For the second study, a web-based survey was developed and distributed to all members of four major health education organizations. A total of 1,925 HEs’ completed the survey and 1,607 responses were utilized in the final analysis. This study indicated that participants had deficient knowledge and unfavorable attitudes toward the CDCproposed genomic competencies. In the third study, a theoretical model was developed to predict HEs’ likelihood to incorporate genomic competencies into their practice. Using techniques from Structural Equation Modeling (SEM), the model was tested with the same data of the second study. Findings supported the proposed theoretical model. While genomic knowledge, attitudes, and self-efficacy were significantly associated with HEs’ likelihood to incorporate genomic competencies into their practice, attitudes was the strongest predictor of likelihood. In summary, these studies indicated that participating HEs had deficient genomic knowledge, unfavorable attitudes toward a set of CDC-proposed genomic competencies, and low likelihood to adopt genomic competencies into health promotion. Relevant training should be developed and advocated. As the SEM analysis results indicated the survey findings supported the proposed theoretical model, which can be utilized to steer future training for HEs. statistics, 2) unadjusted inferential statistics, 3) stratified analysis, and 4) multivariable models. My investigation produced results in accord with generally accepted notions in addition to significant findings that interestingly counter current preconceptions. Intraspecies contact was more common than inter-species, with indirect contact occurring more frequently than direct. Direct contact between species occurred extremely rarely. The most important factors that influenced the rate of contact for both species were water, winter, and cultivated fields. Information regarding probability of infectious agent survival and transfer will be used in the future to advance current epidemiological models, including geographicautomata (Ward et al. 2007: In Press) and cellular automata models (Doran and Laffan 2005) to better understand and manage integrated domestic cattle and free-ranging wildlife populations. Such modeling provides essential and necessary knowledge for developing prevention, detection, response, and recovery strategies – employed in advance, during, and after a disease outbreak, respectively.

Deux enquêtes épidémiologiques mises en place dans les forêts de Brotonne et de Mauny, en Normandie, ont montré que la tuberculose à Mycobacterium bovis était présente à des pourcentages de prévalence importants chez les cerfs élaphes (Cervus elaphus) et les sangliers (Sus scrofa). La souche de M. bovis isolée est la même que celle qui circule dans les élevages bovins voisins depuis au moins 1995. Les sensibilité, spécificité et valeurs prédictives de l'examen nécropsique en tant qu'outil diagnostique indiquent qu'il peut être utilisé pour suivre la maladie dans les populations de cerfs élaphes où la tuberculose bovine est bien installée. La différence du cadre lésionnel entre les cerfs et les sangliers suggère que le cerf joue un rôle plus important dans la dissémination de l'infection. Un modèle déterministe montre qu'une stratégie de lutte fondée sur l'éradication des cerfs élaphes et sur un ramassage exhaustif de viscères permettrait d'obtenir une disparition de l'infection.

The hair shaft has increasing importance in bioarchaeology, since it is now possible to retrieve detailed biomolecular information on recent life history using individual fibres (e.g., on diet, drug use and DNA). Data on hair condition is an important cornerstone to ensuring that reliable information is obtained. The following study defines morphological features of degradative change in human terminal scalp hair using different microscopy techniques. Evidence of degradative change is translated into a ranked histology for assessing hair sample condition. The approach is applied to samples of cut modern scalp hair subjected to degradation under soil burial/simulated grave conditions.

