Matrix Support in Mental Health: Achievements and Limits in Primary Health Care

Changes in mental health care in the city of Fortaleza (Northeastern Brazil) have a recent historical and political process. Compared to other municipalities of the State of Ceara, which in the early 1990s were already pioneers in the process, Fortaleza has not implemented the changes due to the interests of psychiatric hospitals, of psychiatric outpatient clinics of the public network, and because of the difficulty in managing the new mental health devices and equipment present in Primary Care. In the municipality, the reorganization of mental health actions and services has required that the Primary Care Network faces the challenge of assisting mental health problems with the implementation of Matrix Support. In light of this context, we aimed to evaluate Matrix Support in mental health in Primary Care Units and to identify achievements and limitations in the Primary Care Units with Matrix Support. This study used a qualitative approach and was carried out by means of a case study. We interviewed twelve professionals from the Family Health Teams of four Units with implemented Matrix Support. The analysis of the information reveals that access, decision making, participation and the challenges of implementing Matrix Support are elements that are, in a dialectic way, weak and strong in the reorganization of services and practices. The presence of Matrix Support in Primary Care highlights the proposal of dealing with mental health within the network in the municipality. The process has not ended. Mobilization, awareness-raising and qualification of Primary Care have to be enhanced constantly, but implementation has enabled, to the service and professionals, greater acceptance of mental health in Primary Care.

Family Health Support Centers: challenges and opportunities from the perspective of primary care professionals in the city of Sao Paulo, Brazil

Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of Sao Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policy-makers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area.

Predicting clinical response to anticancer drugs using an ex vivo platform that captures tumour heterogeneity

Predicting clinical response to anticancer drugs remains a major challenge in cancer treatment. Emerging reports indicate that the tumour microenvironment and heterogeneity can limit the predictive power of current biomarker-guided strategies for chemotherapy. Here we report the engineering of personalized tumour ecosystems that contextually conserve the tumour heterogeneity, and phenocopy the tumour microenvironment using tumour explants maintained in defined tumour grade-matched matrix support and autologous patient serum. The functional response of tumour ecosystems, engineered from 109 patients, to anticancer drugs, together with the corresponding clinical outcomes, is used to train a machine learning algorithm; the learned model is then applied to predict the clinical response in an independent validation group of 55 patients, where we achieve 100% sensitivity in predictions while keeping specificity in a desired high range. The tumour ecosystem and algorithm, together termed the CANScript technology, can emerge as a powerful platform for enabling personalized medicine.

Physical volcanology, sedimentology, stratigraphy and petrochemistry of the Berry Creek metavolcanics: an Archean calc-alkaline complex, Lake of the Woods, Ontario

The steeply dipping, isoclinally folded early Precambrian (Archean) Berry Creek Metavolcanic Complex comprises primary to resedimented pyroclastic, epiclastic and autoclastic deposits. Tephra erupted from central volcanic edifices was dumped by mass flow mechanisms into peripheral volcanosedimentary depressions. Sedimentation has been essentially contemporaneous with eruption and transport of tephra. The monolithic to heterolithic tuffaceous horizons are interpreted as subaerial to subaqueous pumice and ash flows, secondary debris flows, lahars, slump deposits and turbidites. Monolithic debris flows, derived from crumble breccia and dcme talus, formed during downslope collapse and subsequent gravity flowage. Heterolithic tuff, lahars and lava flow morphologies suggest at least temporary emergence of the edifice. Local collapse may have accompanied pyroclastic volcanism. The tephra, produced by hydromagmatic to magmatic eruptions, were rapidly transported, by primary and secondary mechanisms, to a shallow littoral to deep water subaqueous fan developed upon the subjacent mafic metavolcanic platform. Deposition resulted from traction, traction carpet, and suspension sedimentation from laminar to turbulent flows. Facies mapping revealed proximal (channel to overbank) to distal facies epiclastics (greywackes, argillite) intercalated with proximal vent to medial fan facies crystal rich ash flows, debris flows, bedded tuff and shallow water to deep water lava flows. Framework and matrix support debris flows exhibit a variety of subaqueous sedimentary structures, e.g., coarse tail grading, double grading, inverse to normal grading, graded stratified pebbly horizons, erosional channels. Pelitic to psammitic AE turbidites also contain primary stru~tures, e.g., flames, load casts, dewatering pipes. Despite low to intermediate pressure greenschist to amphibolite grade metamorphism and variably penetrative deformation, relicts of pumice fragments and shards were recognized as recrystallized quartzofeldspathic pseudomorphs. The mafic to felsic metavolcanics and metasediments contain blasts of hornblende, actinolite, garnet, pistacitic epidote, staurolite, albitic plagioclase, and rarely andalusite and cordierite. The mafic metavolcanics (Adams River Bay, Black River, Kenu Lake, Lobstick Bay, Snake Bay) display _holeiitic trends with komatiitic affinities. Chemical variations are consistent with high level fractionation of olivine, plagioclase, amphibole, and later magnetite from a parental komatiite. The intermediate to felsic (64-74% Si02) metavolcanics generally exhibit calc-alkaline trends. The compositional discontinuity, defined by major and trace element diversity, can be explained by a mechanism involving two different magma sources. Application of fractionation series models are inconsistent with the observed data. The tholeiitic basalts and basaltic andesites are probably derived by low pressure fractionation of a depleted (high degree of partial melting) mantle source. The depleted (low Y, Zr) calc-alkaline metavolcanics may be produced by partial melting of a geochemically evolved source, e.g., tonalitetrondhjemite, garnet amphibolite or hydrous basalt.

