No / After many years of equal opportunities legislation, motherhood still limits womens' career progress even in a feminized occupation such as nursing. While the effect of motherhood, working hours, career breaks and school aged children upon career progression has been discussed widely, its actual scale and magnitude has received less research attention. The purpose of this paper is to examine the impact of these factors individually and cumulatively. Design/methodology/approach: This paper considers the impact of the above through a longitudinal analysis of a demographically unique national database, comprising the 46,565 registered nursing workforces in NHS Scotland from 2000-2008. The variables examined include gender, employment grades, number and length of career breaks, lengths of service, age, working patterns, the number and age of dependent children. Findings: The results indicate: motherhood has a regressively detrimental effect on women's career progression. However, this is a simplistic term which covers a more complex process related to the age of dependent children, working hours and career breaks. The degree of women's restricted career progression is directly related to the school age of the dependent children: the younger the child the greater the detrimental impact. Women who take a career break of greater than two years see their careers depressed and restricted. The results confirm that whilst gender has a relatively positive effect on male career progression; a women's career progression is reduced incrementally as she has more children, and part-time workers have reduced career progression regardless of maternal or paternal circumstances. Originality/value: This paper is the only example internationally, of a national workforce being examined on this scale and therefore its findings are significant. For the first time the impact of motherhood upon a women's career progression and the related factors; dependent children, career breaks and part-time working are quantified. These findings are relevant across many areas of employment and they are significant in relation to broadening the debate around equal opportunities for women. Purpose - After many years of equal opportunities legislation, motherhood still limits womens' career progress even in a feminized occupation such as nursing. While the effect of motherhood, working hours, career breaks and school aged children upon career progression has been discussed widely, its actual scale and magnitude has received less research attention. The purpose of this paper is to examine the impact of these factors individually and cumulatively. Design/methodology/approach - This paper considers the impact of the above through a longitudinal analysis of a demographically unique national database, comprising the 46,565 registered nursing workforces in NHS Scotland from 2000-2008. The variables examined include gender, employment grades, number and length of career breaks, lengths of service, age, working patterns, the number and age of dependent children. Findings - The results indicate: motherhood has a regressively detrimental effect on women's career progression. However, this is a simplistic term which covers a more complex process related to the age of dependent children, working hours and career breaks. The degree of women's restricted career progression is directly related to the school age of the dependent children: the younger the child the greater the detrimental impact. Women who take a career break of greater than two years see their careers depressed and restricted. The results confirm that whilst gender has a relatively positive effect on male career progression; a women's career progression is reduced incrementally as she has more children, and part-time workers have reduced career progression regardless of maternal or paternal circumstances. Originality/value - This paper is the only example internationally, of a national workforce being examined on this scale and therefore its findings are significant. For the firs time the impact of motherhood upon a women's career progression and the related factors - dependent children, career breaks and part-time working are quantified. These findings are relevant across many areas of employment and they are significant in relation to broadening the debate around equal opportunities for women.

