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O matriciamento em saúde mental como forma de dispersão de saber

Mon, 23 Mar 2026 00:00:00 GMT

Title: O matriciamento em saúde mental como forma de dispersão de saber Abstract: Introduction: Matrix support in mental health, as a technical-political device of the Brazilian Unified Health System, is grounded in the perspective of the horizontal dispersion of knowledge, articulating Primary Health Care and Psychosocial Care Centers within a logic of shared responsibility. In light of the Brazilian Health Reform and Psychiatric Reform, matrix support seeks to overcome the physician-centered and fragmented model, fostering comprehensive care, territorialization of practices, and strengthening local resolvability. However, the normative institutionalization of matrix support does not ensure its concrete implementation within territories, making critical analysis of its occurrence, organization, and professionals’ understanding within Primary Health Care necessary. Objectives: To evaluate the occurrence of the matrix support process in mental health within Primary Health Care in the Baixada Santista region, its organizational forms, and the understanding of the professionals involved regarding the theme. Method: This is a cross-sectional study with a mixed analytical approach, conducted with Primary Care professionals from the municipalities of Cubatão, Santos, and São Vicente. The estimated sample comprised 240 participants, based on probabilistic calculation with a 5% significance level and 80% statistical power. A self-administered questionnaire developed by the researcher was used, consisting of structured questions to construct the variables 'level of knowledge about matrix support' and 'perceived effectiveness of matrix support,' as well as semi-structured questions subjected to thematic analysis. Association tests between variables were performed, alongside qualitative analysis of narratives concerning participation in care, barriers, and perceptions related to mental health. Results: Heterogeneity was observed in the occurrence and organization of matrix support across units, with distinctions related to the organizational model. An association was identified between greater knowledge about matrix support and higher perceived effectiveness, suggesting a dynamic feedback relationship between knowledge and practice. Qualitative narratives indicated that participation in mental health care does not automatically derive from the formal existence of matrix support, but rather from the internalization of the comprehensive care model. Discourses marked by technical insecurity, persistence of biomedical references, and the presence of stigma emerged, in addition to reports of structural limitations and weaknesses in network articulation. Conclusion: Matrix support proved to be more than an organizational strategy, configuring itself as an ethical-political device capable of challenging traditional models of care. Its consolidation requires continuous investment in professional training, organizational regularity, and integration with Permanent Health Education policies. The interrelationship between knowledge and perceived effectiveness indicates that strengthening knowledge enhances practice, while effective experiences expand collective learning. Despite methodological limitations, the findings contribute to Public Health by reaffirming matrix support as a concrete expression of SUS principles and as an instrument for qualifying mental health care within Primary Health Care. Type: Tese

Análise espacial e temporal da cobertura vacinal contra a poliomielite nas cidades brasileiras de fronteira entre 2016-2024

Thu, 18 Sep 2025 00:00:00 GMT

Title: Análise espacial e temporal da cobertura vacinal contra a poliomielite nas cidades brasileiras de fronteira entre 2016-2024 Abstract: Introduction: Vaccination is one of the most effective strategies for controlling vaccine-preventable diseases, reducing the transmission of infectious agents, preventing severe disease forms, and eradicating pathologies. Its importance for Public Health lies in contributing to disease control and elimination. However, the decline in polio vaccination coverage in Brazil poses a significant risk of virus reintroduction, given that rates remain below the target (95%) recommended by the Ministry of Health and the World Health Organization. Objective: To analyze the spatiotemporal dynamics of polio vaccination coverage in Brazilian border cities between 2016 and 2024. Methods: A mixed ecological study was conducted using publicly available secondary data. Data on administered doses were extracted from the National Immunization Program Information System, while live birth records were obtained from the Live Birth Information System of the Unified Health System’s Department of Informatics. Vaccination coverage (VC) was calculated by dividing the number of administered doses by the number of live births, multiplied by 100. Descriptive analyses, Kruskal-Wallis tests, Dunn’s multiple comparisons, and Mann-Whitney U tests were performed. Spatial analyses were conducted using Global and Local Moran’s indices. Statistical analyses were performed using SPSS 24.0 and QGIS 3.10, with a significance level of 5%. Results: Significant differences in VC were observed across study years (Kruskal-Wallis test,*p*< 0.001). Dunn’s post-hoc test indicated that 2016 had the highest VC compared to other years (*p* < 0.05). Although VC increased in 2022 and 2023 relative to 2021, it remained below the 95% target (*p*< 0.001). By 2024, VC recovered, surpassing 95% and differing significantly from 2021, 2022, and 2023 (*p*< 0.001). In most study years, VC in twin cities was lower than in non-twin cities (*p*< 0.05). Positive global spatial autocorrelation was detected throughout the study period. Spatial analysis of polio VC across 590 Brazilian border municipalities revealed significant variations in coverage distribution from 2016 to 2024. Conclusion: This study situates itself at the forefront of research by proposing a novel binational intervention model for border regions, gap identified by PAHO (2023). The findings not only replicate but expand the existing literature, providing an analytical framework for future health research in Brazilian border areas. Type: Tese

Análise espacial e fatores de risco da cobertura vacinal de crianças de 0 até 2 anos moradoras na Região Metropolitana da Baixada Santista

