A atenção à crise e o apoio matricial: analisadores da estratégia atenção psicossocial

The National Policy on Mental Health is characterized as a territorial - political community , and it has the Psychoso cial Care Strategy (Eaps) as guideline for the proposal and the development of their actions. In its design, CAPS is idealized to be a strategic equipment within the Psychoso cial Care Network/RAPS. Matricial support and at tention to the crisis constitute strategic areas of action of CAPS in its replacement mission , and as it is g uided by the scope of deinstitutionalization, those are essential to the success of these services. We argue that sustain crises in existential territories of life is a condition for the effectiveness of psychosocial care and, ultimately, to the sustainability of its Reform. In this direction, the matricial support tool reveals a territorial supporter, intercessory and powerful in building a psychosocial care to the crisis. Recognized as one of the major challenges by the Brazilian Ministry of Health, forward these fronts materializes for workers in their mi cropolitical crafts. Our research arises as an investment toward empower them , and aimed to understand the operationalization of attention to the crisis and matricial support in a CAPS II, in the view of its workers . Besides, it aims to examine such practi ces forward the principles and purposes of Psychosocial Care Strategy. Inspired by the research - intervention and by the political and social ideas of Institutiona l Analysis, we offer a space for reflection and exchange, by implicational interviews , enablin g workers to launch them in analysis of practices in the EAPs view. We have done a documentary consulting CAPS Technical Project, and a return stage to the institution, by organizing workshop and conversation groups with CAPS workers. The results have show n that there are institutional logics in competition on that service. When operating the logic risk, some difficulties in sustaining most intense crisis situations were identified, the psychiatric hospital internment is used as a facility, particularly in view of some cases, in which the aggressiveness of the person in crises becomes aggressive, and when the brackets SAMU, the CAPS III and Comprehensive Care Beds do not respond satisfactorily to their users requests. Order weaknesses were indicated in this thesis as macropolitical and micropolitical interfering in network support. The matricial actions were identified as a powerful intercessor resource in crisis care appeared weakened, and indicates little porosity in the relationship between the Service and the territory where it takes place. Noticed by the logic of home care, without operate primarily as a knowledge exchange device, we saw capture points in the logic of assistance with ambulatoriza tion production of CAPS, welfare practices and "ext empore " . T he E APs , although it emerge s as a guiding, it is not seen to workers as effective practice. On the one hand, the results signaled that the attention to the crisis and the matricial actions are developed without tenacious connection with the purposes of EA Ps, on the other hand, successful cases were indicated with the main leads to conducting wire of intersectoral actions to the powerful bonds and to the participation of user in their care process es , indicating insurgent forces tha t intend by traditional lo gic .

As ações em saúde mental nos Núcleos de Apoio à Saúde da Família - NASF

The National Police for Basic Care (PNAB), regulated by ordinance nº2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in João Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in João Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams‟actions.

Atitudes e conhecimento dos consumidores sobre os alimentos irradiados: um inquérito conduzido em Natal, Brasil

The aim of this study is to assess the attitudes and knowledge of consumers about irradiated foods. The study sample corresponded to 65.52% women and the mean age was 41.82 (SD: 14.33) years. Only 66.9% of respondents consumers consult the list of ingredients on the label of packaged foods, and 13.4% of them said they had detected the phrase “FOOD TREATED BY IRRADIATION PROCESS.” Furthermore, 86.6% considered that irradiation becomes unsafe food and thus 94.9% of those not consume these foods, as well as 29.6% of those who felt otherwise. Women had a score of attitude towards irradiated foods less favorable than men. The television was considered the most efficient means of communication to report on irradiated foods. We conclude that consumers of the city of Natal lack information about food irradiation and acceptance of these products depends on how the policies are directed to food security and health education, including through the use of sources of mass information dissemination. The information on the labels of irradiated foods is controversial, although sufficient instruments for detection of irradiated foods by these consumers.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Implementação das diretrizes operacionais para a educação básica nas escolas do campo: embates e limitações do trabalho docente no Rio Grande do Norte

