A saúde ambiental e os resíduos de serviços de saúde nos três níveis de complexidade do Sistema Único de Saúde - SUS

The environmental management in the health establishments is a reality still little explored in the health sector in Brazil, especially concerning its wastes. The management of wastes of health services is established in the valid legislation through the National Council of Environment and Sanitary Vigilance Agency (358/2005 and 304/2004 respectively). The present work is about a descriptive work about the environmental health in the health services. The used criterion was to diagnose the environmental management in twelve establishments of health inserted in the three levels of complexity of the Unique Health System (Sistema Ùnico de Saúde SUS). Among the sub criteria used the waste management is the one of bigger concern. The one referring to the water quality is considered good. The analysis of data reveals that 66% of the establishments got a poor environmental ranking, 17% critical and 17% appropriate, showing that the health establishments in the three levels of complexity of the SUS need urgent structural, environmental and educational interventions

A psicologia e o programa de saúde da família :novas possibilidades, velhos dogmas?

The model of attention to health has been suffering alterations due to the difficulty faced to put into practice its universal, democratic and institutional layout. Since the movement of Sanitary Reform, which focused in the demands of a new health context and the process of work in the area of health, one seeks uninterruptedly, to find a way which leads to the execution of the principles of SUS. Despite having tried, the model of Sanitary Vigilance centered within the work of a multi-professional team has shown fragmentation and little adequacy to the necessity of health in the population. Whilst inserting himself in the field of health, the psychology professional has taken with him his clinic way of attending to individuals being one more in the team to act in a de-contextualised and little critical way. In virtue of this framework, the Ministry of Health invests in the Family Health Program as a new guide in the health system, restructuring the basic attention at a new logic of action. In this way, the municipality of Natal-RN implants, in the year 2002, the PSF in the Northern Sanitary District, a context in which professional teams are created where there is not an inclusion of a psychologist. Consequently, this professional is excluded of his work space in the previous Basic Unities of Health. This piece of work constitutes in the investigation of the implementation and instrumentalization of the Northern Sanitary District PSF of Natal-RN, having as its objective to analyze the implications of this execution for the structuring of the health network services and more specifically the alterations that this implementation could be making to the practice of the Psychology Professionals, emphasizing its advances, obstacles and limitations. To make this work feasible it was necessary to search for data and information from the implementation and execution of the PSF in the DSN, carrying interviews from a semi-structured guide, with 21 institutional actors (members of the team, coordinators and directors of the unities and psychologists)

Tontura em idosos institucionalizados da cidade do NATAL/RN: Um estudo caso-controle em vestibulopatas e não-vestibulopatas

the institutionalized elderly presents for being more fragile a lot of body balance s changes, which can induce falls and health frailty. One of the consequences of it is the appearance of dizziness, vestibular or not. This study aims to identify the risk factors related to dizziness in institutionalized elderly, with and without vestibular disorders, in the city of Natal-RN. Method: a case-control study realized in 12 regulated by Health Surveillance Long Term Care Institutions for the elderly in Natal-RN. Elected seniors with good cognitive level and able to walk, totaling 115 individuals, and of these, 102 were selected according to the presence of dizziness in the last year (n = 51) and their controls (n = 51), paired by sex and age. The 51 elderly patients with dizziness were divided into 3 groups case: case one, for elderly with dizziness and without vestibulopathy (n=38); case two, for elderly with dizziness and vestibulopathy (n=13) and case three, for all the seniors with dizziness, or added to the case 1 case 2 (n=51). The 51 seniors who served as controls were also divided into three groups, according to the number of individuals of each case: control 1, n = 38, control 2, n = 13 control and 3 (sum of 1 control with control 2), n = 51. As possible risk factors were analyzed variables related to characteristics of the institution, to the habits of life of older people and those concerned with the health of the elderly. For statistical analysis, we used the chi-square or Fisher exact test for a significance level of 5% and calculating the association magnitude between variables by measuring the Odds Ratio. Results: as risk factors for dizziness without vestibular disorders were found the presence of hypertension and cardiovascular disease, as well as the presence of three or more disorders for elderly and use of gastric protector drugs. For the elderly group from case two were found no associated risk factor. For elderly patients with dizziness in the case group three, we observed the same risk factors found for the elderly in the case group one, plus the presence of osteoarthritis pathology, which was also significant for this group. Conclusion: dizziness in institutionalized elderly is associated with systemic common diseases in this age group and the vestibulopathy presents itself as pathology on an isolated way, not being possible, with our data, associate it with non-risk factors

