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La qualité de vie des parents d'enfant atteint d'autisme reste un champs de recherche encore sous-exploité malgré la richesse des informations qu'il peut apporter afin d'adapter au mieux les interventions aux besoins de l'enfant et de sa famille. Les objectifs de notre étude sont d'évaluer le niveau de qualité de vie qu'estiment avoir les parents d'enfant atteints d'autisme et son évolution dans le temps; observer s'il y a des différences entre les pères et les mères et observer quelles caractéristiques de l'enfant et de la famille sont associées à la qualité de vie des parents et peuvent être susceptible d’en être des déterminants. Nous avons pour cela fait une étude comparative entre 24 familles françaises et 24 familles allemandes et relevé nos données 2 fois á 12 mois d'intervalle. Nos résultats montrent que les enfants allemands, qui ont une prise en charge plus intense que les enfants français, ont une évolution plus importante dans leurs compétences en communication. Que ce soit en France ou en Allemagne, les mères, comme les pères, estiment que la pathologie de leur enfant a un impact moyen avec une tendance négative sur leur qualité de vie, et ce, de façon constante dans le temps. Le niveau d'irritabilité de l'enfant ainsi que le niveau de qualité de vie du conjoint sont fortement corrélés à la qualité de vie des parents, que ce soit en T1 ou en T2. / The quality of life of parents of autistic children rest a subject being little worked on in research despite the loads of information that could be collected to adapt the interventions at its best on the needs of the children and their families. The aims of our study are evaluating the level of the quality of life that the parents of autistic children have and how it develops with the time. It’s an aim to observe if there are differences between mothers and fathers, and which characteristics of the child and its family can be associated with the parents quality of life and can be susceptible of being determinants. That’s why we have made a comparative study between 24 German and 24 French families and collected data in intervals of 2 to 12 month. Our results show that German children, which are taken care of more intense than French children have a better development in their communicative competences. In Germany and in France the mothers and fathers estimate that the pathology of their child has a medium impact with negative tendencies on their quality – constantly. The level of irritability of the child as well as the level of the quality of live of the marriage partner is strongly correlated to the quality of live of the parents, independent of T1 or T2.

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maître en droit (LL.M.)" / Des progrès considérables ont été faits dans le domaine de la xénotransplantation ces dernières années, menant à des essais cliniques controversés impliquant des enfants au Mexique. Des risques sont associés à la xénotransplantation (la transplantation à l'être humain d'organes, de tissus ou de cellules provenant de l'animal) pour le receveur mais aussi pour le public en général. L'objectif de ce mémoire consiste à évaluer l'applicabilité des lois actuelles à la xénotransplantation pour déterminer la protection offerte par cet encadrement juridique. Pour identifier les lois possiblement applicables à la xénotransplantation, nous l'avons divisée en trois périodes: avant la chirurgie, pendant la xénotransplantation et celle post-intervention. Pour chacune de ces périodes, nous avons reconnu quatre groupes de personnes susceptibles d'être touchées par la réalisation de xénotransplantations; les receveurs, leurs proches, l'équipe médicale et finalement, la population en général. Ayant à l'esprit ces paramètres, nous avons vérifié si la loi à l'étude pouvait être applicable à la xénotransplantation en considérant les définitions fournies et son champ d'application. Par exemple, nous avons examiné si le xénogreffon (cellules, tissus ou organes) pouvait se qualifier de drogue ou d'instrument médical selon la Loi sur les aliments et drogues. Une étude de droit comparé est présentée entre les lois canadiennes et celles des États-Unis, de la France et du Royaume-Uni. Nous concluons à la nécessité d'une harmonisation tant au niveau national qu'au niveau international. / Recent advances in transplantation have reached the point where it may be possible to transplant an organ, tissue or ceIl from an animal to a human. Certain potential risks, for the beneficiary and to public health are associated with this procedure, which is referred to as xenotransplantation. The purpose of this study is to evaluate the applicability of current legislation to the possible risks to public health posed by xenotransplantation. In investigating this potential of existing legislation, the xenotransplantation process was divided into three periods : before the surgery, during the xenotransplantation and finaIly, the post-intervention period. For each period, we identified which legislation could apply to the beneficiaries of the xenotransplantation, their relatives, the medical team or the public in general. Then, we verified if that legislation could be applicable to xenotransplantation by looking at the definitions and its field of application. For example, whether the xenograft (ceIls, tissus or organs) could be a drug or a medical instrument under the Canadian Food and Drug Act was considered. The legislation examined include, but are not limited to, those that usuaIly apply to clinical trials, transportation of dangerous goods, working conditions or quarantine. This analysis illustrates the variety of possible legal characterizations of the xenograft. A comparison between Canadian legislation and those of the United States, France and United Kingdom is presented. It is concluded that there is a need to harmonize regulations at both national and intemationallevels.