El present treball analitza al microscopi òptic i al microscopi electrònic de transmissió el testicle de Sus domesticus (raça Landrace - varietat anglesa) a partir de mascles reproductors porcins adults i sans. L'objectiu principal de tots els centres d'Inseminació Artificial Porcina i de les Explotacions de Selecció i Multiplicació Porcina és garantir una excel·lent qualitat espermàtica al llarg de la vida reproductiva útil d'un mascle reproductor porcí. Així doncs, un millor coneixement dels patrons estructural i ultraestructural normals del testicle permetrà diagnosticar amb facilitat quina ha estat l'estructura o funció testicular afectada quan s'observa una disminució de la qualitat del semen. Les anàlisis seminals i hormonals són certament crucials en la valoració d'aquests mascles, però, no són totalment informatives de les alteracions testiculars, ja que és necessari conèixer l'organització microscòpica.Diversos estudis sobre testicle han demostrat que els marcadors més sensibles per a l'avaluació de la funció testicular són els següents: (1) la grandària testicular, (2) el gruix i l'organització de la càpsula testicular, (3) el percentatge de túbuls seminífers i de teixit intersticial en el parènquima testicular, (4) el diàmetre dels túbuls seminífers, (5) l'alçada i la composició de cèl·lules germinals de l'epiteli seminífer, (6) el gruix i l'organització de la làmina pròpia i, (7) la morfologia i la grandària de les cèl·lules de Leydig. El primer objectiu concret del present estudi ha estat, per tant, caracteritzar tots aquests paràmetres testiculars en mascles porcins sans i adults. L'organització estructural del testicle i les mesures quantitatives utilitzades com a marcadors no mostren diferències significatives ni entres els mascles porcins (P > 0,01), ni entre el testicle dret i l'esquerre (P > 0,01). Els testicles, de 330,80  16,99 g de pes, estan envoltats per una càpsula, de 2.375,13  246,68 m de gruix, la qual es divideix en tres capes: la túnica vaginalis constitueix l'1,82  0,78 % de la càpsula i està composta per una capa mesotelial externa i una capa interna de teixit conjuntiu dens; la túnica albuginea representa el 37,31  3,27 % i és de teixit conjuntiu dens i, la túnica vasculosa constitueix el 64,24 4,40 % i és de teixit conjuntiu lax. En el parènquima testicular els túbuls seminífers i el teixit intersticial representen el 72,44  2,12 % i el 27,46  2,12 %, respectivament. Els túbuls seminífers, de 226,23  18,08 m de diàmetre, es troben fortament recargolats i empaquetats, i estan compostos per la làmina pròpia i l'epiteli seminífer. La làmina pròpia, de 4-4,5 m de gruix, està formada per la làmina basal i dues capes de cèl·lules peritubulars. L'epiteli seminífer, amb una alçada mitjana de 66,11  10,62 m, és columnar i estratificat amb cèl·lules de Sertoli i diferents generacions d'espermatogònies, espermatòcits i espermàtides. El teixit intersticial és un teixit conjuntiu lax amb abundants cèl·lules de Leydig polièdriques fortament empaquetades (ca. 15 x 12 m).El segon objectiu concret d'aquest estudi ha estat estudiar des del punt de vista morfològic i morfomètric (alçada, longitud, freqüència relativa d'aparició i durada) els estadis del cicle de l'epiteli seminífer en els mascles porcins de la raça Landrace (varietat anglesa), classificats d'acord amb el mètode de la morfologia tubular. Els estadis premeiòtics ( I, II i III) ocupen el 31,9 % del cicle espermatogènic i es caracteritzen, principalment, per la presència de cèl·lules en les fase inicials de la meiosi I. Les primeres etapes de la meiosi I no afecten els paràmetres morfomètrics de l'epiteli seminífer ja que els valors obtinguts per l'alçada de l'epiteli seminífer, la freqüència relativa, la longitud i la durada d'aquests estadis són molt variables. Els estadis meiòtics (IV i V) representen el 16,4 % del cicle espermatogènic i estan constituïts, principlament, per cèl·lules en un estat avançat de la meiosi I i /o cèl·lules en meiosi II. Les últimes fases de la meiosi I i també de la meiosi II tenen lloc ràpidament, la qual cosa resulta en una baixa freqüència relativa d'aparició i, per tant, en una baixa durada dels estadis meiòtics. Els estadis postmeiòtics (VI, VII i VIII) ocupen el 50,6 % del cicle espermatogènic. L'esdeveniment més important que té lloc en aquests estadis és la fase de maduració de l'espermiogènesi. En la fase de maduració, les espermàtides experimenten diverses modificacions morfològiques i estructurals que donen lloc, finalment, als espermatozoides. La complexitat d'aquests processos fa que els estadis postmeiòtics presentin valors més grans de freqüència relativa, longitud i durada.El tercer objectiu concret d'aquest treball ha estat descriure a nivell ultraestructural el procés d'espermiogènesi, i relacionar les transformacions que experimenten les espermàtides en fase d'elongació amb els canvis ultraestructurals que tenen lloc en les diferents cèl·lules que constitueixen el testicle (cèl·lules germinals, de Sertoli i de