Validação do instrumento dos indicadores observáveis da qualidade do cuidado em instituições de longa permanência para idosos

The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach’s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as “unchanged” in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach’s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance –SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It´s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

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.

SISOnt: sistema de informação em saúde baseado em ontologias

The sharing of knowledge and integration of data is one of the biggest challenges in health and essential contribution to improve the quality of health care. Since the same person receives care in various health facilities throughout his/her live, that information is distributed in different information systems which run on platforms of heterogeneous hardware and software. This paper proposes a System of Health Information Based on Ontologies (SISOnt) for knowledge sharing and integration of data on health, which allows to infer new information from the heterogeneous databases and knowledge base. For this purpose it was created three ontologies represented by the patterns and concepts proposed by the Semantic Web. The first ontology provides a representation of the concepts of diseases Secretariat of Health Surveillance (SVS) and the others are related to the representation of the concepts of databases of Health Information Systems (SIS), specifically the Information System of Notification of Diseases (SINAN) and the Information System on Mortality (SIM)

Flebotomíneos (Diptera: Psychodidae) em um sistema agroflorestal da Região Metropolitana de Natal, Rio Grande do Norte, Brasil

Sandflies stand out as important vectors of leishmaniasis. The females need to ingest blood meals, enabling them to transmit protozoa of the genus Leishmania, which may give rise to visceral leishmaniasis (VL) or American tegumentary leishmaniasis (ATL), in addition to transmitting other parasites. Leishmaniasis are important infirmities, distributed worldwide, whose infection results from the interaction of reservoir animals, the vector insect, parasitic protozoa and the healthy host. In the state of Rio Grande do Norte (RN), Brazil, these insects are important transmitters of VL, which usually presents in the most serious form. It occurs mainly in metropolitan areas, with the dog as its main reservoir and Lutzomyia longipalpis as the vector. ATL is most present in the highland areas of the state. In addition to hematophagia, engaged in by the females, both sexes need to ingest carbohydrates, which are essential to the sand flies energy requirements and may interfere in the development of Leishmania. The aim of this study was to determine the occurrence and abundance of sand flies in different environments on the farm belonging to the Empresa de Pesquisas Agropecuárias do RN (Institute of Agricultural Research of RN), in the municipality of Parnamirim, in order to relate this occurrence with climatological and biological references and eating habits. Three consecutive monthly collections were carried out with CDC traps in a fragment of the Atlantic Forest, in a residence, on a goat breeding farm and on cashew, dwarf and giant coconut, mango, banana, eucalyptus, acacia and bean plantations. A total of 1241 sandflies from eight species (Lutzomyia evandroi, Lutzomyia longipalpis, Lutzomyia shannoni, Lutzomyia sordellii Lutzomyia walkeri, Lutzomyia wellcomei, Lutzomyia whitmani, and Lutzomyia intermedia) were collected, most in the forest environment. L. longipalpis, the main VL transmitter, was confirmed as a species adapted to anthropic environments, whereas others such as L. wellcomei, the vector of ATL, occurred predominantly in forests. Carbohydrate characterization of the sand flies and plants of the region demonstrated that a number of exotic plants such as hay and eucalyptus may play some role in the adaptation of these species to modified environments. Breeding in laboratory showed a mean biological cycle of 53.5 days from egg to adulthood for L. shannoni and the possibility of diapause behavior in L. wellcomei. This study serves as a source of information that may contribute to the epidemiological vigilance of tegumentary and visceral leishmaniasis in the state, given that it analyzes the bioecology of transmitting species, as well as their potential to adapt to new environments

Conhecimento do enfermeiro sobre as ações de vigilância epidemiológica no Hospital Universitário Onofre Lopes, Natal, RN

