Spatial analysis of vaccine coverage in children under the age of 1 year by mesoregions in Paraíba a northeastern Brazilian state.

Immunization is one of the most effective measures in public health, and it is responsible for the reduction of vaccine-preventable diseases. In the present study, vaccine coverage (VC) and the spatial dynamics of homogeneity of VC (HVC) were compared and analyzed in the terms of the immunobiologicals administered to children aged < 1 year in a state in Paraíba, Brazil. This is a mixed ecological study that used public-domain secondary data from the years 2016 and 2017 from the Information System of the Brazilian National Immunization Program (SI-PNI) and the Brazilian National Information System of Live Births (SINASC). VC rates were calculated by dividing the number of administered doses by the number of live births. Then, VC was classified into four categories. The Municipal HVC was considered adequate when the overall VC exceeds 75%. The study included a descriptive analysis and a spatial autocorrelation analysis for HVC using global and local Moran's statistics. The stratified VC analysis revealed a significant number of municipalities in each of the state's mesoregions with low or very low VC rates for all immunobiologicals, with the Mata Paraibana mesoregion having the worst percentages in both years studied. The spatial analysis of HVC revealed several clusters of inadequate homogeneity, with Mata Paraibana being the worst mesoregion in 2016. The analysis of spatial dynamics and spatial statistics techniques allows the precise identification of vulnerable areas, "vaccination pockets," making it possible to develop plans aimed at meeting the targets of the PNI.

Say it right: measuring the impact of different communication strategies on the decision to get vaccinated.

BACKGROUND: Vaccine hesitancy is a concerning menace to the control of vaccine-preventable diseases. Effective health communication could promote an overall understanding of the importance, risks, and benefits of vaccination and reduce vaccine hesitancy. METHODS: In this survey, four fictitious newspaper articles addressing an emerging bogus disease and its vaccine were randomly assigned to participants. The first version focused on information about the disease; the second was akin to the first, including a case description and image. The third version focused on vaccine safety/efficacy; the fourth version was like the third, including a case description and image. After reading a single version of the article, participants responded if they would take the vaccine and if they would vaccinate their children. We used chi-squared tests for comparisons and investigated interactions with vaccine-hesitant attitudes. RESULTS: We included 5233 participants between August/2021 and January/2022; 790 were caregivers of a child ≤ 5 years old, and 15% had prior vaccine hesitancy. Although most declared intention to take the vaccine, the percentage was highest among those exposed to the newspaper article focusing on the vaccine safety/efficacy with the case description and picture (91%; 95% confidence interval 89-92%), and lowest among participants exposed to the article focusing on the disease with no case description (84%; 95% confidence interval 82-86%). Similar trends were observed in the intention of offspring vaccination. We found evidence of effect modification by vaccine-hesitant attitudes, with a higher impact of communication focusing on vaccine safety/efficacy compared to that focusing on disease characteristics among hesitant participants. CONCLUSION: Communication strategies focusing on different aspects of the disease-vaccine duet may impact vaccine hesitancy, and storytelling/emotive imagery descriptions may improve risk perception and vaccine uptake. Moreover, the effect of message framing strategies may differ according to previous vaccine hesitant attitudes.

Spatial analysis of measles vaccination coverage in the State of São Paulo.

BACKGROUND: Measles is a contagious viral disease that seriously affects children. The measles vaccine is widely recommended in Brazil and in the world; however, the disease remains relevant for the health authorities. The aim of the present study was to evaluate first and second dose of measles vaccine coverage (VC) in the cities of São Paulo and its spatial dynamics between 2015 and 2020. METHOD: In this mixed-type ecological study, we used secondary, public domain data from 2015 to 2020, extracted from the Digital Information System of the National Immunization Program, Mortality Information System and the National Live Birth Information System. After calculating the VC, the following four categories were created: very low, low, adequate, and high, and the spatial autocorrelation of VC was analyzed using the Global and Local Moran's statistics. RESULTS: A steady decline in adherence to the vaccination was observed, which dynamically worsened until 2020, with a high number of cities fitting the classification of ineffective coverage and being potentially harmful to the effectiveness of the immunization activities of their neighbors. CONCLUSION: A direct neighborhood pattern was observed between the units with low vaccination coverage, which implied that the reduction in measles VC was somehow related to and negatively influenced by the geographic location and social culture of these areas.