Thu, 30 Jan 2025 00:00:00 GMT

Title: Análise espacial e fatores de risco da cobertura vacinal de crianças de 0 até 2 anos moradoras na Região Metropolitana da Baixada Santista Abstract: Introduction: The National Immunization Program is a global reference in preventing diseases and combating child mortality, being an essential strategy to guarantee a healthy population. Objectives: To spatially analyze the vaccination coverage of children aged 0 to 2 years and identify the risk factors for non-vaccination in the Met-ropolitan Region of Baixada Santista (RMBS). Method: These are two epidemiologi-cal studies. The first is an ecological study with a mixed approach, which used public domain secondary data. The second consists of a cross-sectional study, based on primary data obtained through a population survey carried out at RMBS. Results: The analysis, which used maps as an essential tool for dynamic understanding and decision-making in health, revealed a significant drop in vaccination rates in RMBS municipalities in 2020, especially due to the COVID-19 pandemic. In some regions, rates were below 50%. Factors such as the lack of clear information about vaccines, distrust in the health system and logistical barriers, including inadequate opening hours of health units and lack of vaccines, contributed to this reduction. The research showed that, when health professionals do not inform about the vaccine adminis-tered, the probability of the child not being up to date with vaccinations is 2.55 times greater. Furthermore, the pandemic increased the chance of vaccines being delayed by 3.42 times. Conclusion: The spatial analysis of vaccination coverage in munici-palities is essential to identify geographic inequalities and guide strategic interven-tions. Mapping regions with low vaccine adherence allows us to correlate social, eco-nomic, environmental and health factors, such as access to services, educational levels and local infrastructure. This facilitates the creation of more effective public policies, in addition to enabling continuous monitoring of vaccination rates, evaluating the effectiveness of campaigns and adjusting strategies according to the needs of the most vulnerable areas. The analysis of difficulties in accessing health services, based on self-reported information, highlights barriers perceived by the population, such as lack of information, distance to health posts and lack of trust in the health system. This data is essential to understand the reasons that lead to non-compliance with the vaccination schedule, identifying specific groups that face greater challenges, such as residents of rural areas or outskirts. This understanding allows for the adaptation of vaccination and health education strategies, promoting greater inclusion and en-suring equitable access to vaccines for all. Type: Tese

Análise espacial da cobertura vacinal em crianças com até 12 meses de idade no estado do Rio de Janeiro entre 2016 a 2021

Wed, 04 Sep 2024 00:00:00 GMT

Title: Análise espacial da cobertura vacinal em crianças com até 12 meses de idade no estado do Rio de Janeiro entre 2016 a 2021 Abstract: Introduction: Immunization has a reduced cost when compared to health benefits, representing one of the most effective public policies, and a valuable tool in public health to prevent diseases preventable by immunization, second only to public policies related to basic hygiene and drinking water supply with regard to disease prevention. Objective: Spatial analysis of vaccination coverage of children up to 12 months of age in the state of Rio de Janeiro between 2016 and 2021. Methods: This is a mixed ecological study using secondary data in the public domain. Information on the doses administered was obtained through the National Immunization Program Information System (SI-PNI), while data on births were collected from the Live Birth Information System (SINASC) of the database of the informatics department of the Unified Health System. Information on socioeconomic and environmental data and thematic cartography were obtained from the Brazilian Institute of Geography and Statistics for public access. Information on prenatal coverage was obtained from the Observatory of Children and Adolescents, also with public access. Vaccination coverage (VC) was calculated considering the number of doses administered in the numerator and the live births multiplied by 100 in the denominator. VC was calculated based on immunobiologicals, and stratified according to the definition of the PNI into four categories. The homogeneity of vaccination coverage (HCV) was calculated taking into account the number of adequate vaccines in the numerator and the total number of adequate vaccines for children up to 12 months of age, multiplied by 100. HCV was considered adequate, according to the COAP criterion, if HCV greater than or equal to 75%. Descriptive analysis of all variables was performed, and the Kruskal-Wallis test and Dunn's multiple comparisons were performed. To identify factors related to inadequate HCV, the bivariate and multiple logistic regression model was used. Spatial analysis was performed using Moran's statistics. The level of significance adopted was 5% for all analyses. Result: In 2016, the best vaccination coverage was observed in the entire state of Rio de Janeiro. It is observed that vaccination coverage for BCG remained with high coverage until 2018, with a decrease from 2019 onwards (p<0.001). Hepatitis B 29 had a high coverage rate in 2016, in 2017 coverage began to fall, the year with the lowest coverage rate was 2019 (p<0.001), poliomyelitis dropped in 2017, with the worst index in 2021 (p<0.001), HIB dropped from 2017, with the worst rate in 2021 (p<0.001), DPT dropped in 2017 and its worst coverage was in 2019 (p<0.001). The analysis of the spatial dynamics of BCG vaccination coverage (VC) over the years of study for the state of Rio de Janeiro. During the pandemic, the chance of having inadequate HCV is almost 5 times higher than before the pandemic; and the regions of Center-South Fluminense and Middle Paraíba are places with the best CV. It is observed that from 2019 onwards there is a drop in the levels of adequate VC for all vaccines in the vaccination schedule of children up to 12 months of age, with low and very low VC prevailing, especially in the years 2020 and 2021 (p<0.001). Conclusion: This study highlights the importance of efficient public policies that contribute to increasing vaccination coverage as recommended by the National Immunization Program. Type: Tese