RESUMOEste artigo propõe uma reflexão sobre a integração ensino e serviço a partir das discussões de um grupo multiprofissional de um curso de especialização para ativação de mudanças na formação superior em saúde. Além das reflexões do grupo, o texto traz interlocuções com referenciais teóricos sobre aspectos que envolvem a integração ensino-serviço. São abordadas as relações da integração ensino-serviço com a formação superior dos profissionais de saúde, com os modelos tecnoassistenciais, com a prática do cuidado em saúde, com o trabalho em equipe e com a educação permanente. ABSTRACTThe aim of this article was to propose a reflection about integration of healthcare services and teaching based on the discussions of a multi-professional group of a specialization course for promoting changes in the undergraduate education of health professionals. Besides the group reflections, this text presents references of theoretical nature about combining healthcare service and teaching. The article approaches the relations between service-learning and undergraduate education of health professionals, healthcare models, healthcare services, teamwork and continuing education.

Construção de portfólios coletivos em currículos tradicionais: uma proposta inovadora de ensino-aprendizagemThe construction of collective portfolios in traditional curriculums: an innovative approach in teaching-learning Resumo Tradicionalmente, a educação em saú-de se baseia em metodologias de transmissão de conhecimentos. Porém, agora se exige a formação de profissionais com perfil crítico-reflexivo e capazes de trabalhar em equipes. O que requer novas metodologias de ensino-aprendizagem, tendo na problematização um instrumento de transformação. É relatada experiência utilizando a construção de portfólios coletivos na aprendizagem, como mudança de atitudes e na avaliação de alunos de graduação, em contexto de estrutura curricular tradicional e por disciplinas. Estudo exploratório descritivo, com abordagem quali-quantitativa, fundamentado na análise de portfólios coletivos (n= 9), construídos pelos acadêmicos da disciplina Políticas de Saúde, complementado com a aplicação de um questionário aberto aos alunos (n=58) e com a realização de grupos focais (n=3). Os portfólios coletivos mobilizaram o pensamento crítico-reflexivo sobre a política do Sistema Único de Saúde, ampliando a concepção sobre o processo saúde-doença e as práticas relacionadas aos serviços de saúde, valorizando o trabalho em equipe e a busca ativa na construção do conhecimento, destacando-se os exercícios da alteridade, resiliência e empoderamento. Palavras-chave Portfólio, Metodologias de ensino-aprendizagem, Problematização, Educação em saúde, Formação profissional, Avaliação Abstract Education to promote health has traditionally been based on knowledge transmission methodologies. However, the current scenario calls for the training of professionals with a criticalreflective profile, who are able to work in teams. We present the report of an innovative experience using the construction of collective portfolios as instruments of learning, changing attitudes and training of undergraduates, in a traditional subject-based curriculum structure context. It is a descriptive exploratory study, with a qualitativequantitative approach, based on analysis of collective portfolios (n=9), built by Health Policy students, together with an open questionnaire to students who attended the course (n=58) and also the staging of focus groups (n=3). The use of collective portfolios mobilized students in critical and reflective thinking on Brazilian health policythe Unified Health System -broadening the concept on the health-disease process and practices related to health services, prioritizing teamwork and the active search for knowledge building, stressing the exercise of otherness, resilience and empowerment.

An epidemiological analysis of the association of polydactyly with other congenital anomalies was performed in 5,927 consecutively born polydactyly cases. They were grouped into three categories: duplicated fifth digit, duplicated first digit, and rare polydactylies; also into isolated or associated groups, if other birth defects were or were not observed in the same infant. Associated cases were further subdivided into: combined, if the other defect was a limb defect; syndromic, if a non-limb defect constituted a recognized causal or pathogenetic entity; and MCA, if a non-limb defect did not constitute a recognized entity. In 14.6% of the 5,927 polydactyly cases studied, polydactyly was not the only congenital anomaly. This associated proportion was minimal for postaxial (11.8%), intermediate for preaxial-I (20.0%), and maximal for rare polydactyly (54.9%). Duplication of the fifth toe plus syndactyly of fourth and fifth toes, as well as other syndactylies adjacent to the duplicated digit is the most frequent type. Syndactyly of fourth and fifth toes was also combined with a duplicated fifth finger, suggesting the existence of an arrested or amputated in utero sixth toe. Polydactylies are rarely associated with other congenital anomalies except in recognizable syndromes. When syndromes are excluded, most of the significant positive associations disappear. Trisomy 13, Meckel, and Down syndrome explained 255 of the 338 syndromic polydactyly cases. Down syndrome is strongly associated with first-digit duplication, and negatively associated with postaxial polydactyly. The latter could not be explained by maternal age differences among Black and non-Black case sub-sets.

Three large and comparable series of births were used to test the working hypothesis that if there is a real seasonal variation in the frequency of a given congenital malformation; it would have to be shown by adequate analysis; to be more overt in non-tropical areas; and to be six months out of phase in northern and southern hemispheres. The data set were hospital births from tropical (287,165 births) and non-tropical (582,585 births) South America, and from Italy (508,536 births). Sixteen well-defined malformation types were tested: anencephaly, spina bifida, cephalocoele, hydrocephaly, microtia, cleft palate, cleft lip, oesophageal atresia, anal atresia, hypospadias, pes equino-varus, pes talovalgus, postaxial polydactylyl, pre-axial polydactylyl, diaphragmatic hernia, and Down's syndrome. No seasonal variation was proven (p less than 0.01) for any malformation type in any of the three series of data by means of Walter and Elwood's test, or Hewitt et al's non-parametric test2 applied to seven instances with sample sizes smaller than 50 cases. Variations of borderline significance (p less than 0.05) included oesophageal atresia in tropical South America, none in non-tropical South America, and anencephaly in Italy. It is concluded that seasonal variation in the occurrence of congenital malformations is a rare phenomenon when tests are strictly used within their recommended limitations.