Say it right: measuring the impact of different communication strategies on the decision to get vaccinated

Background Vaccine hesitancy is a concerning menace to the control of vaccine-preventable diseases. Effective health communication could promote an overall understanding of the importance, risks, and benefits of vaccination and reduce vaccine hesitancy. Methods In this survey, four fictitious newspaper articles addressing an emerging bogus disease and its vaccine were randomly assigned to participants. The first version focused on information about the disease; the second was akin to the first, including a case description and image. The third version focused on vaccine safety/efficacy; the fourth version was like the third, including a case description and image. After reading a single version of the article, participants responded if they would take the vaccine and if they would vaccinate their children. We used chi-squared tests for comparisons and investigated interactions with vaccine-hesitant attitudes. Results We included 5233 participants between August/2021 and January/2022; 790 were caregivers of a child ≤ 5 years old, and 15% had prior vaccine hesitancy. Although most declared intention to take the vaccine, the percentage was highest among those exposed to the newspaper article focusing on the vaccine safety/efficacy with the case description and picture (91%; 95% confidence interval 89–92%), and lowest among participants exposed to the article focusing on the disease with no case description (84%; 95% confidence interval 82–86%). Similar trends were observed in the intention of offspring vaccination. We found evidence of effect modification by vaccine-hesitant attitudes, with a higher impact of communication focusing on vaccine safety/efficacy compared to that focusing on disease characteristics among hesitant participants. Conclusion Communication strategies focusing on different aspects of the disease-vaccine duet may impact vaccine hesitancy, and storytelling/emotive imagery descriptions may improve risk perception and vaccine uptake. Moreover, the effect of message framing strategies may differ according to previous vaccine hesitant attitudes.

Spatial analysis of vaccine coverage on the first year of life in the northeast of Brazil.

BACKGROUND: Over time, vaccination has been consolidated as one of the most cost effective and successful public health interventions and a right of every human being. This study aimed to assess the spatial dynamics of the vaccine coverage (VC) rate of children aged < 1 year per municipality in the Brazilian Northeast at 2016 and 2017. METHODS: This is a mixed-type ecological study that use a Public domain data Health Information. Vaccine doses were obtained from the Information System of the Brazilian National Immunization Program, and live births from the Brazilian Information System of Live Births of the Brazilian Unified Health System. Descriptive analysis of the coverage of all the vaccines for each year of the study was conducted, and Mann-Whitney U test was used to compare VC between the study years. Chi-squared test was used to evaluate the association between the years and VC, which was stratified into four ranges, very low, low, adequate, and high. Spatial distribution was analyzed according to both each study year and vaccine and presented as thematic maps. Spatial autocorrelation was analyzed using Moran's Global and Local statistics. RESULTS: Compared with 2017, 2016 showed better VC (p < 0.05), except for Bacillus Calmette-Guérin. In the spatial analysis of the studied vaccines, the Global Moran's Index did not show any spatial autocorrelation (p > 0.05), but the Local Moran's Index showed some municipalities, particularly the Sertão Paraibano region, with high VC, high similarity, and a positive influence on neighboring municipalities (p < 0.05). In contrast, most municipalities with low VC were concentrated in the Mata Paraibano region, negatively influencing their neighbors (p < 0.05). CONCLUSION: Uneven geographic regions and clusters of low VC for children aged < 1 year in the State of Paraíba were spatially visualized. Health policy makers and planners need to urgently devise and coordinate an action plan directed at each state's regions to fulfill the vaccination calendar, thereby reversing the vulnerability of this age group, which is at a higher risk of diseases preventable by vaccination.

Association between high-risk pregnancy and environmental contaminants in the Metropolitan Region of Baixada Santista, Brazil.

The Metropolitan Region of Baixada Santista (MRBS) is a highly contaminated area. High-risk pregnancy is one factor that leads to a higher chance of both morbidity and mortality of the mother-fetus binomial. The purpose of this study is to analyze the association between exposure to environmental contaminants and high-risk pregnancy. Case-control study, using a probabilistic and random sample composed of 201 high-risk pregnant women (cases) and 201 no high-risk pregnant women (control) followed up during prenatal care at a Public Hospital. The instrument used was a self-administered questionnaire. Contaminated areas data were obtained from the Environmental Company of the São Paulo State. The participants were georeferenced by their place of residence. Descriptive analysis, Chi-square test, and univariate and multiple logistic regression analysis were performed. The multiple logistic regression model demonstrated that living in a contaminated area (OR = 1.565; 95%CI: 1.033; 2.370), preterm delivery in the current pregnancy (OR = 1.989; 95%CI: 1.239; 3.194), and more than 35 years old (OR = 2.822; 95%CI: 1.692; 4.706) are factors jointly related to high-risk pregnancy. Environmental contaminants play an important role in high-risk pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy.