Nervos: rede de discursos e práticas de cuidado na atenção básica no município de Natal/RN

The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter

Estratégias de cuidado integral à saúde: os CAPS no processo de implementação do apoio matricial em Natal/RN

This study aims to analyzing the implementation of the Matrix Support proposal with professionals of Substitutive Services in Mental Health in the city of Natal/RN. The Matrix Support (MS) is an institutional arrangement which has been recently adopted by the Health Ministry, as an administrative strategy, for the construction of a wide care net in Mental Health, deviating the logic of indiscriminate follow-through changed by one of co-responsibility. In addition to this, its goal is to promote a major resolution as regards health assistance. Integral attention, as it is intended by the unique health system, may be reached by means of knowledge and practices interchange, establishing an interdisciplinary work logic, through an interconnected net of health services. For the accomplishment of this study, individual interviews of semi-structured character were used as instrument, with the coordinators and technical staff of the CAPs. The data collection was done in the following services: CAPS II ( East and West) and CAPS ad ( North and East), in the city of Natal/RN. The results point out that the CAPs to initiate of the discussion the process in the implementation of the MS aiming, to promote the reorganization and redefinition of the flow in the net, thus not acting in a fragmented way. Nevertheless, there is no effective articulation concerning the basic attention services, there is a major focus of the attention in mental health on the specialized services, little insertion in the territory and in the everyday life of the community

O fazer do psicólogo no núcleo de apoio à saúde da família

The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care

PALEOCLIMATIC CONTROLS ON STABLE OXYGEN AND CARBON ISOTOPES IN CALICHE OF THE ABO FORMATION (PERMIAN), SOUTH-CENTRAL NEW-MEXICO, USA

The stable oxygen and carbon isotopic composition of caliche in fluvial and supratidal rocks of the Abo Formation (Permian), south-central New Mexico, is controlled by palecoclimate and depositional environment. Fluvial caliche consists of low-Mg calcite nodules and vertically oriented tubules that display stage II texture. Micrite matrix support, brecciation, ooids/pisoliths, aveolar-septal texture, and peloids are common in the fluvial caliche and, along with red color and slickensides in the host shale, indicate pedogenesis in a well-oxidized vadose zone. In contrast, periodic waterlogging of the supratidal paleosols, probably due to high water table, is indicated by drab colors, carbonaceous flecks, horizontal rhizoliths, and the paucity of vadose textures in the stage II caliche nodules.Stable oxygen isotopes are similar in the fluvial and supratidal caliches and range from 21.6 to 30.5 parts per thousand (SMOW). The data exhibit a crude bimodality and delta-O-18 enrichment with a decrease in age (higher in the section). Consideration of these data in the context of delta-temperature relations suggests that 1) surface waters responsible for caliche formation increased in delta-O-18 (from roughly -8 to + 1 parts per thousand) over the 18 m.y. time interval that separated the lowest stratigraphic nodule horizon from the highest, 2) the increasing delta-O-18 values also reflect a warming trend (approximately 15-degrees to nearly 30-degrees-C) in the mean monthly temperature over this same time period, with perhaps an associated increase in Permian ocean temperatures, and 3) the significant variation in delta-O-18 from oldest to youngest caliche was probably enhanced by the amount effect, such that as the temperature increased, the amount of precipitation decreased, resulting in high delta-O-18 values.Caliches in the Abo are enriched in heavy carbon (-7.2 to -1.5 part per thousand PDB) compared to that of soil carbonate derived exclusively from C3 plants (-12 part per thousand PDB), and the supratidal caliches contain somewhat heavier carbon compared to the fluvial caliche. The delta-C-13 values for both environments increase with a decrease in caliche age. These results indicate that as the temperature increased and rainfall decreased with time, the level of C3 plant productivity apparently declined, allowing a greater influx of atmospheric CO2 into the soil. This can only occur when soil respiration rates are quite low or at very shallow depths (less than 10 cm), or both. Atmospheric CO2 seems to have invaded the supratidal soils to a somewhat greater extent than the fluvial soils.