This is an exploratory descriptive study with quantitative approach, aiming to verify the nurses' knowledge concerning the epidemiological surveillance activities at the Onofre Lopes hospital (HUOL), in Natal, Rio Grande do Norte. The study was performed with 63 nurses from the hospital and the data were collected through a questionnaire. All data were analyzed using descriptive statistics. The results were discussed and organized into four sections: nurses' knowledge on hospital epidemiological surveillance; procedures of the professional nurse through compulsory notification diseases; difficulties found by nurses to register the compulsory notification diseases and suggestions of strategies to joint epidemiological surveillance service with the care practices of nurses. The results showed that 55.55% of nurses know the main action of epidemiological surveillance, compulsory notification of diseases, and that 42.86% reported to the Hospital Epidemiology Center , while 57.14% did not allocate the information for this service. Most nurses found it difficult to perform notification for not knowing its flow; for the surveillance service does not operate 24 hours and for vagueness on diagnostic of disorders. Suggestions of strategies to improve the quality of epidemiological information are focused on training of nurses in hospital epidemiological surveillance; working in partnership with the surveillance center; diffusion of information on surveillance and conducting a daily active search. It comes to conclusion that most nurses don't notify the Surveillance Center about Compulsory Notification Diseases and it wasn't observed the incorporation of integrality values between the hospital surveillance and all nurses, since this principle guides the actions of health services based on dialogue, listening, ethical commitment, sharing of knowledge among professionals of various services and respect towards other professionals. Therefore, the integrality gap in the actions of the nurses studied, as well as in the surveillance service does not mobilize the potential of such services to changes in the sense of achievement of practices aimed at a special attention model that combines preventive and corrective actions, proposed and desired by SUS. Through the difficulties presented, it becomes important to recommend educational processes with strategy to transform the conducts, besides proposing actions under the principle of integrality provide responses agile and effective, as the purpose of VE hospital emergency care by the current epidemic

Produção de forragem verde em sistema hidropônico usando esgoto tratado

In the urban areas of the cities a larger problem of destiny of effluents of the treatment stations is verified due to the junction of the sewages in great volumes. This way the hidroponic cultive becomes important, for your intensive characteristic, as alternative of reuse. This work presents as objective the improvement of the relation hidric-nutritious of the hidroponic cultive of green forage (FVH) using treaty sewage. The production of forage was with corn (Zea mays L.), using double hybrid AG1051, in the experimental field of the Federal University of Rio Grande do Norte (UFRN), in the city of Natal-RN-Brazil. The treated effluent essentially domestic had origin of anaerobic reactor, type decant-digester of two cameras in series followed by anaerobic filters drowned. The hidroponic experimental system was composed of 08 stonemasons, with limited contours for masonry of drained ceramic brick, measuring each one 2,5 meters in length for 1,0 meter of width, with inclination of 4% (m/m) in the longitudinal sense, leveled carefully, in way to not to allow preferential roads in the flow. These dimensions, the useful area of Isow was of 2 square meters. The stonemasons of cultive were waterproof (found and lateral) with plastic canvas of 200 micres of thickness, in the white color. Controlled the entrance and exit of the effluente in the stonemasons, with cycles of 12,68 minutes, it being water of 1,18 minutes. The treatments were constituted of: T1 - 24 hours/day under it waters with flow of 2 L/min; T2 - 12 hours/day under waters with flow of 4 L/min; T3 - 12 hours/day under waters with flow of 2 L/min; and T4 - 16 hours/day under waters with flow of 3 L/min. There were evaluations of the evapotranspirometric demand, of hidroponic system affluent and effluent seeking to characterize and to monitor physical-chemical parameters as: pH, temperature, Electric Conductivity and Fecal Coliforms. This last one was analyzed to the 11 days after isow (DAS) and to the 14 DAS. The others were analyzed daily. I sow it was accomplished in the dates of February 21, 2007, first experiment, and April 10, 2007, second experiment. The density of Isow was of 2 kg of seeds, germinated before 48 hours, for square meter of stonemason. The statistic delineament was it casual entirely with two repetitions, in two experiments. It was applied Tukey test of average to five percent of probability. The cultivation cycle was of 14 DAS with evapotranspirometric demand maximum, reached by T1, of 67,44 mm/day. The analyzed parameters, as mass of green matter - Kg, productivity-Kg/m2 and reason of production of seed FVH/Kg used in Isow, the best result was presented by T1, obtaining value of up to 19,01 Kg/m2 of cultive. Without significant difference, the T4 presented greats values with 16 hours under cycle of water. The Treatments 2 and 3 with 12 hours under cycle of water, they obtained inferior results to the other Treatments. As treatment system, came efficient in the reduction of the salinity. T1 obtained reduction medium maxim of 62,5%, to the 7 DAS, in the amount of salts that enter in the system in they are absorbed in the cultivation. The cultivation FVH acted reducing the microbiologic load. Significant percentile of reduction they were reached, with up to 90,23% of reduction of Units of Colonies (UFC), constituting, like this, the Hidroponic System as good alternative of treatment of effluents of Reactors of high Efficiency