Considerações sobre o impacto da covid-19 na relação indivíduo-sociedade: da hesitação vacinal ao clamor por uma vacina / Considerations on COVID-19 impact on the individual-society relationship: from vaccine hesitancy to the clamor for a vaccine

Resumo Desde março de 2020, quando a Organização Mundial de Saúde declarou que o mundo vivia uma pandemia de covid-19, acompanhamos um quadro sanitário sem precedentes nos últimos 100 anos. As medidas atuais contra a doença têm como objetivo o controle da transmissão e envolvem ações individuais e coletivas de higiene e distanciamento físico, enquanto a busca por uma vacina se apresenta como a esperança para vencer a pandemia. Considerando o contexto social de clamor por uma nova vacina, este ensaio crítico discute o paradoxo e as contradições da relação indivíduo-sociedade no contexto da covid-19 à luz da hesitação vacinal como fenômeno histórico e socialmente situado. Este ensaio aponta que as tomadas de decisão sobre (não) vacinar ou sobre (não) seguir as medidas preventivas e de controle da propagação da covid-19 são conformadas por pertencimentos sociais e atravessadas por desigualdades que tendem a se exacerbar. A infodemia que cerca a covid-19 e a hesitação vacinal refletem a tensão entre o risco cientificamente validado e o risco percebido subjetivamente, também influenciada pela crise de confiança na ciência. Percepções de risco e adesão a medidas de saúde extrapolam aspectos subjetivos e racionais e espelham valores e crenças conformados pelas dimensões política, econômica e sociocultural.

Abstract Since March 2020, when the World Health Organization (WHO) declared that COVID-19 was a pandemic at global level, we are facing an unprecedented health crisis over the past 100 years. While the search for a vaccine represents the hope to overcome the pandemic, measures were established to control the disease transmission through individual and collective actions of hygiene and physical distancing. Based on the popular clamor for new vaccines, this critical essay discusses the paradox and contradictions of the individual-society relationship in the context of COVID-19 considering vaccine hesitancy as a historical and social phenomenon. We also argue that decisions on (not) vaccinating or (not) following COVID-19 control and preventive measures are influenced by social belonging and traversed by inequalities that tend to exacerbate. COVID-19 surrounding infodemic and vaccine hesitancy reflect the tension between scientifically-validated and self-perceived risk, besides being impacted by the crisis of confidence in science. Perceiving risk and adhering to precautionary measures extrapolate subjectivity and rationality, and mirror values and creed shaped by the political, economic, and sociocultural dimensions.

Covid-19 and its impact on immunization programs: reflections from Brazil.

Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil's national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil's current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

Covid-19 and its impact on immunization programs: reflections from Brazil

ABSTRACT Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil's national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil's current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

Culture versus the law in the decision not to vaccinate children: meanings assigned by middle-class couples in São Paulo, Brazil. / A (não) vacinação infantil entre a cultura e a lei: os significados atribuídos por casais de camadas médias de São Paulo, Brasil.

This study aimed to learn how middle-class parents in the city of São Paulo, Brazil, interpreted the country's prevailing vaccination requirements, based on their experiences with vaccinating, selectively vaccinating, or not vaccinating their children. A qualitative approach was used with in-depth interviews. The analytical process was guided by content analysis and the theoretical framework of the anthropology of the law and morality. For parents that vaccinated, Brazil's culture of immunization outweighed the feeling of compliance with the law; for selective parents, selection of vaccines was not perceived as deviating from the law. In both, the act of vaccinating their children was a matter of moral status. Meanwhile, the non-vaccinators, counter to the legal perspective, attributed their choice to care for the child on grounds that mandatory vaccination was contrary to their way of life; they experienced a feeling of social coercion and fear of legal impositions. Vaccination is an important practice in public health, but it can reveal tensions and conflicts from normative systems, whether moral, cultural, or legal.