Considering the situation of neglect existing in Brazilian public education and, specially, in the process of rural schooling, this dissertation aims to analyze the process of implementation of the Operational Guidelines for Basic Education in Rural Schools (DOEBEC), regulatory framework of the national policy of rural education. On it, we analyze the conditions of teaching work in rural schools of Rio Grande do Norte (RN), in 2010. The sample of the survey has as reference the representativeness of the chosen universe in relation to the totality of rural schools belonging to the state of RN. To answer the goals of the research, we opted to present a critical analysis of the following points: 1) Implementation of the DOEBEC; 2) Conditions of teaching work and teaching training. The points or categories of research were chosen based in the determinations of the DOEBEC (Resolution CNE/CEB n. 01/2002). For the data collection in the referred schools, we opted for the realization of interviews with the teachers and managers of these teaching establishments, in 2010. It was also utilized, for the characterization of school attendance in rural schools of RN, in 2010, official statistical data available by the State Secretary of Education and Culture (SEEC/RN). The analysis of the statistical data and of the primary data collected in field research indicated that the conditions of teaching work are still an obstacle to the development of the educative work of the teacher in rural areas. According to interviews with the participants of the research, we realized that the DOEBEC, despite being sanctioned in 2002, were still dimly known and discussed by the interviewees of the referred schools in 2010. Thus, we propose that the implementation of the policy of rural education in RN, instituted by DOEBEC’s legal landmark, and reaffirmed by the Rio Grande do Norte’s Charter to Rural Education (Brazil, 2005), is rethought and reconsidered, in the sense of ensuring that the changes proposed in this legal text, inherent to the school functioning, to the conditions of teaching work, to the rural schools’ management, to the remuneration and valorization of teaching work, to the teaching training, to the conditions of school transport, among others, be turned into concrete actions to improve the quality of education offered in the rural schools of RN state.

Implementação das diretrizes operacionais para a educação básica nas escolas do campo: embates e limitações do trabalho docente no Rio Grande do Norte

Considering the situation of neglect existing in Brazilian public education and, specially, in the process of rural schooling, this dissertation aims to analyze the process of implementation of the Operational Guidelines for Basic Education in Rural Schools (DOEBEC), regulatory framework of the national policy of rural education. On it, we analyze the conditions of teaching work in rural schools of Rio Grande do Norte (RN), in 2010. The sample of the survey has as reference the representativeness of the chosen universe in relation to the totality of rural schools belonging to the state of RN. To answer the goals of the research, we opted to present a critical analysis of the following points: 1) Implementation of the DOEBEC; 2) Conditions of teaching work and teaching training. The points or categories of research were chosen based in the determinations of the DOEBEC (Resolution CNE/CEB n. 01/2002). For the data collection in the referred schools, we opted for the realization of interviews with the teachers and managers of these teaching establishments, in 2010. It was also utilized, for the characterization of school attendance in rural schools of RN, in 2010, official statistical data available by the State Secretary of Education and Culture (SEEC/RN). The analysis of the statistical data and of the primary data collected in field research indicated that the conditions of teaching work are still an obstacle to the development of the educative work of the teacher in rural areas. According to interviews with the participants of the research, we realized that the DOEBEC, despite being sanctioned in 2002, were still dimly known and discussed by the interviewees of the referred schools in 2010. Thus, we propose that the implementation of the policy of rural education in RN, instituted by DOEBEC’s legal landmark, and reaffirmed by the Rio Grande do Norte’s Charter to Rural Education (Brazil, 2005), is rethought and reconsidered, in the sense of ensuring that the changes proposed in this legal text, inherent to the school functioning, to the conditions of teaching work, to the rural schools’ management, to the remuneration and valorization of teaching work, to the teaching training, to the conditions of school transport, among others, be turned into concrete actions to improve the quality of education offered in the rural schools of RN state.

Gestão e gerenciamento de resíduos sólidos: diretrizes jurídico-ambientais para a sustentabilidade

rates in the Brazilian cities, which time there is an inexistent theoretical reflection about public policy statement adding the way of Urban Solid Waste (USW) and tailing integrated management plans in the majorly Brazilian cities. The unappropriated solid waste disposal and final pollution result in a strong socioenvironmental problems and material extravagancies that should be used to recycling and reusing waste material, besides bringing immense challenges for the thematic Strategy Urban and Environmental Management it considers the Sustainable City Model. Moreover, this labor projects a discussion about USW problematic through legally and environmentally point of view, including the public environmental policy and the social technologies as resolution tactics. At that time, it reports rights, scientific articles, documents and Environmental Law Doctrine on findings thematic studies, also the propose displays an interdisciplinary research methodology which combines bibliographic method - focusing theory aspects of the legally environmentally guiding principle, public policy and social technologies. Those are theorist features very important to create a Municipal Integrated Solid Waste Management Plan (PMGIRS) - modus operandi of the Federal Law n. 12.305/2010 (National Solid Waste Policy - PNRS). That policy is interesting to receive financial resources from federal government (Cities Ministry; idem, Federal Decree n. 7.404/2010 and Federal Law n. 10.257/2001) helping the preservation of the environment, regional development, generation of jobs and income (art. 6º), in addition broadening spreading’s private companies dedicated to waste management. Consequently, the PNRS contains a set of guidelines and general procedures; it should be an operation of this legal policy contextualized by Social Technologies theory (TS) into social issues, legal, economic and environmental aspects. Therefore, this research notes the possibility of public policy statement implementation over and done with the PNRS by the terms of development and sustainability in the urban space.