Leydig, principalment). L'espermiogènesi del mascle porcí de la raça Landrace (varietat anglesa) s'ha dividit en 9 passos que vénen definits per 9 tipus diferents d'espermàtides. Al llarg de l'espermiogènesi no s'observen diferències ultraestructurals significatives (P > 0,01) ni entre els mascles porcins ni entre el testicle esquerre i dret en les cèl·lules que constitueixen el testicle. / The present study describes the structure and ultrastructure of the Sus domesticus testis (Landrace breed -british variety) from healthy adults boars. The main goal of the whole of Porcine Artifitial Insemination Centres and of the Porcine Livestocks is to guarantee an excellent spermatic quality along the boar reproductive life. Therefore, a better knowlegment of the normal structural and ultrastructural patterns of the testis will improve the prognosis of subfertility when a low spermatic quality is observed. Both seminal and hormonal analysis are certainly crucial in the assessment of these males, but it is also necessary to know the microscopic organization.Several studies have demonstrated that the most sensitive markers of impaired function are: (1) the testicular size, (2) the thickness and organization of the testicular capsule, (3) the percentage of seminiferous tubules and interstitial tissue in the testicular parenchyma, (4) the diameter of seminiferous tubules, (5) the height and germ cell composition of the seminiferous epithelium, (6) the thickness and organization of the lamina propria, and (7) the Leydig cell size and morphology. The first aim of this study has been to characterize all these testicular parameters in healthy adults boars. The structural organization of the testis and quantitative measures used as markers did not differ significantly either among boars (P > 0.01), or between left and right testes (P > 0.01). Testes, of 330.80  16.99 g weight, were surrounded by a capsule, of 2,375.13  246.68 m thick, divided into three layers: the tunica vaginalis constituted 1.82  0.78% of the capsule and was composed by an outer mesothelial layer and an inner dense connective tissue layer; the tunica albuginea represented 37.31  3.27% and was of dense connective tissue and the tunica vasculosa constituted 64.26  4.40% and was of loose connective tissue. In the testicular parenchyma, the seminiferous tubules and the interstitial tissue comprised 72.44  2.12% and 27.46  2.12%, respectively. Seminiferous tubules were highly convoluted ducts of 226.23  18.08 m in diameter composed by a lamina propria and the seminiferous epithelium. The lamina propria, of 4-4.5 m thick, was formed by basal lamina and two layers of peritubular cells. The seminiferous epithelium, of 66.11  10.62 m high, was stratified columnar with Sertoli cells and different generations of spermatogonia, spermatocytes and spermatids. The interstitial tissue was loose connective tissue with abundant and closely-packed polyhedral Leydig cells (av. 15 x 12 m).The second aim of this study has been to describe the morphological features of the eight stages of the seminiferous epithelium in Landrace boars (british variety) according to the tubular morphology method, as well as their relative frequency, length, height and duration. Premeiotic stages (I, II and III) occupied the 31.9 % of the spermatogenic cycle and were mainly characterized by the presence of cells in the initial phases of meiosis I. Early meiosis I did not affect the morphometric parameters of the seminiferous epithelium as indicated by the variable values obtained in the seminiferous epithelium height, as well as in the relative frequency, length, and duration of premeiotic stages. Meiotic stages (IV and V) represented the 16.4 % of the spermatogenic cycle and were constituted, mainly, by cells in advanced meiosis I and/or cells in meiosis II. Last phases of meiosis I and also meiosis II occurred rapidly, resulting in low relative frequency and, therefore, in low duration of meiotic stages. Postmeiotic stages (VI, VII and VIII) occupied the 50.6 % of the spermatogenic cycle. The most important event of these stages was the maturation phase of spermiogenesis. The maturation phase included several morphological and ultrastructural modifications in spermatids, resulting in the formation of spermatozoa. The complexity of these processes correlated with the high relative frequency, length, and duration of postmeiotic stages.The third aim of this study has been to describe the spermiogenesis process at ultrastructural level and, to relate the spermatid transformations along the spermiogernesis with the ultraestructural changes undergoing in testicular cells (mainly germinal, Sertoli and Leydig cells).The spermiogenesis of Landrace boars (british variety) was divided into 9 steps, each one characterized by the presence of an specific spermatid type. Significant differences were found neither among the three healthy boars (P > 0.01), nor the left and right testes (P > 0.01) in the ultrastructure of the testiculars cells along spermiogenesis.