A (não) vacinação infantil entre a cultura e a lei: os significados atribuídos por casais de camadas médias de São Paulo, Brasil / La (no)vacunación infantil entre la cultura y la ley: los significados atribuidos por parejas de clase media de São Paulo, Brasil / Culture versus the law in the decision not to vaccinate children: meanings assigned by middle-class couples in São Paulo, Brazil

Resumo: O objetivo deste estudo foi compreender como pais de camadas médias de São Paulo, Brasil, significam as normatizações da vacinação no país, a partir de suas vivências de vacinar, selecionar ou não vacinar os filhos. Foi realizada abordagem qualitativa por meio de entrevista em profundidade. O processo analítico guiou-se pela análise de conteúdo e pelo referencial teórico da antropologia do direito e da moral. Para os pais vacinadores, a cultura de vacinação se sobressaiu à percepção de cumprimento da lei; para os seletivos, a seleção de vacinas não foi percebida como ação desviante da lei. Em ambos, o ato de vacinar os filhos assumiu um status moral. Já os não vacinadores, em contraponto à perspectiva legal, atribuem essa escolha a um cuidado ao filho respaldado pela ilegitimidade que a vacinação assume para o modo de vida deles e vivenciam um cenário de coerção social e medo de imposições legais. A vacinação é uma prática importante no campo da Saúde Pública, porém, pode revelar tensões e conflitos oriundos de sistemas normativos, sejam eles de ordem moral, cultural ou legal.

Resumen: El objetivo de este estudio fue comprender como padres de clase media de São Paulo, Brasil, dan significado a las normativas de la vacunación en el país, a partir de sus vivencias al vacunar, o elegir no vacunar a los hijos. Se realizó un enfoque cualitativo mediante una entrevista en profundidad. El proceso analítico se guio por el análisis de contenido y por las referencias teóricas de la antropología del derecho y de la moral. Para los padres vacunadores, la cultura de vacunación sobresalió a la percepción de cumplimiento de la ley; para los selectivos, la selección de vacunas no fue percibida como una acción desviada de la ley. En ambos, el acto de vacunar a los hijos asumió un status moral. Por el contrario los no vacunadores, en contrapunto a la perspectiva legal, atribuyen esa elección a un cuidado al hijo, respaldado por la ilegitimidad que la vacunación asume para el modo de vida de ellos y vivencian un escenario de coerción social y miedo de imposiciones legales. La vacunación es una práctica importante en el campo de la salud pública, no obstante, puede revelar tensiones y conflictos oriundos de sistemas normativos, sean de orden moral, cultural o legal.

Abstract: This study aimed to learn how middle-class parents in the city of São Paulo, Brazil, interpreted the country's prevailing vaccination requirements, based on their experiences with vaccinating, selectively vaccinating, or not vaccinating their children. A qualitative approach was used with in-depth interviews. The analytical process was guided by content analysis and the theoretical framework of the anthropology of the law and morality. For parents that vaccinated, Brazil's culture of immunization outweighed the feeling of compliance with the law; for selective parents, selection of vaccines was not perceived as deviating from the law. In both, the act of vaccinating their children was a matter of moral status. Meanwhile, the non-vaccinators, counter to the legal perspective, attributed their choice to care for the child on grounds that mandatory vaccination was contrary to their way of life; they experienced a feeling of social coercion and fear of legal impositions. Vaccination is an important practice in public health, but it can reveal tensions and conflicts from normative systems, whether moral, cultural, or legal.

Decision-making on childhood vaccination by highly educated parents.

OBJECTIVE To analyze the sociocultural aspects involved in the decision-making process of vaccination in upper-class and highly educated families. METHODS A qualitative approach based on in-depth interviews with 15 couples from the city of Sao Paulo, Southeastern Brazil, falling into three categories: vaccinators, late or selective vaccinators, and nonvaccinators. The interpretation of produced empirical material was performed through content analysis. RESULTS The study showed diverse and particular aspects surrounding the three groups' decisions whether to vaccinate their children. The vaccinators' decision to vaccinate their children was spontaneous and raised no questions. Most late or selective vaccinators experienced a wide range of situations that were instrumental in the decision to delay or not apply certain vaccines. The nonvaccinator's decision-making process expressed a broader context of both criticism of hegemonic obstetric practices in Brazil and access to information transmitted via social networks and the internet. The data showed that the problematization of vaccines (culminating in the decision to not vaccinate their children) occurred in the context of humanized birth, was protagonized by women and was greatly influenced by health information from the internet. CONCLUSIONS Sociocultural aspects of the singular Brazilian context and the contemporary society were involved in the decision-making on children's vaccination. Understanding this process can provide a real basis for a deeper reflection on health and immunization practices in Brazil in light of the new contexts and challenges of the world today.