L'autisme est un trouble universel et plusieurs études confirment la présence de l'autisme en Inde. Il y a de plus en plus d'études en Inde mais il manque encore d'informations précises sur les types d'interventions les plus utilisés. La qualité de vie des parents d'enfant avec autisme, reste un champ de recherche, encore peu exploité au niveau international. La qualité de vie parentale peut apporter une richesse d'informations afin d'adapter au mieux les interventions aux besoins de l'enfant et de sa famille. Les représentations sociales sur l'autisme nous permettent d'identifier des cognitions liées à l'autisme chez les parents et des professionnels indiens. Dans cette étude nous décrivons les caractéristiques de 15 enfants les interventions mise en place et la qualité de vie des mères et nous analysons les liens entre ces trois aspects. Nous établissons également une comparaison entre l'Inde et la France. Les résultats montrent des liens entre le nombre d'heures d'interventions et les caractéristiques adaptatives et psychologiques de l'enfant ainsi qu'avec la qualité de viedes mères. L'étude comparative montre des différences dans le profil adaptatif des enfants et les interventions des deux pays. Une deuxième partie aborde les questions des représentations sociales de l'autisme de 30 parents et 30 professionnels indiens et montre des différences entre les représentations des deux groupes. / Autism has been now established to be universal and several studies have confirmed the presence of Autism in India. There are an increasing number of studies in India but there is not much precise information on the most commonly used intervention techniques. The quality of life of parents of children with autism is an area of research that has not been sufficiently exploited despite its potential to influence intervention techniques and its adaptation to the child's and the family's unique situation. Social representations of autism will allow us to identify cognitions of parents and professionnels related to autism. In this study, we describe the characteristics of 15 children with autism, the quality of life of their mothers and the intervention techniques used. We also study the relationship between these three factors. A comparative study of these aspects between India and France is done. The results show links between the hours of interventions and the children's adaptive behaviour and psychological characteristics as well as with the quality of life of mothers. The comparative study shows differences in adaptive behaviour and intervention techniques between the two countries.A second part of the study deals with social representation of autism in 30 parents and professionals of autism. This study shows differences in the representations between the two groups.

[pt] O presente trabalho consistirá em um estudo de direito comparado, em que serão analisados instrumentos de participação política, consagrados como tais, nos ordenamentos jurídicos brasileiro e libanês. Isto é, os meios de exercício da soberania popular, já que as constituições de ambos os Estados adotam o princípio democrático. Para isso, serão fornecidas indicações básicas atinentes aos contextos jurídicos e sociopolíticos dos dois Estados; após, identificar-se-ão as principais normas dos sistemas eleitorais e partidários dos ordenamentos jurídicos brasileiro e libanês, bem como as regras referentes ao exercício da soberania popular, mais especificamente o direito de sufrágio e a previsão de instrumentos de participação política direta. Por fim, será realizado o cotejo, tendo em mente aferir a efetividade da participação política nos dois países, a partir de suas previsões legais, principalmente quanto à amplitude dessa participação, aos instrumentos indiretos e diretos consagrados e aos mecanismos de controle adotados. / [en] This work consists in a study of comparative law, in which instruments of political participation, established as such in the Brazilian and Lebanese legal systems are going to be analyzed. That is, the means of exercise of popular sovereignty, since the constitutions of both states adopt the democratic principle. For this purpose, basic indications relating to the legal, social and political contexts of the two states will be provided, and then the main rules of the electoral and party systems of the Brazilian and Lebanese legal systems are going to be identified, as well as the rules concerning the exercise of popular sovereignty, more specifically the right of suffrage and instruments of direct political participation established. Finally, the comparison will be done in order to assess the effectiveness of political participation in both countries, considering their legal provisions, particularly as to the extent of such participation, as the direct and indirect instruments comprised; and the control mechanisms adopted.

Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011 / INTRODUCTION: The University of the Witwatersrand (Wits) changed its medical curriculum in 2003 from a traditional, six-year curriculum to an integrated, problem-based, four year Graduate Entry Medical Programme (GEMP), preceded by two years of basic and medical sciences at university level or a suitable undergraduate degree. AIMS: To compare the preparedness for internship of Wits graduates from the old and new curricula on fifty seven items grouped into nine categories which were identified during the development and validation of a Model of the Competent South African Intern. METHODS: A stratified random sample of interns was drawn from the last graduates of the traditional curriculum and a matched sample of interns from the first graduates of the GEMP. Both quantitative and qualitative methods were used. For each sampled intern a supervisor, colleague and patient were selected by convenience sampling. A questionnaire was completed by interns, supervisors and colleagues followed by an interview to qualify responses at the extremes of the Likert-type scale and link them to curriculum learning opportunities. A semi- structured interview was conducted with patients and a global score allocated. The Cochran-Mantel-Haenszel Statistic for ordinal data was used. Comparisons were drawn between the competence of graduates from the traditional and GEMP curricula from the perspectives of interns, supervisors, colleagues and patients. Interview data were analysed using thematic analysis techniques. RESULTS: Significant differences were reported by interns in six of the nine categories. In one category, “fundamental theoretical knowledge” the GEMP graduates rated themselves significantly less prepared in the basic medical sciences (Pathology, Microbiology and Pathophysiology, p=0.01; Pharmacology, p<0.0001) but highly significantly better prepared in the theory of interpersonal communication, p<0.000001). The GEMP graduates rated themselves significantly better prepared in the other five categories, “medical problem solving” (p=0.009), “holistic patient management” (p=0.0004), “community health” (p=0.0002), “communication skills” (p=0.02) and “self directed learning” (p=0.0001). vii Supervisors reported significant differences in “teamwork” (p=0.045) and “personal attributes” (p=0.045) giving fewer low scores to the GEMP graduates. There were no significant differences between the category scores for colleagues. Qualitative analysis included vertical summaries of interview data and horizontal or comparative interpretations with quotations in order not to lose the voice of the interns, supervisors, colleagues and patients. DISCUSSION AND CONCLUSION: GEMP graduates rated themselves better prepared in those areas which had been identified as reasons for curriculum change but less prepared in specific basic medical sciences. Although these were not reported as significantly different by supervisors or colleagues they require attention. Other than this, according to the judgements of the informants, the competence of GEMP graduates was similar to that of traditional graduates in certain areas and significantly better in others, which appears to justify the major medical curriculum change undertaken at this University.