Representação social em saúde mental na perspectiva de médicos generalistas da ESF na cidade de Diadema-SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Tratamento de efluentes provenientes de abatedouro de bovinos por meio de reator enzimático seguido de reator aeróbio operado em bateladas sequenciais

Brazil has one of the largest cattle herds in the world, so the cattle slaughter is one of the most important economic activities in the Brazilian market. But this activity requires a high demand of water, resulting in serious problems about the correct disposal of wastewater generated in the process. This effluent has a high pollution load, becoming its receiving bodies (streams and rivers) unfit for various activities such as public water supply, recreation, fisheries. To minimize the environmental impacts of its industrial wastewater and fallow the local environmental legislation, refrigerators must make the treatment of these effluents. This study aimed to verify the efficiency of a enzymatic reactor, when occur hydrolysis of lipids present in the effluent industrial of an cattle slaughter industry. The treatment system used was composed of two separate reactors: one being the anaerobic fluidized bed reactor (AFBR), inoculated with immobilized enzymes on the matrix support, and the other by sequential batch reactor (SBR) inoculated with activated sludge. Whereas, the reactors have been developed and installed at the Wastewater Treatment Laboratory, Faculdade de Ciências e Tecnologia, UNESP, campus Presidente Prudente. The procedure operating occurred differently for each reactor: preparation and inoculation of enzyme granules, filling the reactor, hydrolysis, and AFBR emptying, filling, aerobic reaction, sedimentation, and emptying the SBR. We performed three experimental stages, with the first and second stage of the work were done reactor analyzes separately, and the third step of the analysis were made with the interconnected reactors... (Complete abstract electronic access below)

Planejamento, implantação e gestão de um curso a distância a partir da percepção dos enfermeiros da atenção básica sobre a integralidade na saúde

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Apoiador matricial: uma possibilidade de promover a interdisciplinaridade entre profissionais da saúde

This study aims to reflect the organization of the mental health services in primary care from a new organizational arrangement to health work, defined as Matrix Support (Campos, 1999), which aims to build technical and educational support in the relationship between health professionals from mental health professionals in the Family Health Strategy. The methodology used in the Matrix Support the “Wheel” method, which is mediated by a supporter who, through questions and reflections, points out possibilities for case discussions, promotes links between the health teams, discusses the concept of link between professionals and users, strengthens the co-responsability for the actions of health and tries to break the logic related with the services organized by referrals. So the wheels when they occur in health services enables the interdisciplinary, and through it, it is expected to talk about the complexity of the phenomena that surround each subject, so that they overcome the dichotomy between individual and collective, social and biological revealing new values to be incorporated into health practices. In front of this analysis that is theoric and conceptual, allied with the experience from a nursisn area professional that worked in this work method, can be concluded that this experience related here, eas strategic for the health care actions for strengthen based on the Unique Health system and Psych Rebuild principles.

O apoio institucional como uma das faces da função apoio no Núcleo de Apoio à Saúde da Família (NASF): para além das diretrizes

The aim of this study was to add to the debate about Family Health Support Centers (FHSCs), starting from reflections about the support function. Support is generally presented, in official documents from the Ministry of Health and in academic-scientific publications, accompanied by descriptors that characterize it. Differences in terminology are commonly encountered: “institutional support”, “managerial support”, “matrix support” and so on. With regard to FHSCs, published papers have highlighted the central role played by matrix support. However, we pose the question: what are the faces that the support function has been taking on in implementing such programs? To reflect on this and other issues, we developed a study of qualitative nature within a FHSC team in Paraná, outside of the state capital, using the methodological tools of participant observation, semi-structured interviews and discussion groups. We sought to demonstrate that the dynamics of the support function in FHSCs make it possible for both matrix support and institutional support to emerge.

Estratégia saúde da família e adolescência: as necessidades de cuidados e recursos utilizados em saúde mental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise molecular do subcomplexo Brasiliensis (Hemiptera, Triatominae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)