A questão ambiental nos cursos de graduação em Educação Física no estado do Rio Grande do Norte

Environmental education started to be discussed since the intensification of the human activity, as a consequence of the industrial revolution. In Brazil, the proposal has gained attention due to the National Environmental Policy, which suggested inserting environmental education in all education levels and later as a crosscutting topic pervading the contents offered in all courses, according to the National Curricula Parameters. Faced with such a challenge, this work aimed to identify how environmental concerns is being considered in physical education licentiate courses at Rio Grande do Norte. For this purpose, we have adopted a descriptive method starting from interviews with coordinators of six institutions offering a physical education licentiate degree (UFRN, UNI-RN, UNIFACEX, FANEC, and UERN – Mossoró and Pau dos Ferros Campi), the application of a questionnaire with 30% of graduating students in the second half of 2015, and observations from the pedagogical projects and syllabi of the institutions that have provided such documents. Results have pointed out the acknowledgement of students and coordinators on the importance of addressing environmental concerns in physical education. However, coordinators and students contradict each other in all investigated institutions. According to the coordinators, environmental education effectively is in some courses of the curriculum as a mandatory requirement from the Brazilian National Ministry of Education. Nonetheless, in practice, most graduating students have no knowledge about environmental education in their courses, stating that they do not have training suited to meet these concerns. When requested to exemplify how they would deal with environmental education, a fragile education to address this topic in their future workspaces was revealed, showing uncritical activities. Despite the obligatoriness in the educational context already exists for decades and the importance of this topic revealed in the speeches of professionals, environmental education is still shy in physical education curricula and education courses, thereby showing the need of a curricular restructuration and a new understanding on this topic, as well as making it to be more present in the daily activities of the future teachers who should take it into consideration in their classes.

A questão ambiental nos cursos de graduação em Educação Física no estado do Rio Grande do Norte

Environmental education started to be discussed since the intensification of the human activity, as a consequence of the industrial revolution. In Brazil, the proposal has gained attention due to the National Environmental Policy, which suggested inserting environmental education in all education levels and later as a crosscutting topic pervading the contents offered in all courses, according to the National Curricula Parameters. Faced with such a challenge, this work aimed to identify how environmental concerns is being considered in physical education licentiate courses at Rio Grande do Norte. For this purpose, we have adopted a descriptive method starting from interviews with coordinators of six institutions offering a physical education licentiate degree (UFRN, UNI-RN, UNIFACEX, FANEC, and UERN – Mossoró and Pau dos Ferros Campi), the application of a questionnaire with 30% of graduating students in the second half of 2015, and observations from the pedagogical projects and syllabi of the institutions that have provided such documents. Results have pointed out the acknowledgement of students and coordinators on the importance of addressing environmental concerns in physical education. However, coordinators and students contradict each other in all investigated institutions. According to the coordinators, environmental education effectively is in some courses of the curriculum as a mandatory requirement from the Brazilian National Ministry of Education. Nonetheless, in practice, most graduating students have no knowledge about environmental education in their courses, stating that they do not have training suited to meet these concerns. When requested to exemplify how they would deal with environmental education, a fragile education to address this topic in their future workspaces was revealed, showing uncritical activities. Despite the obligatoriness in the educational context already exists for decades and the importance of this topic revealed in the speeches of professionals, environmental education is still shy in physical education curricula and education courses, thereby showing the need of a curricular restructuration and a new understanding on this topic, as well as making it to be more present in the daily activities of the future teachers who should take it into consideration in their classes.