AbstractChange is incorporated in our personal and professional lives and there is no argument about that. In today’s era of constant technological and economical evolution, businesses are forced to adapt to the new circumstances by leveraging efficiency, decreasing time of adaptability in order to gain competitive advantage and survive. For this reason, the change management field’s role is considered to be crucial for all organizations in all industries. The change management process obtains multiple components among others, communication, leadership and resistance to be the most significant but at the same time the most challenging and problematic. It is widely recognized that organizational culture does play a substantial role in the overall change management process, however culture is being defined by another attribute too; nationality. Thus, the purpose of this thesis is to investigate which cultural factors influence and challenge change management. Furthermore, this research intends to investigate how masculinity versus femininity as a dimension in Hofstede’s cultural framework is reflected in the change management process.In order to address there two research questions, a qualitative multiple case study took place by obtaining data from two international companies operating in Sweden and Greece. The results of this research indicated that national culture has an impact on the change management process throughout multiple dimensions of Hofstede’s cultural framework. Last but not least, masculinity versus femininity appeared throughout all the examined change management processes. Participation and inclusion are concepts substantial for the feminine cultures whereas competition and individual benefits for the masculine ones. All these concepts for each culture should be taken into account in order to reduce change resistance and enhance the leadership efficiency. Overall, companies should take into consideration the national characteristics of the country they operate when forming strategies and applying processes in order to work an efficient and beneficial way for their employees.

Studiens syfte är att belysa hur den fysiska inomhusmiljön ser ut med likheter och skillnader i en förskola i Sverige samt en förskola i Sydafrika. De här tre frågeställningar har vi utgått från för att besvara syftet och få fram ett resultat, vad för artefakter exponeras i förskolornas fysiska inom-husmiljö? Vilka likheter och skillnader synliggörs på artefakter i de fysiska inomhusmiljöerna i Sverige och i Sydafrika? Vilka likheter och skillnader synliggörs på utrustning och utrymmen i de fysiska inomhusmiljöerna i Sverige och i Sydafrika? I studien används sociokulturellt perspektiv som teoretiskt perspektiv då det sociokulturella perspektivet har en stor betydelse för hur man kan se på artefakter och dess betydelse. I studien så användes dels en komparativ metod dels en kvalitativ form där observation genom fotografier användes som metod. Två förskolor deltog i studien, en i Sverige och en i Sydafrika. Antal fotografier i studien är 50 bilder från förskolan i Sverige respektive 30 bilder från förskolan i Sydafrika som användes för att analysera resultatet utifrån en kodningstabell. Resultatet visar på vilka skillnader och likheter det finns mellan de olika förskolorna samt vilka artefakter som exponeras i den fysiska inomhusmiljön / The aim of this study is to illustrate how the physical indoor environment is designed, with similarities and differences in a preschool in Sweden and a preschool in South Africa. We have investigated the following three questions: What artefacts are exposed in the preschools' physical indoor environment? What similarities and differences are made visible on artefacts in the physical indoor environments in Sweden and in South Africa? What similarities and differences are made visible on equipment and spaces in the physical indoor environments in Sweden and in South Africa? In the study a comparative method and a qualitative approach where observation through photographs was used as a method. Two preschools participated in the study, one in Sweden and one in South Africa. The number of photographs in the study is 50 images from the preschool in Sweden and 30 images from the preschool in South Africa that were used to analyse the results based on a coding table. The result shows the differences and similarities between the different preschools and how they have designed the physical indoor environment.