[Care and (non)-vaccination in the context of high-income and well-schooled families in São Paulo in the state of São Paulo, Brazil]. / Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil.

This paper analyzes the parental care dimension and the relationship with the decisions on (non)-vaccination of their children in the context of high-income and well-schooled families in São Paulo city/state. The research adopts the qualitative approach, using in-depth interviews conducted with 15 couples that were divided into three groups: vaccinators, selective vaccinators and non-vaccinators. The analytic-interpretative study of the data was performed by means of content analysis and in line with the benchmarks of care of health and family. For all the couples analyzed, the option of (non)-vaccination of their children is perceived as parental care and protection of the child. However, for the vaccinators, protection is to vaccinate their children; for the selective vaccinators, protection is to study case by case; and for the non-vaccinators, protection is not to vaccinate their children, but to protect them against the risks of vaccination. The study also revealed that the reasons for non-vaccination, selection and/or postponement of the vaccination schedule were similar to those found in the international literature. The study highlights the importance of socio-cultural comprehension of (non)-acceptance of vaccination in the context of parental care.

Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil / Care and (non)-vaccination in the context of high-income and well-schooled families in São Paulo in the state of São Paulo, Brazil

O trabalho analisa a dimensão do cuidado parental e suas relações com as decisões de (não) vacinar os filhos no contexto de famílias de alta renda e escolaridade de São Paulo, SP. A pesquisa se orienta pela abordagem qualitativa, com uso de entrevista em profundidade, realizada com 15 casais alocados em três grupos: vacinadores, vacinadores seletivos e não vacinadores. O percurso analítico-interpretativo dos dados foi realizado por meio da análise de conteúdo e segundo os referenciais de cuidado em saúde e família. Para todos os casais do estudo, a escolha da (não) vacinação dos filhos é concebida como um cuidado parental e proteção ao filho, porém, para os vacinadores, proteger é vacinar os filhos; para os vacinadores seletivos, proteger é singularizar cada caso; e para os não vacinadores, proteger é não vacinar os filhos, é proteger contra os riscos da vacinação. O estudo revelou, também, que as justificativas da não vacinação e da seleção e/ou postergação do calendário vacinal foram semelhantes às encontradas na literatura internacional. O estudo aponta a importância da compreensão sociocultural da (não) aceitabilidade da vacinação no contexto do cuidado parental.

This paper analyzes the parental care dimension and the relationship with the decisions on (non)-vaccination of their children in the context of high-income and well-schooled families in São Paulo city/state. The research adopts the qualitative approach, using in-depth interviews conducted with 15 couples that were divided into three groups: vaccinators, selective vaccinators and non-vaccinators. The analytic-interpretative study of the data was performed by means of content analysis and in line with the benchmarks of care of health and family. For all the couples analyzed, the option of (non)-vaccination of their children is perceived as parental care and protection of the child. However, for the vaccinators, protection is to vaccinate their children; for the selective vaccinators, protection is to study case by case; and for the non-vaccinators, protection is not to vaccinate their children, but to protect them against the risks of vaccination. The study also revealed that the reasons for non-vaccination, selection and/or postponement of the vaccination schedule were similar to those found in the international literature. The study highlights the importance of socio-cultural comprehension of (non)-acceptance of vaccination in the context of parental care.

Criança com dificuldade de aprendizagem: o processo de construção de uma guia de encaminhamento de alunos com queixas escolares a serviços de saúde / Children with learning disabilities: the process of building a routing guide of students with school issues to health services

INTRODUÇÃO: Atualmente, assiste-se a um aumento de crianças com queixas escolares encaminhadas a profissionais de saúde, havendo uma comunicação pouco eficiente entre escola e serviço de saúde. Este artigo buscou compartilhar a experiência de construção de uma guia de encaminhamento de alunos com queixas escolares. MÉTODO: Relato de experiência. RESULTADOS: A partir de encontros entre coordenadores pedagógicos e profissionais de saúde, o modelo inicial de guia de encaminhamento, que contemplava apenas a solicitação de informações sobre as queixas escolares dos alunos, foi sendo aperfeiçoado até chegar a um modelo mais ágil e racional de comunicação que facilitasse a troca de informações entre profissionais da educação e saúde. CONCLUSÃO: O aprimoramento da guia melhorou a comunicação entre as escolas e o serviço, facilitou a discriminação das queixas pelos professores e permitiu uma melhor compreensão inicial da queixa escolar do aluno encaminhado.(AU)