Integração ensino e serviço: dizer e fazer saúde na atenção básica

The current discussion on Education and Health has shown the need for greater integration between health services and academia, and this issue has been addressed by researchers in the area as being of great importance. How do we say what we need to do? The National Policy on Education Permanent Health proposes the dissemination of pedagogical skills at SUS, so that the public health clearance to constitute an area of teaching and learning in work performance. This study aimed to know how is the process of integration between education and health services in primary health care, from the knowledge on the role of mentors in the training of undergraduate students in the healthcare field in UFRN. Qualitative Methodology possible, from the use of the techniques of Semi-Structured Interview and Direct Observation of achieving this goal. The analysis of data taken from the Hermeneutic-Dialectic Approach, taking as mediators knowledge of the areas of Education, Health Education and Public Health, showed that the performance of preceptors constitutes an important strategy to enable the integration of teaching and service, and the professionals involved in the preceptorship educate themselves while they educate. The educational process is permeated by knowledge and experiences heterogeneous, highly favorable to the training of students and professionals factor. Innovative educational practices proven capable of starting the mediation of preceptors and other professionals involved in the Work Programme Education for Health, extend learning. The curriculum components Integrated Activity of Health, Education and Citizenship, and Tutorial Program for Integrated Health Work chosen as the basis for this experiment set, for preceptors, the need to seek new knowledge, allowing each actor transcend its specific area of academic training and interact with other areas, which makes learning interesting, enjoyable and meaningful.

Humanização do atendimento à criança na atenção básica: visão dos profissionais

Objetivou-se compreender a humanização do atendimento à criança na Atenção Básica na visão dos profissionais. Estudo qualitativo, realizado em uma Unidade de Saúde da Família de Natal-RN, Brasil. Dezesseis profissionais responderam a um formulário contendo questões referentes ao atendimento à criança, à humanização e às práticas realizadas para humanizar o atendimento. Os dados foram categorizados por temas e analisados a partir dos princípios da Política Nacional de Humanização. Para os profissionais, humanizar o atendimento envolve acolher, escutar, aconselhar sobre o que está sendo realizado com a criança, valorizar a família, e tornar o sujeito ativo no atendimento, mesmo que de forma incipiente. A maioria dos profissionais descreveu atendimento que valorizava parte dos princípios da política de humanização, mesmo com dificuldades para implementá-los na rotina. Requer, portanto, estímulos e atualização dos profissionais para uma postura autocrítica sobre o atendimento

Cooperação e competição entre políticas no Brasil: os custos da governabilidade no presidencialismo de coalizão

Public policies have been studied in the various fields of humanities and social sciences, from different theoretical and technical aspects. However, there is still a lack of studies that incorporate the dimension that encompasses the political action and its interference in such actions, also recognizing the importance of the institutional setting of the Brazilian presidential model in implementing these policies. This fragmented and multiparty system has led to power heterogeneous sets of political parties. Thus, the ministerial offices, more than assisting the President´s government project, manage particularized agendas, which are party biased and have the influence of interest groups in hegemonic themes addressed by government agencies. When these agendas operate in sectoral and specialized policies, the friction level is apparently low. However, when this occurs in intersectoral actions, such as in regional development, there is evidence of strong signs of competition among government agencies, which in theory, should operate in an integrated manner. Although this is not a specific feature of Luiz Inacio Lula da Silva´s government- the period to be studied- there was similar behavior in Fernando Henrique Cardoso´s presidency, one realizes that the expansion of coalition on behalf of governance is increasingly interfering in the outcome of intersectoral public policies, due to these multiple arguments in action. In order to understand these processes, this study focused on the Sustainable and Integrated Development Programme for Differentiated Meso-Regions (PROMESO), part of the National Policy for Regional Development (NPRD). The program provides interface with various government agencies and their public policies in a clear intersectoral design. The research sought to identify and analyze the relationships between government agencies and their programs with interest groups, whether political parties or other segments of civil society, highlighting the logic of favoritism, which poses in second place the integration of actions in the intersectoral policies. Therefore, besides the theoretical debate that incorporates several categories of political science, public administration, public policy, geography and economics, the study focused on secondary sources, using different government agencies databases in order to raise information. It was observed that the interference of partisan politics has been disastrous for some public policies. Thus, the research confirms that cooperative character is fragile within government agencies, often limited to official documents, and that there is indeed, a striking feature of competition, especially when it comes to transversalized policies