INTRODUÇÃO: Re-hospitalização é uma medida de desfecho reconhecida e utilizada em estudos para acessar prevenção de recaída que é considerada um dos principais indicadores de efetividade de um antipsicótico. Foi testada a hipótese que a clozapina seria superior aos demais antipsicóticos na prevenção de re-hospitalizações em pacientes com esquizofrenia que receberam alta do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1 de dezembro de 1997 e 31 de dezembro de 2004. MÉTODOS: Este foi um estudo observacional de coorte, retrospectivo, desenhado para avaliar o tempo de re-hospitalização de pacientes que receberam alta em uso de antipsicóticos convencionais ou antipsicóticos de segunda geração, exceto clozapina ou clozapina, por um período de três anos. A análise de sobrevivência foi estimada pela fórmula produtolimite de Kaplan-Meier. Foi utilizado o modelo de regressão de Cox para identificar fatores associados à re-hospitalização. RESULTADOS: Dos 464 pacientes com esquizofrenia que receberam alta no período do estudo, foram selecionados 242 pacientes. A re-hospitalização foi observada em 12 (17%) pacientes em uso de antipsicóticos convencionais, 27 (24%) pacientes em uso de antipsicóticos de segunda geração, exceto clozapina, e nove (15%) pacientes em uso de clozapina. As análises de sobrevivência demonstraram uma diferença estatisticamente significante entre os três grupos e entre os grupos de antipsicóticos de segunda geração e clozapina. As variáveis clínico-demográficas não foram associadas à re-hospitalização. CONCLUSÕES: O grupo de pacientes que recebeu clozapina apresentou menor taxa de re-hospitalização do que os demais grupos. As diferenças entre tempo de rehospitalização foram estatisticamente significantes entre os três grupos e entre os grupos de pacientes que receberam clozapina e antipsicóticos de segunda geração. Os resultados são limitados pela heterogeneidade da gravidade do transtorno entre os grupos. / INTRODUCTION: An important outcome parameter of drug effectiveness in schizophrenia is relapse prevention which can be reliably measured by time to rehospitalization. We tested the hypothesis that clozapine was superior to other antipsychotics in preventing rehospitalization in patients with schizophrenia discharged from the Institute of Psychiatry. METHODS: This is a retrospective observational cohort study designed to evaluate rehospitalization rates of patients with schizophrenia discharged from the Institute of Psychiatry of the Hospital das Clínicas of the University of Sao Paulo between Dec 1, 1997 and Dec 31, 2004 on a regimen of either conventional antipsychotics or nonclozapine second generation antipsychotics or clozapine during a three years follow-up. Risk factors associated with rehospitalization were examined by Cox regression model and survival curves were estimated by the product-limit formula (Kaplan-Meier). RESULTS: Of the 464 patients with schizophrenia discharged from hospital 242 met criteria to enter the study. They were followed at IPq outpatient clinic for three years. Of these 12 (17%) patients discharged in use of conventional antipsychotic, 27 (24%) in use of non-clozapine second generation antipsychotic, and nine (15%) in use of clozapine were rehospitalized. Survival analysis demonstrated a significant difference in timeto-rehospitalization between groups and between clozapine and second generation antipsychotics groups. CONCLUSIONS: Patients with clozapine were less rehospitalized than the others groups. The differences in time to rehospitalization were statistically significant between the three groups and between clozapine and nonclozapine second generation antipsychotics groups. Results were limited due to the heterogeneity of severity of illness between groups.

A hipertrofia ventricular esquerda (HVE) é importante fator de risco cardiovascular. O objetivo deste estudo retrospectivo foi verificar a associação de critérios eletrocardiográficos de HVE com as características anatômicas e histológicas do coração, em 51 pacientes submetidos à necropsia. Procedeu-se à medição do diâmetro transverso dos cardiomiócitos e da porcentagem de fibrose do ventrículo esquerdo e direito. Entre os pacientes que apresentavam HVE anatômica, o critério de Romhilt foi positivo em 92,3%, sendo superior aos demais critérios avaliados, com especificidade de 89,5% e sensibilidade de 68,8%, Foi o único que se associou a características anatômicas e histológicas do coração / The left ventricular hypertrophy (LVH) is an important cardiovascular risk factor. The purpose of the present retrospective paper is to examine the association of LVH electrocardiographic criteria with both anatomical and histological characteristics of the heart on 51 patients submitted to the necropsy. The study carried out the measurement of the transverse diameter of cardiomyocytes, as well as the percentage of fibrosis at both left and right ventriculi. Among those patients who presented anatomic LVH, the Romhilt criterium resulted positive in 92.3% of the cases, thus surpassing the other criteria evaluated, with specificity and sensibility up to 89.5% and 68.8% respectively. This was the only criterium associated to both anatomic and histological characteristics of the heart