estimar a prevalência de deficiência de ferro e sua contribuição para anemia, ajustando para potenciais fatores de confusão por análise de regressão múltipla de Poisson (risco relativo ajustado [RRa]). RESULTADOS: As prevalências com intervalo de confiança (IC) de 95% de anemia materna, deficiência de ferro e anemia ferropriva no parto foram de 17,3% (14,0–21,0%), 42,6% (38,0–47,2%) e 8,7% (6,3–11,6%), respectivamente (n = 462). No primeiro ano de idade (n = 646), 42,2% (38,7–45,8%) das crianças estudadas eram anêmicas, 38,4% (34,6–42,3%) eram deficientes em ferro e 26,3 (23,0–29,9%) tinham anemia ferropriva. Aos dois anos de idade (n = 761), esses valores diminuíram para 12,8% (10,6–15,2%), 18,1% (15,5–21,1%) e 4,1% (2,8–5,7%), respectivamente; aos cinco anos de idade (n = 655), 5,2% (3,6–7,2%) eram anêmicos. A deficiência de ferro (RRa = 2,19, IC95%: 1,84–2,60) e consumo de alimentos ultraprocessados (AUP) (RRa = 1,56, IC95%: 1,14–2,13) foram contribuintes significantes para anemia no 1° ano de idade, após ajuste para escolaridade materna. Aos 2 anos, a anemia associou-se significativamente à anemia materna no parto (RRa = 1,67; IC95%: 1,17–2,39), malária desde o nascimento (2,25; 1,30–3,87) e deficiência de ferro (2,15; 1,47–3,15), após ajuste para idade das crianças e índice de riqueza familiar. CONCLUSÕES: A anemia continua sendo altamente prevalente durante a gravidez e a primeira infância na Amazônia. Políticas públicas de saúde devem abordar a deficiência de ferro, o consumo de AUP, a anemia materna e a malária para prevenir e tratar a anemia em crianças amazônicas.

ABSTRACT OBJECTIVE: To describe the frequency of behavioral problems and the internal consistency of the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in Amazonian preschool children during the covid-19 pandemic. METHODS: Data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon, were used. The SDQ-P was applied in 2021 at the five-year follow-up visit to parents or caregivers of 695 children (49.4% of which were girls). This instrument is a short behavioral screening questionnaire composed of 25 items reorganized into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Cases of behavioral problems were defined according to the original SDQ cut-offs based on United Kingdom norms. Moreover, cut off points were estimated based on the SDQ-P percentile results of our study sample. Internal consistency was assessed by calculating Cronbach's alpha coefficient and McDonald's omega for each scale. RESULTS: According to the cut-offs based on our studied population distribution, 10% of all children had high or very high total difficulty scores, whereas it was almost twice when the original SDQ cut-offs based on United Kingdom norms, were applied (18%). Differences were also observed in the other scales. Compared to girls, boys showed higher means of externalizing problem and lower means of prosocial behavior. The five-factor model showed a moderate internal consistency of the items for all scales (0.60 ≤ α ≤ 0.40), except for total difficulty scores, which it considered substantial (α > 0.61). CONCLUSIONS: Our results support the usefulness of SDQ in our study population and reinforce the need for strategies and policy development for mental health care in early life in the Amazon.

RESUMO OBJETIVO: Descrever a frequência de problemas de comportamento e a consistência interna da versão para os pais do Questionário de Capacidades e Dificuldades (SDQ-P) em crianças pré-escolares da Amazônia durante a pandemia de covid-19. MÉTODOS: Foram utilizados dados do estudo de saúde e nutrição Materno-Infantil no Acre (MINA-Brasil), uma coorte de nascimentos de base populacional na Amazônia Ocidental Brasileira. O SDQ-P foi aplicado aos pais e cuidadores em 2021 na visita de acompanhamento de cinco anos de 695 crianças (49,4% das quais eram meninas). Esse instrumento é um breve questionário de rastreamento comportamental composto por 25 itens reorganizados em cinco subescalas: sintomas emocionais, problemas de conduta, hiperatividade/desatenção, problemas de relacionamento com colegas e comportamento pró-social. Os casos de problemas de comportamento foram definidos de acordo com os pontos de corte originais do SDQ, baseados nas normas do Reino Unido. Além disso, os pontos de corte foram estimados com base nos percentis dos resultados do SDQ-P da amostra do nosso estudo. A consistência interna foi avaliada pelo cálculo do coeficiente alfa de Cronbach e ômega de McDonald para cada escala. RESULTADOS: De acordo com os pontos de corte baseados na distribuição da população estudada, 10% de todas as crianças apresentaram escores totais de dificuldade elevados ou muito elevados, o que quase dobrou quando os pontos de corte originais do SDQ, baseados nas normas do Reino Unido, foram utilizados (18%). Este estudo também encontrou diferenças nas demais escalas. Comparados às meninas, os meninos apresentaram maiores médias de problemas de externalização e menores médias de comportamento pró-social. O modelo de cinco fatores apresentou consistência interna dos itens moderada para todas as escalas (0,60 ≤ α ≤ 0,40), exceto para a escala de pontuação total de dificuldades, a qual foi considerada substancial (α > 0,61). CONCLUSÕES: Nossos resultados apoiam a utilidade do SDQ em nossa população de estudo e reforçam a necessidade de estratégias e desenvolvimento de políticas para o cuidado em saúde mental no início da vida na Amazônia.