Interesses da habitação social : políticas e processos no Rio Grande do Norte

En 2003, le gouvernement brésilien (gestion Lula) a initié une nouvelle phase dans son histoire de l habitation, en intensifiant les constructions de logements sociaux au Brésil. Un tel accroissement a eut des répercussions tant en ville comme à la campagne, et fût marqué dans le Rio Grande do Norte, par la production a grande échelle d ensembles d habitations, dans les programmes de Gouvernement. Afin de viabiliser ces transformations, des instruments politiques, financiers et de gestion ont étés articulés conjointement, utilisant la répétition d une typologie d édification, comme modèle, accompagnée de la reproduction d une morphologie dans les constructions de logements sociaux. Afin de comprendre ce processus nous introduisons une recherche urbanistique et socio-économique du problème du logement social au Brésil, en cherchant à mettre en relation les aspects techniques avec les questions historique, professionnelles et culturelles, éléments complémentaires. Notre analyse cherche a identifier comment les politiques de gestion et financement officielles (administrées dans sa grande majorité par la Caisse Économique Fédérale -CEF-), influencent le processus de conception de projets, en provoquant les répétitions de type/morphologiques, déjà citées. Basée sur l observation directe au cour de deux expériences différenciées pour du logement social en milieu rural, au Rio Grande do Norte, nous montrerons aussi certaines limitations et possibilités des acteurs sociaux, face aux agents et politiques officielles pour le logement social au Brésil, proposant des solutions alternatives standardisées qui caractérisent le résultat des projets financées et gérés par la CEF. Nos principales références théoriques et méthodologiques sont Nabil Bonduki (1998), David Harvey (2009,1982), Henry Lefèbvre (1970), Ermínia Maricato (2010, 2009, 2000, 1987) et Raquel Rolnik (2010, 2009, 2008, 1997)

Estudo clínico-laboratorial e histopatológico de cães naturalmente infectados por Leishmania chagasi com diferentes graus de manifestação física

Canine Visceral Leishmania (CVL) is an important zoonotic disease that has a world wide distribution and has a large impact on public health on the American Continent, especially in Brazil, where the nature of endemic diseases in humans affects a large part of the nation. The influence of the prevalence of CVL in the increased rate of human cases in endemic areas and in the unleashing of epidemic outbreaks shows the need for a more profound understanding, that would generate significant advances in the current measures used to control the reservoirs of sickness that are practiced by the Programa Nacional de Vigilância e Controle da Leishmaniose Visceral. The present work describes and compares the clinical-laboratorial and histopathological findings of twenty-three dogs that were naturally infected by Leishmania chagasi, from endemic areas in metropolitan Natal, Rio Grande do Norte, Brazil. These animals, that were selected and given physical and serological exams (IFI and ELISA rK-39), were classified according to the degree of clinical severity and had blood samples drawn (whole blood and serum) for a complete hemogram and a coagulogram to be done as well as biochemical tests for kidney and liver function. The confirmation of infection by L. chagasi was done after the euthanasia of the animals, through the direct demonstration of the parasite in the impression of the spleen and liver crowned with GIEMSA and through a cultivation by means of NNN/Schneider. According to the clinical evaluation, the animals were classified as asymptomatic (7), oligosymptomatic (7) and polysymptomatic (9). Among the animals that were chosen to be autopsied, there were 2 asymptomatic, 3 oligosymptomatic and 3 polysymptomatic, for the purpose of studying their histopathology, having collected fragments of the spleen, liver, kidneys and skin and were fixed in 10% tamponed formol. The comparison between the average parameters of the clinical-laboratory tested animals in the groups was done through the Student t test (a<0.05). The main clinical signals observed were lymphadenomegaly, alopecy, dermatitis, exfoliation, cutaneous ulcers, onicogriphosis and emaciation. The main clinical-laboratorial alterations established, mainly in the polysymptomatic group, were anemia, hyperproteinemia, hyperglobulinemia, alterations in the albumin/globulin ratio and increased ALT activity. Renal alterations were not verified (urea and creatinine levels were normal). Thrombocytopenia was observed in three clinical groups. However, the other indicators of coagulation function (TAP and TTPA) did not have abnormal variations. There were inflammatory infiltrations and leishmania amastigotes in the skin of polysymptomatic dogs, however, they were not found in the skin of asymptomatic animals. Hypertrophy and hyperplasia of the phagocyte mononuclear system, leishmania amastigote parasites were found in the macrophages, extramedullary hematopoiesis and degenerative alterations were detected in the spleen and liver of 8 of the animals submitted to histopathological exams. In accord with these results, it was demonstrated that the expected alterations in the hematological and biochemical parameters in function of their viscerotropic nature of CVL are mainly observed in the more advanced stages of the disease. The absence of inflammatory infiltration and parasite load in the skin suggest that infected animals without symptoms may have an importance irrelevant to the infectiousness of the vector