Doutor -- Escola Nacional de Saude Publica, Rio de Janeiro, 2000.

For decades the care of disabled population in Brazil has been neglected by the government and was provided largely by the charitable institutions. It was as only recently, as in the year 2011 that Brazilian government created the national plan for the rights of the disabled people. The plan articulates policies regarding social inclusion, access to education, accessibility and health care. The last section of the plan includes the provision of wheelchairs free of cost to the Brazilians citizens, who are in need of a wheelchair. It is common knowledge that a wrong wheelchair specification can lead to physical damage for the user and the carer; the abandonment of device, and wastage of time and resources involved in the wheelchair provision. The World Health Organization has propounded several good practices and training material with reference to wheelchair services towards enabling of right wheelchair fit to the user characteristics. Though, there is no evidence that the service provided in Brazil adheres to these guidelines or any other wheelchair service good practice. This research reviews the wheelchair service provision in Belo Horizonte city, Brazil with the aim to understand the functionality of these services in order to provide context-specific interventions and recommendations to improve the design of current services. Herein, three main studies were conducted using a mix of methods: A first exploratory study was conducted to assess the Belo Horizonte assistive technology services and identify a research focus. A second study was conducted to develop an in-depth insight on the understanding of the wheelchair service provided and to collect the necessary information towards creating a context-based and collaborative designed intervention. A third study was conducted to evaluate and improve the proposed interventions. A total of sixty-six interviews were conducted (n=66) with service stakeholders and two hundred and fifty user care observed (n=250) from which ninety-five (n=95) tested the proposed interventions.

Esta tese analisa a emergência histórica da participação comunitária no campo da saúde e as ressonâncias contemporâneas desta experiência na prática política do Fórum em Defesa do SUS do Rio Grande do Sul, em sua luta contra a privatização da saúde. A participação comunitária emerge como um foco de experiência no contexto de irrupção da Reforma Sanitária e de defesa de um sistema público de saúde. As condições de possibilidade para a emergência deste foco de experiência vinculam-se à produção histórica dos diferentes lugares que ocuparam os sujeitos, como foco de investimento, na construção das políticas públicas de saúde brasileiras desde o século XIX. Esse foco de experiência produz os sujeitos como força política ativa na formulação e implementação da política pública de saúde. Ele tem como parte de seu regime de veridicção a distinção entre público e privado, contornando o privado como aquilo do qual o público deve afastar-se, demarcando fronteiras dicotomizadas. O foco de experiência da participação comunitária, ao aproximar-se do direito, como estratégia política de luta e de institucionalização nas malhas do Estado, percorre o caminho em direção à imunização negativa do direito à saúde pelo Estado. A participação comunitária, quando encontra o direito, insere-se nesse universo dual do sistema de propriedades e passa a generalizar o comum de sua reivindicação em um sentido de propriedade pública, ou seja, propriedade estatal. Nesse sentido, propomos uma participação comunitária que não se limite a reproduzir modelos e que rompa com a dicotomia público/privado, em prol da noção de comum e da afirmação de uma norma de vida. Isso pressupõe uma inversão, não mais o direito e seu regramento reproduzindo modelos de vida, mas a vida produzindo normas de vida sem cessar. / This thesis analyzes the historical emergence of community participation in the health field and contemporary resonances of that experience in the political practice of the Forum in Defense of SUS of Rio Grande do Sul, in its fight against health privatization. Community participation has emerged as a focus of experience in the context of the Sanitary Reform and defense of a public health system. The conditions of possibility for the emergence of such focus of experience are linked to the historical production of different places the subjects have occupied, as a focus of investment, in the construction of Brazilian public health policies since the nineteenth century. This focus of experience has produced the subjects as an active political force in both the formulation and implementation of the public health policy. As an integral part of its veridiction regime, it has the distinction between public and private delineating the private as something from which the public should be moved