Graphicacy is the fundamental human capability of communicating through still images. Graphicacy has been described as the fourth ace within education, alongside literacy, numeracy and articulacy. However, it has been neglected, both within education and the research field. This thesis investigates graphicacy and students learning, structured around 3 objectives: establishing what graphicacy is and how it is used in the school curriculum; demonstrating the wider significance of design and technology teaching and learning by collecting evidence of the importance of graphicacy across the curriculum; and establishing how the abilities to understand and create images affect students learning. A literature review was conducted focused on three areas. Firstly, identifying the meaning of graphicacy, elements contained within it and relevant prior studies including its use in different subject areas and image use within teaching. This formed the foundations for a new taxonomy of graphicacy. Secondly, the levels of drawing and developmental stages children go through were investigated and the need for further research on children s abilities aged 11 to 14 was identified. The well balanced arguments concerning the nature versus nurture debates are described. Thirdly, the methodology used to measure graphicacy, and map the results to reflect levels of different competencies were reviewed. A naturalistic and often opportunistic approach was followed in this research. The research methodology was based on the analysis of textbooks and later, on research within practice. The research included the development, validation and use of the taxonomy of graphicacy; case studies in Cyprus, the USA and England on identifying graphicacy use across the curriculum; and the creation of continuity and progression descriptors through the analysis of students work. This work covered: rendering, perspective drawing, logo designing, portrait drawing and star profile charts. Research methodologies developed and implemented for conducting co-research and the Delphi studies are also described. Through interviews with experts, the taxonomy was validated as an appropriate research tool to enable the identification of graphicacy use across the curriculum. These research studies identified links between design and technology and all other subject-areas studied. Similar patterns of graphicacy use were identified across 3 schools, one in Cyprus, USA and the UK. Photographs were the most commonly used graphicacy element across all subject areas studied. Design and technology within England was found to use the widest variety of graphicacy elements, providing evidence towards research objective 3; establishing how the ability to understand and create images affects students learning. Continuity and progression (CaP) descriptors were created for each area covered by this research. The success of the CaP descriptors relied on the technical complexity involved in the creation of each image. Some evidence was found concerning the limits of natural development and how nurture can further develop graphicacy skills. In addition, co-research as a methodology, its limitations and potentials are identified.

Prognostic models have clinical appeal to aid therapeutic decision making. In the UK, the Nottingham Prognostic Index (NPI) has been used, for over two decades, to inform patient management. However, it has been commented that NPI is not capable of identifying a subgroup of patients with a prognosis so good that adjuvant therapy with potential harmful side effects can be withheld safely. Tissue Microarray Analysis (TMA) now makes possible measurement of biological tissue microarray features of frozen biopsies from breast cancer tumours. These give an insight to the biology of tumour and hence could have the potential to enhance prognostic modelling. I therefore wished to investigate whether biomarkers can add value to clinical predictors to provide improved prognostic stratification in terms of Recurrence Free Survival (RFS). However, there are very many biomarkers that could be measured, they usually exhibit skewed distribution and missing values are common. The statistical issues raised are thus number of variables being tested, form of the association, imputation of missing data, and assessment of the stability and internal validity of the model. Therefore the specific aim of this study was to develop and to demonstrate performance of statistical modelling techniques that will be useful in circumstances where there is a surfeit of explanatory variables and missing data; in particular to achieve useful and parsimonious models while guarding against instability and overfitting. I also sought to identify a subgroup of patients with a prognosis so good that a decision can be made to avoid adjuvant therapy. I aimed to provide statistically robust answers to a set of clinical question and develop strategies to be used in such data sets that would be useful and acceptable to clinicians. A unique data set of 401 Estrogen Receptor positive (ER+) tamoxifen treated breast cancer patients with measurement for a large panel of biomarkers (72 in total) was available. Taking a statistical approach, I applied a multi-faceted screening process to select a limited set of potentially informative variables and to detect the appropriate form of the association, followed by multiple imputations of missing data and bootstrapping. In comparison with the NPI, the final joint model derived assigned patients into more appropriate risk groups (14% of recurred and 4% of non-recurred cases). The actuarial 7-year RFS rate for patients in the lowest risk quartile was 95% (95% C.I.: 89%, 100%). To evaluate an alternative approach, biological knowledge was incorporated into the process of model development. Model building began with the use of biological expertise to divide the variables into substantive biomarker sets on the basis of presumed role in the pathway to cancer progression. For each biomarker family, an informative and parsimonious index was generated by combining family variables, to be offered to the final model as intermediate predictor. In comparison with NPI, patients into more appropriate risk groups (21% of recurred and 11% of non-recurred patients). This model identified a low-risk group with 7-year RFS rate at 98% (95% C.I.: 96%, 100%).