OBJECTIVE: Currently has been observed an increase of children with school issues forwarded to health professionals, with an inefficient communication between the parties. This study aimed to portray the creation of a routing guide for students with school issues to health services. METHODS: A experience report. RESULTS: From meetings with teaching coordinators and reviews by health team, routing guide, that starts with a basic model of information request about the students with school issues, was sought to develop a more streamlined and rational model of communication that ease up the exchange of information between the spheres of education and health. CONCLUSION: The use of the guide improved the communication between school and our service, making it easier to discriminate complaints by teachers and allowing a better initial understanding of the students learning disabilities.(AU)

Decision-making on childhood vaccination by highly educated parents / Vacinação infantil e tomada de decisão por pais de alta escolaridade

OBJECTIVE To analyze the sociocultural aspects involved in the decision-making process of vaccination in upper-class and highly educated families. METHODS A qualitative approach based on in-depth interviews with 15 couples from the city of Sao Paulo, Southeastern Brazil, falling into three categories: vaccinators, late or selective vaccinators, and nonvaccinators. The interpretation of produced empirical material was performed through content analysis. RESULTS The study showed diverse and particular aspects surrounding the three groups’ decisions whether to vaccinate their children. The vaccinators’ decision to vaccinate their children was spontaneous and raised no questions. Most late or selective vaccinators experienced a wide range of situations that were instrumental in the decision to delay or not apply certain vaccines. The nonvaccinator’s decision-making process expressed a broader context of both criticism of hegemonic obstetric practices in Brazil and access to information transmitted via social networks and the internet. The data showed that the problematization of vaccines (culminating in the decision to not vaccinate their children) occurred in the context of humanized birth, was protagonized by women and was greatly influenced by health information from the internet. CONCLUSIONS Sociocultural aspects of the singular Brazilian context and the contemporary society were involved in the decision-making on children’s vaccination. Understanding this process can provide a real basis for a deeper reflection on health and immunization practices in Brazil in light of the new contexts and challenges of the world today. .

OBJETIVO Analisar os aspectos socioculturais envolvidos no processo de tomada de decisão da vacinação em famílias de alta renda e escolaridade. MÉTODOS Abordagem qualitativa, com uso de técnica de entrevista em profundidade, realizada com 15 casais residentes na cidade de São Paulo, SP, alocados em três grupos: vacinadores, vacinadores tardios ou seletivos e não vacinadores. O percurso analítico-interpretativo do material empírico foi realizado por meio da análise de conteúdo. RESULTADOS O estudo encontrou diversidades e particularidades frente à decisão de (não) vacinação infantil nos três grupos. Nos casais vacinadores, a decisão em vacinar os filhos apresentou-se sem questionamentos. A maioria dos vacinadores tardios ou seletivos vivenciaram diferentes situações que foram determinantes para a decisão de postergar ou excluir algumas vacinas. O processo de decisão nos casais não-vacinadores foi expresso num contexto mais amplo envolvendo a crítica às práticas obstétricas hegemônicas no país e o acesso às informações veiculadas pelas redes sociais e internet. Os dados evidenciaram que a problematização das vacinas (que culminou na tomada de decisão de não vacinar os filhos) ocorreu no contexto do parto humanizado, foi protagonizada pelas mulheres e teve importante influência das informações em saúde veiculadas na internet. CONCLUSÕES Aspectos socioculturais singulares do contexto brasileiro e da sociedade contemporânea mais ampla estão envolvidos na tomada de decisão em vacinar ou não os filhos. A compreensão desse processo é importante para fornecer subsídios a uma reflexão mais profunda sobre as práticas de saúde e imunização no Brasil, nos novos contextos e desafios do mundo contemporâneo. .

