[Medical education and the integration of teaching and health care activities]. / Formação médica e integracão de atividades docentes e assistenciais.

A research project involving eighty first-year medical students who observed the experiences of first-time patients admitted to a university hospital in South-eastern Brazil was undertaken during the first semester of 1989. The students conducted 260 interviews and followed the patients through from the time of admittance, observing the patients' expectations, values and attitudes towards minor complaints. The objective of the experience was to open a forum for discussion about excessive specialization and inadequacies in the curriculum in preparing the future medical professional to meet the needs of the population. Both the criticisms in the students' testimonies and the data collected at the interviews, as well as the concrete facts and practical proposals regarding the modification of the curriculum, concur with the Edinburgh Declaration of 1988. They point to the need for the adoption of a mode by which teaching and assistance activities, might be integrated from the very beginning of the physician's training.

[The relationship between payment for childbirth care and prevalence of cesarean sections in maternity hospitals in Rio de Janeiro: a review of Carlos Gentile de Mello's hypothesis] / Associação entre a remuneração da assistência ao parto e a prevalência de cesariana em maternidades do Rio de Janeiro: uma revisão da hipótese de Carlos Gentile de Mello.

The purpose of this study was to compare prevalence of cesarean sections in nine private maternity hospitals in the city of Rio de Janeiro in 1968 and 1993, seeking to correlate the form of payment with prevalence of cesareans. We analyzed 3,413 deliveries in 1968 in nine maternity hospitals, at a time when a form of payment called "per service unit" was used. Twenty-five years later, these same maternity hospitals were reanalyzed, with a total of 11,065 births. These data were from Gentile de Mello (1968) and the Report from the Information System on Live Births, by the Rio de janeiro Municipal Health Secretariat. We performed a statistical analysis on the proportion of cesareans comparing the two years and observed a statistically significant increase in their prevalence in 1993 as compared to 1968, although payment was nearly equal for childbirth care in the two years. The elimination of the "per service unit" payment system and the implementation of equal payment for transvaginal and cesarean deliveries proved insufficient to decrease the prevalence of cesareans. We suggest that form of payment alone does not determine the high prevalence of cesarean sections, and that other variables are impacting this phenomenon.