De nos jours, il est de plus en plus fréquent de recourir à des mesures intermédiaires d’efficacité telles que la survie sans progression (SSP) et le temps avant la progression de la tumeur (TPT) afin d’estimer l’efficacité d’un nouvel agent anticancéreux. Cependant, l’absence de mesures finales comme la survie globale (SG) complexifie la prise de décision par rapport au remboursement des nouveaux traitements anticancéreux. Ainsi, cette thèse se concentre sur différents aspects de l’intégration des mesures intermédiaires d’efficacité dans les évaluations économiques en oncologie, spécifiquement en cancer du sein métastatique. Une première étude a évalué la relation entre la SSP/TPT et la SG dans le contexte du cancer du sein métastatique. Une revue systématique de la littérature a identifié les études cliniques randomisées portant sur l’efficacité d’un traitement anticancéreux chez les femmes atteintes d’un cancer du sein métastatique et rapportant des données de SSP/TPT et de SG. Les résultats de cette étude ont démontré qu’il existe une relation statistiquement significative, d’une part, entre la SSP/TPT médiane et la SG médiane (r = 0.428; p ≤ 0,01), et d’autre part, entre l’effet de traitement sur la SSP/TPT et l’effet de traitement sur la SG (r = 0.427; p ≤ 0,01). Selon les résultats obtenus, la SSP/TPT pourrait être considérée comme un substitut valide de la SG, justifiant ainsi son utilisation dans les évaluations économiques en cancer du sein métastatique. Une deuxième étude a évalué l’utilisation des mesures intermédiaires de survie dans les évaluations économiques en cancer avancé et identifié les méthodes utilisées pour intégrer ces mesures en l’absence de données de SG. Une revue systématique de la littérature a été réalisée pour recenser les évaluations économiques de type coût-efficacité et coût-utilité ayant intégré des mesures intermédiaires de survie. Cette étude a démontré l’ampleur de l’utilisation des mesures intermédiaires de survie dans les évaluations économiques en cancer avancé. Par ailleurs, plusieurs approches ont été identifiées pour pallier l’absence de données de SG, notamment l’utilisation d’un risque de décès post-progression équivalent pour les groupes à l’étude, le recours à des comparaisons indirectes basées sur de nombreuses hypothèses, l’utilisation d’une mesure intermédiaire comme proxy de la SG, le recours à l’opinion d’experts et l’utilisation de données associées à un traitement différent ou une ligne de traitement différente. Enfin, une troisième étude s’est penchée sur le développement d’un modèle pharmacoéconomique générique canadien intégrant les mesures intermédiaires de survie en cancer du sein métastatique. Ce modèle de Markov inclut des paramètres spécifiques aux traitements sous évaluations (coût de traitement, données de survie et incidence des effets indésirables) de même que des paramètres globaux qui ne dépendent pas des traitements évalués (caractéristiques des patientes, valeurs d’utilité associées aux états de santé du modèle, pertes d’utilité et coûts des effets indésirables, coûts d’administration des traitements, coûts de suivi médical et coûts des soins prodigués en fin de vie). Le modèle a été validé en évaluant sa capacité à répliquer des résultats d’études existantes. Ce modèle permet d’uniformiser l’évaluation économique des nouveaux traitements en cancer du sein métastatique et pourrait par conséquent, devenir un outil d’aide à la décision de référence pour les organismes responsables du remboursement des médicaments au Canada. Bref, les résultats de ces trois études répondent à une problématique importante dans l’évaluation économique des traitements en oncologie et pourront contribuer à faciliter la prise de décision en santé. / Nowadays, intermediate endpoints such as progression-free survival (PFS) and time to progression (TTP) are frequently used in clinical trials of advanced cancer. However, use of such endpoints instead of overall survival (OS) poses a significant challenge in the economic evaluation of anticancer drugs. This thesis focuses on different aspects of the integration of intermediate endpoints in the economic evaluation of anticancer drugs, especially in the context of metastatic breast cancer. A first study assessed the relationship between PFS/TPT and OS in metastatic breast cancer using a trial-based approach. A systematic review of the literature was performed to identify randomized clinical trials of metastatic breast cancer therapy reporting both PFS/TTP and OS data. Results of this study indicated a statistically significant relationship between the median PFS/TTP and the median OS (r = 0.428; p < 0.01), and between the treatment effect on PFS/TTP and the treatment effect on OS (r = 0.427; p < 0.01). Findings of this study suggest that PFS/TTP may be considered as a potential surrogate for OS, thus justifying its use in cost-effectiveness or cost-utility analyses of metastatic breast cancer therapy. A second study evaluated the use of intermediate endpoints in the