Uso urbano não potável de água de lagoas do sistema de drenagem de Natal

The detention and infiltration ponds of urban drainage system has function to protect the population from undesirable effects of floods. In general these ponds are not completly used and it potential is wasted. As it are disseminated at different places at cities it can reduce costs with water transport and permit water preservation of best quality. Some it utilities includes use in green areas irrigation, industrial among than cooling towers and boiler, soil compaction, cleaning urban road, pisciculture and fire fighting system. The quality these water is influenced by anauthorized sewage in the drainage system. This study was performed in six detention and infiltration ponds at drainage system of Natal, which aim was to verify the non-portable use these ponds on urban environment. As indirect aim would to incentive the water utilization these ponds as a water source to another uses in urban environment. These ponds represents the characteristics of detention and infiltration of Natal city and consequently of Brazil. As the water quality, the ponds presents following characteristics: three has apparently good quality, other showed intermediate condition and two had water polluted. Were performed twenty sample in each ponds and the following parameters assessed: pH, temperature, dissolved oxygen, turbidity, electrical conductivity, coliform thermotolerant, ammonia, organic nitrogen, TKN, nitrate, total phosphorus and alkalinity, bicarbonate, chloride, total hardness, calcium and magnesium hardness, total solids, TSS, TDS, COD and SAR°. To utilization on pisciculture we recommend use in ponds which presents the best quality. Only one pond presented higher pollutants and it not being appropriated for use in cooling tower. The content of solids suspension restricted the water use in all ponds in boilers. As water use in soil compaction, cleaning urban road and fire fighting system the water from these ponds are not appropriated. However, the recommended limits from literature are to domestic sewage, due to this, the parameters are restrictive to diminish the sanitary risk that could be offered with it utilization. The infiltration velocity of water these assessed ponds restrict a moderato use, however the effects are potentiated only in soil less sandy, which not occur in Natal. It is recommend the unrestricted irrigation utilization in ponds with best quality of water, and a restricted irrigation to ponds with worst quality of water. As load of pollutants, it is recommended a complementary treatment in those ponds whit higher load to diminish sanitary risks. In only one pond was found one helminth eggs and due to the convention formula of results, it was found for all ponds less than 1 helminth/liter eggs.

Simulação do sistema de esgotamento sanitário de Ponta Negra- Natal: mitigação dos riscos ambientais e estratégia de manutenção preditiva