away, thus drawing dichotomized borders. The focus of experience of community participation, by approximating to law, as a political strategy of fight and institutionalization in the State meshes, follows the path of negative immunization of the right to health by the State. Community participation, by associating with law, enters this dual universe of the system of properties and starts generalizing what is common in its claim as being public property, i.e. State property. In this sense, we have proposed a kind of community participation that is not limited to the reproduction of models and is able to disrupt the public/private dichotomy in favor of both the notion of common and the affirmation of a life norm. This presupposes an inversion - instead of the reproduction of ways of life by law and its rules, the incessant production of life norms by life itself.

Esta tese objetivou compreender as interfaces entre educação e saúde no contexto da educação especializada, especificamente em Programas de Residência Multiprofissional em Saúde. Foi embasada nas contribuições das preceptoras e dos preceptores que atuam na Residência Integrada em Saúde do Grupo Hospitalar Conceição (RIS/GHC), de Porto Alegre, Brasil. As questões orientadoras da pesquisa foram delineadas para identificar o seguinte: 1) fatores que estimulam ou dificultam o trabalho dos preceptores no âmbito da docência, da atenção e do desenvolvimento institucional em saúde; 2) forma como as preceptoras e os preceptores interagem com as equipes multiprofissionais e as/os residentes; 3) aspectos indicativos do trabalho imaterial em um contexto de Residência Multiprofissional em Saúde; e 4) elementos necessários para que uma instituição-escola na saúde promova formação mediante este tipo de Residência. Algumas pistas descobertas permitiram indicar que o trabalho real desenvolvido no exercício da preceptoria resulta em uma sobrecarga de tarefas, ultrapassando fronteiras entre disciplinas, sendo diferente do trabalho prescrito, que é embasado em limites profissionais. Possui valores sem dimensão, pois é impossível mensurá-los pelos critérios vigentes de tempo e espaço. Parece haver uma assincronia entre o que a Residência Multiprofissional em Saúde precisa e o que a instituição-escola na saúde proporciona, sendo um exemplo as diferentes expectativas de seus protagonistas. As proposições estão ligadas às necessidades identificadas de contar com profissionais para prestar atenção à saúde em número proporcional ao tempo que os preceptores dedicam à docência; reconhecer que o trabalho da docência em serviço é permeado pela (re)criação; e proporcionar que o possível seja encarado como potência rumo ao avanço, não à limitação. O ponto de chegada da tese constitui mais uma indicação de continuidade do que um ponto final. O desafio passa a ser reconhecer que a instituição-escola na saúde está em permanente (re)construção. / This thesis aimed to understand the interfaces between education and health under the context of specialized education, provided by Health Multiprofessional Residency Programs. It was based on the input of the preceptors who are linked to the Residência Integrada em Saúde do Grupo Hospitalar Conceição (RIS/GHC), from Porto Alegre, Brazil. The guiding questions of the research were designed to identify the following: 1) factors that encourage or hinder the work of preceptors within the scope of health teaching, care, and institutional development; 2) how preceptors interact with the multiprofessional teams and the residents; 3) aspects indicating immaterial work in the context of the Multiprofessional Health Residency Program; and, 4) elements that are necessary for a health institution-school to promote education by means of this kind of Residency. Some clues that were found have allowed me to indicate that the real work developed by the preceptors results in an overload of tasks, surpassing frontiers between disciplines, being different from the prescribed work, which is based on professional limits. It has values that cannot be gauged, since it is impossible to measure them according to current criteria of time and space. There seems to be a lack of synchronicity between what the Multiprofessional Residency demands and what the health institution-school provides, one example being the different expectations of its protagonists. The propositions are linked to the identified needs to have enough professionals to provide health care according to the proportion of time the preceptors dedicate to teaching; to acknowledge that the in-service teaching work is permeated by (re)creation; and, to provide that the possible is seen as potency towards the advancement, not limitation. The point reached by this thesis is more an indication to continuation than a final point. The challenge now is to acknowledge that the health institution-school is under permanent (re)construction.

