Evaluation of the Happy Child Program: a randomized study in 30 Brazilian municipalities. / Avaliação do Programa Criança Feliz: um estudo randomizado em 30 municípios brasileiros.

The Happy Child Program (Programa Criança Feliz - PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at promoting neuropsychomotor development. Based on a conceptual model, PCF implementation and impact were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of whom were prospectively followed up from late 2018 to late 2021. Development was assessed by the Ages and Stages Questionnaire (ASQ3). During the three-year study period, visits were replaced by virtual contacts for an average of 12 months due to COVID-19. At the endline survey, intent-to-treat analyses showed mean scores of 203.3 in the IG and 201.3 in the CG. Additional analyses using instrumental variables and propensity scores matching also showed no effect, since the number of contacts with the program was not associated with ASQ3 scores. No impact was observed on stimulation, responsive interactions or psychological attributes of children. The implementation study revealed low coverage in the IG, contamination of the CG, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate an impact of PCF implemented under routine conditions, but provides elements for its improvement.

O Programa Criança Feliz (PCF) atinge 1,4 milhão de crianças brasileiras menores de três anos com visitas domiciliares visando o desenvolvimento neuropsicomotor. Com base em modelo conceitual, avaliou-se implementação e impacto do PCF em estudo randomizado, em 30 municípios. Ao todo 3.242 crianças foram alocadas para o grupo intervenção (GI) ou controle (GC), sendo 80,0% acompanhadas prospectivamente durante três anos. O desenvolvimento foi avaliado pelo Ages and Stages Questionnaire (ASQ3). Análises por intenção de tratar mostraram escores médios de 203,3 no GI e 201,3 no GC. Análises adicionais com variáveis instrumentais e emparelhamento por escores de propensão tampouco mostraram efeito, uma vez que o número de contatos recebidos não esteve associado aos escores ASQ3. Tampouco foi observado impacto sobre estimulação, interações responsivas ou atributos psicológicos das crianças. As visitas foram interrompidas durante 12 meses devido à COVID-19, sendo substituídas por contatos virtuais. O estudo de implementação revelou baixa cobertura no GI, contaminação do GC, deficiências na gestão e baixa qualidade das visitas em muitos municípios. O estudo não demonstrou impacto do PCF implementado sob condições de rotina e fornece elementos para seu aprimoramento.

Depression and anxiety among the University community during the Covid-19 pandemic: a study in Southern Brazil.

This study aimed to assess the mental health of a University community in South Brazil during the COVID-19 pandemic. A cross-sectional web-based survey was conducted between July-August 2020 through a self-administered questionnaire. All University staff and students were eligible. Depression was measured using the Patient Health Questionnaire-9 and anxiety by the Generalized Anxiety Disorder-7. To evaluate the effect of social distancing and mental health factors on outcomes, Poisson regression models with robust variance were performed, estimating Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI). 2,785 individuals participated in the study. Prevalence of depression and anxiety were 39.2% (95%CI 37.3-41.1) and 52.5% (95% CI 50.6-54.4), respectively. Undergraduate students showed a higher prevalence of the outcomes. Not leaving the house routinely, mental health care, and previous diagnosis of mental illness were associated with both outcomes. Those with a previous medical diagnosis of depression had a 58% (PR 1.58; 95%CI 1.44; 1.74) and anxiety a 72% (PR 1.72; 95%CI 1.56; 1.91) greater prevalence of depression than their peers. An alarming prevalence of psychopathologies was observed. Despite the well-known benefits of social distancing to public health, it requires a surveillance on the population's mental health, especially students and those with previous mental illness diagnosis.

[Impact of social distancing on reports of violence against children and adolescents in Rio Grande do Sul, Brazil]. / Impacto do distanciamento social nas notificações de violência contra crianças e adolescentes no Rio Grande do Sul, Brasil.

This study aimed to analyze the rates of reports of violence against children and adolescents in the state of Rio Grande do Sul, Brazil, from 2015 to 2020, and the changes in trends by period due to the novel coronavirus pandemic (COVID-19). This is an ecological time series study with secondary data obtained from the Bi Saúde Portal in the panel on Interpersonal Violence and Suicide. The study collected reports on violence in individuals 0 to 19 years of age in the months of March and April each year, stratified by sex, age bracket, race/color, and type of violence. Prais-Winsten regression was used to analyze the time trend. Of the 7,718 reports analyzed, there was a drop of 54% in the year 2020 compared to the same period in 2019. The analysis of the trend until 2019 indicated an increase in the reporting rates (2.04, 95%CI: 1.01; 3.07, p = 0.002), but with the inclusion of the year 2020 in the time series, the direction of the trends in reporting rates was reversed to negative, losing statistical significance (-0.39, 95%CI: -1.16; 2.14, p = 0.632). The study concludes that social distancing due to the pandemic reduced the reporting rates of violence against children and adolescents due to underreporting, thus requiring strategies to improve the identification of suspected cases of violence during the pandemic. This highlights the need for inter-sector planning and rapid and specific actions (health, social protection, justice, and public security) in order to guarantee the rights of children and adolescents.