economic evaluation of new treatments for advanced cancer and the methodological approaches adopted when OS data are unavailable or of limited use. A systematic review of the literature was conducted to identify cost-effectiveness and cost-utility analyses using an intermediate endpoint as an outcome measure. This study showed that intermediate endpoints are widely used in the economic evaluation of new treatments for advanced cancer. Several approaches are used in the absence of OS data such as assuming an equal risk of death for all treatment groups, using indirect comparison based on numerous assumptions, using of a proxy for OS, using unpublished external information (consultation with clinical experts), and using published external information from different treatment settings. Finally, a third study aimed to develop a global economic model to assess the cost-effectiveness of new treatments for metastatic breast cancer in Canada. This Markov model, which integrates intermediate endpoints, includes parameters specific to the treatments under evaluation (drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs)), as well as global parameters that are consistent regardless of the treatment under evaluation (patient characteristics, health states utilities, disutilities and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care). The model was validated by assessing its ability to replicate results of existing studies. This model standardizes the economic evaluation of new therapies for metastatic breast cancer, and could thus be used as a benchmark by drug reimbursement authorities in Canada. In summary, the results of these three studies address an important challenge encountered in the economic evaluation of anticancer drugs, and therefore, can be very valuable for decision-making purposes.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

The significance of flows of temporary, skilled labour migrants under conditions of globalization is widely acknowledged. Using a case study of elite cricket professionals moving from the UK to Australia for a maximum duration of 6 months, out and return migration flows and processes are examined. In doing so, this thesis exposes migration motives, notably in relation to career progression and personal development, and the processes and regulations that control temporary sojourns. Furthermore, the discussion reveals important social, cultural, economic and familial impacts of undertaking temporary, skilled, international migration. Using this case study of a sport-led migration, a largely under-researched occupational sector in migration studies, a number of theoretical, conceptual and empirical contributions are provided, which advance knowledge of skilled, international migration. First, utilising Bourdieu's (1986) notions of capital as an analytical framework, the comparative importance of migration motives are emphasised. Second, it is shown that migration can be viewed as a normalised aspect of a skilled worker's career trajectory, and that desired outcomes can be achieved during increasingly temporary stays overseas. Third, a three phase model of the migration flow is adopted to enable the development of professionalization and migration within cricket to be examined. It is asserted that cricket, as a professional sport, has changed under conditions of globalization, alongside smaller scale developments initiated by both employers and intermediaries, and the migrant cricketers. It is concluded that these connections will have salience for the other skilled occupations identified in Salt's (1997) typology of highly-skilled migrants.

This study aims to cover the topic of hindrances for sustainability progression within the service industry and address contextual differences which might influence the identified hindrances. The researchers have chosen to follow a qualitative research design using a multiple case study. Data was gathered through in-depth semi-structured interviews with two MNE’s and two SME’s in the service industry and was analyzed through data reduction and careful analysis.   Through the selected methods four main findings were identified. Primarily, the absence of engaging and supportive management was seen to drastically deter sustainability progression within a business to the extent of causing a complete stagnation in several cases. Additionally, the results point towards the importance of all levels of employees within an organization. Lack of employee engagement towards sustainability was a key hinderance which could disrupt implementation over a long periods of time. Thirdly the external environment was observed to have a major role in enabling as well as hindering suitability implementation. While the external environment was seen to provide guidance and motivation for corporate sustainability, it also led to varying limitations for all identified cases. Finally, prioritization of other areas was observed to hinder sustainability temporarily until focus could revert back to the topic.