Submitted by Gustavo Gomes (gustavolascasas@gmail.com) on 2013-11-19T12:52:28Z No. of bitstreams: 1 A contribui????o do Projeto Apoiador do COSEMSMG no espa??o de gest??o regional.pdf: 1416576 bytes, checksum: 241c1b2fb04a4f16c8585fbce0fcc7c0 (MD5) / Approved for entry into archive by Roger Guedes (roger.guedes@fjp.mg.gov.br) on 2013-11-19T16:24:14Z (GMT) No. of bitstreams: 1 A contribui????o do Projeto Apoiador do COSEMSMG no espa??o de gest??o regional.pdf: 1416576 bytes, checksum: 241c1b2fb04a4f16c8585fbce0fcc7c0 (MD5) / Made available in DSpace on 2013-11-19T16:24:14Z (GMT). No. of bitstreams: 1 A contribui????o do Projeto Apoiador do COSEMSMG no espa??o de gest??o regional.pdf: 1416576 bytes, checksum: 241c1b2fb04a4f16c8585fbce0fcc7c0 (MD5) Previous issue date: 2012 / - / A implementa????o da pol??tica de sa??de, num pa??s federativo como o Brasil, demanda a integra????o de a????es dos diversos n??veis de governo com equil??brio entre competi????o e coopera????o, mantendo a unidade na diversidade, o entrela??amento entre os n??veis de governo e a rela????o de equil??brio entre a autonomia dos pactuantes e a interdepend??ncia entre eles. A rela????o intergovernamental inerente ao processo de descentraliza????o remete ao problema te??rico cl??ssico sobre a possibilidade de a????o coletiva ou de coopera????o entre os entes aut??nomos na ades??o ?? pol??tica nacional de sa??de. Para potencializar o processo de descentraliza????o, fortalecendo estados e munic??pios para exercerem papel de gestores e para que as demandas dos diferentes interesses loco-regionais possam ser organizadas e expressadas na regi??o, ?? refor??ada a diretriz da Regionaliza????o do Sistema ??nico de Sa??de (SUS). O processo de regionaliza????o da aten????o ?? sa??de em Minas Gerais, especialmente referente ?? gest??o regional de sa??de trouxe ?? luz um novo cen??rio para o Colegiado dos Secret??rios Municipais de Sa??de de Minas Gerais (COSEMS/MG). Este cen??rio imp??s uma nova proposta de atua????o do COSEMS/MG, com a implanta????o do Projeto Apoiador, frente ?? gest??o regional de sa??de, buscando fortalecer a institui????o, os COSEMS Regionais e os gestores municipais na gest??o microrregional de sa??de. O objeto deste trabalho ?? analisar o Projeto Apoiador como estrat??gia de melhoria da rela????o intergovernamental, especialmente para os gestores municipais, no espa??o regional de gest??o do SUS/MG, a partir da percep????o dos gestores de sa??de que atuam no espa??o regional. Os resultados obtidos apontam que Projeto rebaixa os custos de transa????o propiciando a coopera????o na rela????o intergestores no espa??o regional; promove a dissemina????o de informa????es; fortalece a atua????o regional do COSEMS; fortalece a capacidade pol??tico institucional dos munic??pios e dos COSEMS Regionais nas rela????es intergovernamentais que precisam de coopera????o e coordena????o em nosso Estado Federativo; aglutina gestores no COSEMS Regional e possibilita a contextualiza????o da discuss??o estadual do COSEMS com a Secretaria de Estado da Sa??de de Minas Gerais (SES/MG). / Sa??de