The simulation of SES-Natal Ponta Negra: mitigation of environmental risks and predictive maintenance strategy was developed in the context of several operational irregularities in the pumping stations and sewage systems in the system Ponta Negra. Thus, the environmental risks and complaints against the company due to overflows of sewage into the public thoroughfare became common. This neighborhood has shown in recent years an increase of resident higher than the initial expectation of growth. In this sense presumed the large population growth and generation of sewers higher than expected, associated to the use of corrective maintenance and misuse of the system may be the main causes of operational failures occurring in the SES. This study aimed at analyzing the hydraulic behavior of SES Ponta Negrathrough numerical simulation of its operation associated to future scenarios of occupation. The SES Ponta Negra has a long lengthof collection networks and 6 pumping stations interconnected, being EE 1, 2, 4 coastal way, and beach Shopping interconnected EE3 to receives all sewers pumped from the rest pumping station and pumped to the sewage treatment station of neighborhood which consists of a facultative pond followed by three maturation ponds with disposal of treated effluent into infiltration ditches. Oncethey are connected with each other, the study was conducted considering the days and times of higher inflow for all lifts. Furthermore, with the aim of measuring the gatherer network failures were conducted data survey of on the networks. Thephysical and operational survey data was conducted between January/2011 and janeiro/2012. The simulation of the SES was developed with the aim ofdemonstrating its functioning, eithercurrently and in the coming years, based in population estimates and sewage flow. The collected data represents the current framework of the pumping stations of the SES Ponta Negra and served as input to the model developed in MS Excel ® spreadsheet which allowed simulating the behavior of SES in future scenarios. The results of this study show thatBeach Shopping Pumping Station is actually undersized and presents serious functioning problemsthatmay compromise the environmental quality of surrounding area. The other pumping stations of the system will reach itsmaximum capacity between 2013 and 2015, although the EE1 and EE3 demonstrateoperation capacity, even precariously, until 2017. Moreover, it was observed that the misuse of the network system, due to the input of both garbage and stormwater, are major factors of failures that occur in the SES. Finally, it was found that the corrective maintenance appliance, rather than predictive,has proven to beinefficient because of the serious failuresin the system, causing damage to the environment and health risks to users

Caracterização e avaliação do macro sistema urbano de distribuição de água de Natal RN

The aim of this study is to characterize and evaluate the Macro System of Regional Water Distribution Natal North (RNN) and Southern Regional Natal (RNS), covering 35% and 65% respectively of the Natal-RN City. The terms of the quality and quantity of water (surface and groundwater) were also evaluated in order to adjust the parameters that contribute to proper distribution and control in water reserves. The methodology of the work took place from collecting volumetric data of production capacity and distribution of the two treatment plants for Regional as well as the flow rates of wells. Yet the quantitative capacity of reservation, distribution and consumption of the main reservoirs, population numbers and consumption of members neighborhoods were collected. Data were tabulated and used in computational simulator EPANET to diagnose possible through the water balance, the offers and demands on the water supply system in the neighborhoods of the capital, linking them to specific distribution points. We also evaluated the wells in the levels of nitrate in water consumed. As a result it was found that some neighborhoods in the South Regional Natal, was ranked as critical supply situation: City of Hope, Lagoa Nova and Nova Descoberta, where demand exceeds supply. While in most Northern Regional Natal present deficiency in the supply system as: Lagoa Azul, the Parque dos Coqueiros, igapó, Amarante and Salinas. The rates of nitrate in the city were significant, but manageable with corrective and preventive measures. The averages were 12 mg /l-N in Candelária, 10 mg/l-N in Lagoa Nova, 9 mg/l-N in Satelite, 20 mg/l-N in Gramore and 15 mg/l-N in N. Sra. Apresentação. Therefore proper distribution of water abstracted and implementation of quality control ensures the supply required by the system, associated with preservation of Water Resources of the Metropolitan Region of Natal