O objetivo do estudo foi analisar as taxas de notificações de violência infanto-juvenil no Estado do Rio Grande do Sul, Brasil, de 2015 a 2020 e as alterações em suas tendências por períodos devido à pandemia do novo coronavírus (COVID-19). É um estudo ecológico de séries temporais com dados secundários obtidos pelo Portal Bi Saúde no painel de Violência Interpessoal/Suicídio. Foram coletadas as notificações de violência em indivíduos de 0 a 19 anos, nos meses de março e abril de cada ano, estratificadas por sexo, faixa etária, raça/cor e tipo de violência. Utilizou-se a regressão de Prais-Winsten para a análise de tendência temporal. Das 7.718 notificações analisadas, observou-se uma queda de 54% no ano de 2020 comparado com o mesmo período em 2019. A análise de tendência até 2019 indicou aumento nas taxas de notificações (2,04, IC95%: 1,01; 3,07, p = 0,002), porém, com a inclusão do ano de 2020 à série temporal, o direcionamento na tendência das taxas de notificações inverteu-se para negativo, perdendo a significância estatística (-0,39, IC95%: -1,16; 2,14, p = 0,632). Conclui-se que o distanciamento social devido à pandemia reduziu as taxas de notificações de violência contra crianças e adolescentes devido à subnotificação, exigindo estratégias que melhorem a identificação dos casos suspeitos de violência durante a pandemia. Ressalta-se a necessidade de planejamento e ações intersetoriais (como saúde, proteção social, justiça e segurança pública) rápidas e específicas com o objetivo da garantia dos direitos das crianças e dos adolescentes.

El objetivo del estudio fue analizar las tasas de notificaciones de violencia infanto-juvenil, en el estado de Río Grande do Sul, Brasil, de 2015 a 2020, y las alteraciones en sus tendencias por períodos, debido a la pandemia del nuevo coronavirus (COVID-19). Es un estudio ecológico de series temporales con datos secundarios, obtenidos mediante el Portal Bi Saúde, en la sección de Violencia Interpersonal/Suicidio. Se recogieron las notificaciones de violencia en individuos de 0 a 19 años, durante los meses de marzo y abril de cada año, estratificadas por sexo, franja de edad, raza/color y tipo de violencia. Se utilizó la regresión de Prais-Winsten para el análisis de tendencia temporal. De las 7.718 notificaciones analizadas, se observó una caída de un 54% en el año 2020, comparado con el mismo período en 2019. El análisis de tendencia hasta 2019 indicó un aumento en las tasas de notificaciones (2,04, IC95%: 1,01; 3,07, p = 0,002), no obstante, con la inclusión del año de 2020 en la serie temporal, la dirección en la tendencia de las tasas de notificaciones se invirtió en negativo, perdiendo la significación estadística (-0,39, IC95%: -1,16; 2,14, p = 0,632). Se concluye que el confinamiento social, debido a la pandemia, redujo las tasas de notificaciones de violencia contra niños y adolescentes, a causa de la subnotificación, lo que exige estrategias que mejoren la identificación de los casos sospechosos de violencia durante la pandemia. Se resalta la necesidad de planificación y acciones intersectoriales como: salud, protección social, justicia y seguridad pública, rápidas y específicas, con el objetivo de garantizar los derechos de los niños y adolescentes.

Impact of social distancing on reports of violence against children and adolescents in Rio Grande do Sul, Brazil

This study aimed to analyze the rates of reports of violence against children and adolescents in the state of Rio Grande do Sul, Brazil, from 2015 to 2020, and the changes in trends by period due to the novel coronavirus pandemic (COVID-19). This is an ecological time series study with secondary data obtained from the Bi Saúde Portal in the panel on Interpersonal Violence and Suicide. The study collected reports on violence in individuals 0 to 19 years of age in the months of March and April each year, stratified by sex, age bracket, race/color, and type of violence. Prais-Winsten regression was used to analyze the time trend. Of the 7,718 reports analyzed, there was a drop of 54% in the year 2020 compared to the same period in 2019. The analysis of the trend until 2019 indicated an increase in the reporting rates (2.04, 95%CI: 1.01;3.07, p = 0.002), but with the inclusion of the year 2020 in the time series, the direction of the trends in reporting rates was reversed to negative, losing statistical significance (-0.39, 95%CI: -1.16;2.14, p = 0.632). The study concludes that social distancing due to the pandemic reduced the reporting rates of violence against children and adolescents due to underreporting, thus requiring strategies to improve the identification of suspected cases of violence during the pandemic. This highlights the need for inter-sector planning and rapid and specific actions (health, social protection, justice, and public security) in order to guarantee the rights of children and adolescents.