Esta tese objetivou compreender as interfaces entre educação e saúde no contexto da educação especializada, especificamente em Programas de Residência Multiprofissional em Saúde. Foi embasada nas contribuições das preceptoras e dos preceptores que atuam na Residência Integrada em Saúde do Grupo Hospitalar Conceição (RIS/GHC), de Porto Alegre, Brasil. As questões orientadoras da pesquisa foram delineadas para identificar o seguinte: 1) fatores que estimulam ou dificultam o trabalho dos preceptores no âmbito da docência, da atenção e do desenvolvimento institucional em saúde; 2) forma como as preceptoras e os preceptores interagem com as equipes multiprofissionais e as/os residentes; 3) aspectos indicativos do trabalho imaterial em um contexto de Residência Multiprofissional em Saúde; e 4) elementos necessários para que uma instituição-escola na saúde promova formação mediante este tipo de Residência. Algumas pistas descobertas permitiram indicar que o trabalho real desenvolvido no exercício da preceptoria resulta em uma sobrecarga de tarefas, ultrapassando fronteiras entre disciplinas, sendo diferente do trabalho prescrito, que é embasado em limites profissionais. Possui valores sem dimensão, pois é impossível mensurá-los pelos critérios vigentes de tempo e espaço. Parece haver uma assincronia entre o que a Residência Multiprofissional em Saúde precisa e o que a instituição-escola na saúde proporciona, sendo um exemplo as diferentes expectativas de seus protagonistas. As proposições estão ligadas às necessidades identificadas de contar com profissionais para prestar atenção à saúde em número proporcional ao tempo que os preceptores dedicam à docência; reconhecer que o trabalho da docência em serviço é permeado pela (re)criação; e proporcionar que o possível seja encarado como potência rumo ao avanço, não à limitação. O ponto de chegada da tese constitui mais uma indicação de continuidade do que um ponto final. O desafio passa a ser reconhecer que a instituição-escola na saúde está em permanente (re)construção. / This thesis aimed to understand the interfaces between education and health under the context of specialized education, provided by Health Multiprofessional Residency Programs. It was based on the input of the preceptors who are linked to the Residência Integrada em Saúde do Grupo Hospitalar Conceição (RIS/GHC), from Porto Alegre, Brazil. The guiding questions of the research were designed to identify the following: 1) factors that encourage or hinder the work of preceptors within the scope of health teaching, care, and institutional development; 2) how preceptors interact with the multiprofessional teams and the residents; 3) aspects indicating immaterial work in the context of the Multiprofessional Health Residency Program; and, 4) elements that are necessary for a health institution-school to promote education by means of this kind of Residency. Some clues that were found have allowed me to indicate that the real work developed by the preceptors results in an overload of tasks, surpassing frontiers between disciplines, being different from the prescribed work, which is based on professional limits. It has values that cannot be gauged, since it is impossible to measure them according to current criteria of time and space. There seems to be a lack of synchronicity between what the Multiprofessional Residency demands and what the health institution-school provides, one example being the different expectations of its protagonists. The propositions are linked to the identified needs to have enough professionals to provide health care according to the proportion of time the preceptors dedicate to teaching; to acknowledge that the in-service teaching work is permeated by (re)creation; and, to provide that the possible is seen as potency towards the advancement, not limitation. The point reached by this thesis is more an indication to continuation than a final point. The challenge now is to acknowledge that the health institution-school is under permanent (re)construction.