Dificuldade de aprendizagem no ensino fundamental e médio: a percepção de professores de sete escolas públicas de São Paulo - SP / Learning disabilities in elementary and secondary school: perception of seven public school teachers of São Paulo-SP

INTRODUÇÃO: Atualmente, assiste-se ao aumento de crianças com queixa de dificuldades de aprendizagem encaminhadas a profissionais da saúde OBJETIVO: Este estudo visou compreender a percepção de professores de escolas públicas sobre as dificuldades de aprendizagem em seus alunos MÉTODO: Estudo descritivo, realizado em sete escolas públicas na região central de São Paulo-SP, no ano de 2011. Professores de todos os anos do Ensino Fundamental e Médio foram convidados a participar, respondendo a um questionário fechado autoaplicado. Para a análise dos dados foi usado o teste de qui-quadrado e admitido nível de significância de 5% RESULTADOS: Participaram do estudo 104 professores. A maioria percebeu ser muito frequente a dificuldade de aprendizagem (60,8%). Os tipos de dificuldades percebidos como mais frequentes foram escrita, leitura, desatenção e alterações de comportamento, porém, foram as de ordem comportamental as mais "difíceis de lidar". Os participantes destacaram o desinteresse dos pais e a dificuldade em dar atenção individualizada ao aluno como importantes fatores associados às dificuldades de aprendizagem. Os profissionais da área da saúde que os professores julgaram ser mais necessários para a avaliação das crianças com dificuldades de aprendizagem foram o psicólogo (66,7%), seguido pelo fonoaudiólogo e psicopedagogo CONCLUSÕES: Os professores participantes conceberam a dificuldade de aprendizagem como algo muito frequente na sua prática cotidiana e referiram dificuldades no seu enfrentamento. Estudos como este podem contribuir para uma reflexão mais ampla acerca do tema e para o reconhecimento e valorização dessa queixa no âmbito escolar, melhorando o diálogo entre os diferentes atores envolvidos com o desenvolvimento infantil.

INTRODUCTION: Currently has been observed an increase of children with learning disabilities complaints forwarded to health professionals OBJECTIVE: This study aimed to understand the perception of public school teachers on the learning difficulties of their students METHOD: A descriptive study was conducted in seven public schools in the central region of São Paulo-SP in 2011. Teachers of all grades of elementary and middle school were invited to participate by answering an enclosed self-applied questionnaire. For data analysis a chi-square test was employed and a significance level of 5% allowed RESULTS: 104 teachers participated in the study. The majority perceived to be very often the learning disability (60.8%). The types of difficulties most frequently mentioned were writing, reading, inattention and behavioral changes, however, the behavioral was shown as the most difficult to cope with. The participants highlighted the lack of interest of the student´s parents and the difficulty in giving individual attention to each student as significant factors associated to learning difficulties. The health professionals considered by the teachers to be required for the evaluation of children with learning disabilities were the psychologist (66.7%), followed by a speech therapist and a pedagogue CONCLUSIONS: Teachers conceived the learning disability to be very frequent in daily practice and reported difficulties in facing them. Studies like this can contribute to a wider reflection on the subject and the recognition and appreciation of this complaints in schools, improving the dialogue between the different players involved with child development.

Criança com dificuldade de aprendizagem: o processo de construção de uma guia de encaminhamento de alunos com queixas escolares a serviços de saúde / Children with learning disabilities: the process of building a routing guide of students with school issues to health services

INTRODUÇÃO: Atualmente, assiste-se a um aumento de crianças com queixas escolares encaminhadas a profissionais de saúde, havendo uma comunicação pouco eficiente entre escola e serviço de saúde. Este artigo buscou compartilhar a experiência de construção de uma guia de encaminhamento de alunos com queixas escolares. MÉTODO: Relato de experiência. RESULTADOS: A partir de encontros entre coordenadores pedagógicos e profissionais de saúde, o modelo inicial de guia de encaminhamento, que contemplava apenas a solicitação de informações sobre as queixas escolares dos alunos, foi sendo aperfeiçoado até chegar a um modelo mais ágil e racional de comunicação que facilitasse a troca de informações entre profissionais da educação e saúde. CONCLUSÃO: O aprimoramento da guia melhorou a comunicação entre as escolas e o serviço, facilitou a discriminação das queixas pelos professores e permitiu uma melhor compreensão inicial da queixa escolar do aluno encaminhado.

OBJECTIVE: Currently has been observed an increase of children with school issues forwarded to health professionals, with an inefficient communication between the parties. This study aimed to portray the creation of a routing guide for students with school issues to health services. METHODS: A experience report. RESULTS: From meetings with teaching coordinators and reviews by health team, routing guide, that starts with a basic model of information request about the students with school issues, was sought to develop a more streamlined and rational model of communication that ease up the exchange of information between the spheres of education and health. CONCLUSION: The use of the guide improved the communication between school and our service, making it easier to discriminate complaints by teachers and allowing a better initial understanding of the students learning disabilities.