A tuberculose (TB) é uma doença infecciosa bacteriana causada por Mycobacterium tuberculosis (Mtb), acomete seres humanos em todo mundo, e é considerada uma das principais causas de morbidade e mortalidade dentre as doenças infecciosas. Nesse cenário, a TB ainda é vista como um grande desafio para a ciência e para medicina. Com o estudo de novos alvos moleculares para terapia e diagnóstico, por exemplo, a sinalização Notch tem sido descrita como uma via importante para a manutenção da resposta imunológica durante a infecção por Mtb. Assim, o objetivo deste trabalho foi avaliar a participação da via Notch na modulação da resposta imune durante a infecção por Mtb em humanos. Neste trabalho foram incluidos 13 pacientes com tuberculose ativa e 13 indivíduos saudáveis. Células mononucleares de sangue periférico (PBMCs) foram isoladas e avaliadas quanto à expressão de receptores Notch 1 - 2 em células T e ligantes Notch, DLL1 - 4 em subpopulações de monócitos por citometria de fluxo e expressão de genes relacionados à via Notch e resposta imune. Além disso, o plasma foi utilizado para avaliar níveis de citocinas, CD14s e CD163s. Ainda, avaliamos a função celular dependente da ativação da via Notch durante a infecção de células mononucleares de sangue periférico de indivíduos saudáveis com Mtb H37Rv in vitro. Observamos que pacientes com TB ativa apresentaram aumento na expressão de DLL4 em monócitos intermediários e não-clássicos e diminuição na expressão de Notch 2 em células T CD8+. In vitro, observamos nas culturas de PBMCs, aumento da expressão de DLL4 em monócitos intermediários e Notch 2 em células T CD4+. A expressão do ligante DLL4 em monócitos intermediários e a expressão do Notch 1 em células T CD4+ em pacientes com TB ativa se correlacionaram positivamente com o grau de lesão pulmonar. Além disso, pacientes com quadros de lesão pulmonar moderado e avançado têm maior expressão de Notch 1 em células T CD4+ quando comparados a pacientes com grau mínimo de lesão pulmonar. Pacientes com TB ativa apresentam aumento significativo nos níveis plasmáticos de IL-6, IP- 10, CD14s e CD163s e diminuição nos níveis de IFN-?, IL-17A, IL-4, IL-2, IL-1? e RANTES. Os níveis plasmáticos de IFN-?, TNF-?, IL-17A, IL-4, IL-2, IL-12, IL-1?, RANTES e IL-10 se correlacionaram positivamente com o maior grau de lesão pulmonar.Além disso, demonstramos que os níveis de IFN-?, IL-17A, IL-1?, IL-4 e IL-2 se relacionam com maior expressão do receptor Notch 1 em células T CD4+ , enquanto níveis plasmáticos de IP-10, CD163s e de procalcitonina se correlacionam com maior expressão de Notch 1 em células T CD8+. Evidenciamos maior tendência na expressão de HES1 em pacientes com TB ativa e células infectadas in vitro, indicando que a via Notch está sendo ativada durante a infecção por Mtb. De forma interessante, in vitro as culturas de PBMCs tratadas com inibidor farmacológico da via Notch (GSI), reduziram a produção de IL-17A, IL-2 e IL-10 e aumentaram IL-8, enquanto o tratamento com anti-hDLL4 promoveu o aumento significativo nos níveis de TNF-? e atividade fagocítica de monócitos. Em conclusão, a expressão de receptores e ligantes Notch é alterada durante a TB, em especial o ligante DLL4 em subpopulações de monócitos. Além disso, a via Notch parece ser importante na modulação de respostas pró e anti-inflamatórias. Nesse trabalho, sugerimos que a expressão de Notch 1 em células T e DLL4 em subpopulações de monócitos estão associados com a gravidade da TB. Assim, a detecção desses constituintes da via Notch em PBMCs de pacientes com TB ativa são potenciais biomarcadores para avaliar a progressão da doença. / Tuberculosis (TB) is a bacterial infectious disease caused by Mycobacterium tuberculosis (Mtb), affects humans worldwide, and is considered a major cause of morbidity and mortality among infectious diseases. In this scenario, TB is still seen as a major challenge for science and medicine. With the study of new molecular targets for therapy and diagnosis, for example, Notch signaling has been described as an important pathway for the maintenance of immune response during Mtb infection. Thus, the objective of this work was to evaluate the participation of the Notch pathway