RESUMO KEY-WORDS-Single Health System.-Professional Practice.-Health Services. ABSTRACT The aim of this article was to reflect critically on the importance of the training process for health professionals, focusing on issues involving the production of subjectivity, or healthcare models that approach health education in such a way as to expand individuals' autonomy and their capacity to intervene in their own lives through experience with otherness with users of the production of technical and scientific skills and adequate knowledge of the Single Health System (SUS). The article highlights the relevance of linkage and interaction between health services and educational institutions

We present descriptive epidemiologic data on ambiguous genitalia (AG), obtained in the period 1967-1982 by the Latin American Collaborative Study of Congenital Malformations (ECLAMC) through 70 participating hospitals located in 34 cities of 9 South American countries. The observed prevalence rate for isolated AG was about 1/20,000 births, with at least 1/4 and probably as much as 1/2 due to congenital adrenal hyperplasia. When AG cases associated with other congenital anomalies were also considered, the overall frequency of AG was 1/6,900 total births (1/10,000 for live and 1/350 for stillbirths). The prevalence rates were homogeneously distributed among the different countries, and there was a stable secular trend. AG was more frequent in nontropical than in tropical areas of South America, and there was a significant seasonal variation with its acrophase in August (winter). A case-control analysis of 14 risk factors showed an association of AG with a prenatal history of acute maternal illnesses. These data do not support an etiological relationship between AG and hypospadias.

O Fórum Nacional de Educação das Profissões na Área de Saúde -FNEPAS, criado em 2004,no contexto do "Seminário Nacional sobre o SUS e as Graduações na Saúde", promovido pelo Ministério da Saúde, assumiu o compromisso de promover e contribuir para o processo de mudanças curriculares nos cursos de graduação, visando a formação de profissionais habilitados e comprometidos com a Política Nacional de Saúde. Pretende também que tais mudanças sejam orientadas pelos princípios do SUS e das Diretrizes Curriculares Nacionais e particularmente, que desenvolvam na teoria e na prática a concepção/ desafio da Integralidade na atenção em saúde.Atualmente, o FNEPAS é composto pelas seguintes entidades: Associação Brasileira Brasileira de Pós-Graduação em Saúde Coletiva (ABRASCO), Sociedade Brasileira de Fonoaudiologia (SBFa) e Rede Nacional de Ensino em Terapia Ocupacional (RENETO).Com apoio do Ministério da Saúde, esse grupo de entidades vem desenvolvendo um projeto que compreende a realização de oficinas, que visam fortalecer a articulação entre as diferentes profissões e destas com atores estratégicos que compõem o SUS, além de ampliarem, potencializarem e aprofundarem a discussão e a troca de experiências desenvolvidas no contexto de projetos inovadores que busquem integrar ensino, assistência, extensão e pesquisa para o SUS.Nesse percurso já foram realizadas oficinas por categorias profissionais em todo o país e neste ano serão realizadas oficinas regionais, articulando todos os atores, com o objetivo de proporcionar o compartilhamento entre as profissões dos diferentes olhares e formulações a respeito dos desafios da implementação das diretrizes curriculares nesses dois campos; criar oportunidades para a reflexão conjunta em torno do tema da integralidade, considerado central para a inovação das práticas e da formação em saúde e construir um repertório mínimo compartilhado que subsidie a realização de oficinas e outros movimentos de aproximação regional entre as diferentes profissões da saúde.Para a Terapia Ocupacional, a participação nesse movimento tem sido muito produtiva e propiciado, no contexto do diálogo com tantas entidades, espaços valiosos de reflexão e troca de experiências, mas gostaríamos que a participação da área fosse ampliada e que mais profissionais pudessem ingressar nesse processo, especialmente nos espaços que serão abertos com a realização das oficinas em todo o país.Assim, convidamos a todos para juntarem-se a nós nessa construção, para isso sugerimos o acesso ao site do FNEPAS -www.fnepas.org.br para a obtenção de informações sobre a sua região e o contato com os coordenadores de cada uma delas, outra possibilidade é o contato com os representantes da RENETO, pois estamos, em um trabalho artesanal, ampliando nossas parcerias e participação e contamos com você.

Escape from purely theoretical classes is a major challenge during the basic cycle of education in the healthcare arena, as well as the maintenance of student attention during such classes. This generation is connected to a virtual world and has been addicted to technology since childhood, so it's necessary to find a language closer to their own to attract their interest to more theoretical topics, for example, through countless TV shows set in hospitals that are able to illustrate themes such as genetic diseases. The use of such television series has the advantage of using an innovative, dramatic, and shocking way to illustrate medical issues to be addressed in the classroom, even though it may be a bit exaggerated. Still, this participative methodology is able to capture the attention of the student and involves him/her in the selected theme, allowing a critical analysis of the video shown after the theoretical teaching of the subject chosen so that the student him or herself can discern fiction fantasy of real problems encountered in practice. The results observed are participatory classes, with greater contribution to the development of reasoning and drawing conclusions based on the strengthening of critical awareness and the active pursuit of knowledge.Word Keys: participative methodology, TV shows, education Supported by: UNIRIO