Otimização de um sistema de distribuição predial de água fria: estudo de caso

This dissertation presents a methodology to the optimization of a predial system of cold water distribution. It s about a study of a case applied to the Tropical Buzios Residential Condominium, located in the Búzio s Beach, Nísia Floresta city, the east coast of the Rio Grande do Norte state, twenty kilometers far from Natal. The design of cold water distribution networks according to Norm NBR 5626 of the ABNT - Brazilian Association of Techniques Norms, does not guarantee that the joined solution is the optimal solution of less cost. It s necessary the use of an optimization methodology, that supplies us, between all the possible solutions, the minimum cost solution. In the optimization process of the predial system of water distribution of the Tropical Búzios Condominium, is used Method Granados, that is an iterative algorithm of optimization, based on the Dynamic Programming, that supplies the minimum cost s network, in function of the piezometric quota of the reservoir. For the application of this Method in ramifies networks, is used a program of computer in C language. This process is divided in two stages: attainment of the previous solution and reduction of the piezometric quota of headboard. In the attainment of the previous solution, the minors possible diameters are used that guarantee the limit of maximum speed and the requirements of minimum pressures. The piezometric quota of headboard is raised to guarantee these requirements. In the second stage of the Granados Method, an iterative process is used and it objective is to reduce the quota of headboard gradually, considering the substitution of stretches of the network pipes for the subsequent diameters, considering a minimum addition of the network cost. The diameter change is made in the optimal stretch that presents the lesser Exchange Gradient. The process is locked up when the headboard quota of desired is reached. The optimized network s material costs are calculated, and is made the analysis of the same ones, through the comparison with the conventional network s costs

Os profissionais de saúde diante da violência :mapeando o processo de implantaçãoda notificação na rede básica de saúde em Natal/RN

Violence is a complex and multifarious phenomenon that has convoked the government to think about strategies to face the question. This work is about one of these strategies proposed by brazilian Health Minister: the Individual notification/investigation Card - Domestic Violence, Sexual and/or others Interpersonal Violences . This instrument is a notification protocol which is been implanted in all of the country. This process is in course in Natal/RN. This work is a report of one research realized in five units of basic health care network of Natal/RN concerning this process about the implementation of the violence notification card. The study aims to cartography all the process of card implantation, discussing the used strategies, the drawn course, difficulties and possibilities as well as how the researcher intended to map subjective process involved at health professional acting at violence case and the propose to use the card. Meetings were held at each unit and a daily fieldwork report was used as research instrument. In this investigation it was observed that notifying violence involves a complexity that is not present in other kinds of notification as consequence of the phenomenon characteristic and health workers are invited to act in different perspective that knowledge and instruments of traditional health fieldwork available does not work. It was observed that the notification card, as a possible instrument of intervention, are considered important detectors from process of work at health basic care and health policies. Depending the way the instrument is used, it may incentive different discussions and manners to offer health care or in other way it can reproduce control and vigilance logics. Consequently it is necessary to consider some factors pointed out at this experience, implanting instruments like this, thinking about these limits and possibilities

Serviço Social Audit Saúde no SUS/RN: projeto ético político profissional e de reforma sanitária

Health policies in Brazil, the decentralization of SUS management responsibilities for the three spheres of government has driven the creation and regulation of the audits of health services in the National Audit Office, this is a trend of neoliberal policies imposed by international bodies like the World Bank and IMF to peripheral countries characterized by productive restructuring and reforming the state focuses on the presence of two competing projects in the area of health: Health Sector Reform Project which is based on the democratic rule of law with the assumption of health as social right and duty of the State in defending the extension of the conquest of rights and democratization of access to health care guaranteed through the public financing strategies and the effective decentralization of decisions pervaded by social control and privatized Health Project which is based on the state minimum, with a reduction in social spending or in partnerships and privatization, stronger nonprofit sector, subject to capitalist interests, is made effective through strategies targeting health policy and refilantropização actions. In this context, the present study is an analysis on the work of social audits of public health in infants from a qualitative and quantitative approach, embodied by the critical method of dialectical Marxist social theory that enabled us to unveil the characterization, the demands, challenges and outline the profile of Social Work in teams inserted audits of SUS in RN, but also provided evidence to demonstrate the prospects and possibilities of this area of activity of social workers. It was also found that through the audit work that the state fulfill its role as bureaucratic and regulator of health services with efficiency, effectiveness and economy. Yet, paradoxically, the audits of SUS may provide a vehicle for enforcing rights and ensuring the fundamental principles contained in the project of health reform, because it can be configured in a space of political struggle as representing a new field of knowledge production that needs to be appropriate for a theoretical critic able to redirect the social interests in favor of the user. From this perspective, it is concluded that the work of social audits of public health in infants despite the social relevance that prints, as they constitute an activity study of reality and its transformation proposition requires a transformative political action guided the discussion Marxist theory holds that the ethical project professional politician of Social Work