in the modulation of the immune response during Mtb infection in humans. In this study, 13 patients with active tuberculosis and 13 healthy individuals were included. Peripheral blood mononuclear cells (PBMCs) were isolated and evaluated for Notch 1 - 2 receptor expression in T cells and Notch, DLL1 - 4 ligands in monocyte subpopulations by flow cytometry and expression of Notch - pathway related genes and immune response. In addition, plasma was used to assess levels of cytokines, CD14s and CD163s. Furthermore, we evaluated the cellular function dependent on the activation of the Notch pathway during the infection of peripheral blood mononuclear cells of healthy subjects with Mtb H37Rv in vitro. We observed that patients with active TB had increased DLL4 expression in intermediate and nonclassic monocytes and decreased expression of Notch 2 in CD8+ T cells. In vitro, we observed in the cultures of PBMCs, increased expression of DLL4 in intermediate monocytes and Notch 2 in CD4+ T cells. The expression of the DLL4 linker in intermediate monocytes and the expression of Notch 1 in CD4+ T cells in patients with active TB correlated positively with the degree of lung injury. In addition, patients with moderate and advanced lung injury have higher Notch 1 expression in CD4+ T cells when compared to patients with a minimal degree of lung injury. Patients with active TB showed a significant increase in plasma levels of IL-6, IP-10, CD14s and CD163s, and decreased levels of IFN-?, IL-17A, IL-4, IL-2, IL-1? and RANTES. The plasma levels of IFN-?, TNF-?, IL-17A, IL-4, IL-2, IL-12, IL-1?, RANTES and IL-10 correlated positively with the highest degree of lung injury. In addition, we demonstrated that levels of IFN-?, IL-17A, IL-1?, IL-4 and IL-2 are related to higher Notch 1 receptor expression in CD4+ T cells, whereas plasma levels of IP-10,CD163s and procalcitonin correlate with increased Notch 1 expression in CD8+ T cells. We have shown a greater trend in HES1 expression in patients with active TB and in vitro infected cells, indicating that the Notch pathway is being activated during Mtb infection. Interestingly, in vitro cultures of PBMCs treated with the Notch pharmacological inhibitor (GSI), reduced IL-17A, IL-2 and IL-10 production and increased IL-8, while anti-hDLL4 treatment promoted the significant increase in TNF-? levels and monocyte phagocytic activity. In conclusion, the expression of Notch receptors and ligands is altered during TB, especially the DLL4 linker in monocyte subpopulations. In addition, the Notch pathway appears to be important in modulating pro and anti-inflammatory responses. In this work, we suggest that Notch 1 expression in T cells and DLL4 in monocyte subpopulations is associated with TB severity. Thus, detection of these constituents of the Notch pathway in PBMCs of patients with active TB are potential biomarkers to assess disease progression.

Este trabalho tem como objetivo aprofundar as discussões sobre a Progressão Continuada a partir dos conceitos de crescimento e experiência educativa em John Dewey. Para tanto, buscamos analisar a bibliografia existente, principalmente sobre a legislação que implantou tal regime no sistema público de ensino do Estado de São Paulo, estabelecendo relação com a leitura aprofundada de algumas das principais obras de Dewey, o principal referencial teórico deste estudo. A partir de Dewey, foi possível entender que alguns pressupostos da progressão continuada, como por exemplo: toda criança é capaz de aprender se lhe forem oferecidas as condições necessárias, ou que cada criança tem um ritmo de aprendizagem, encontram-se solidamente fundadas no princípio democrático de educação. Mais ainda, que o problema não é exatamente a progressão continuada, mas a forma como esta foi implantada, sem uma preparação dos professores e uma adequação do sistema como um todo. Em função dessa análise, passamos a considerar que a progressão continuada não deve ser concebida como um fim em si mesma, mas como um meio, um instrumento para o processo de democratização do ensino e da aprendizagem. / The aim of this master thesis is to carry on the discussion about the regimen of continued progression centered in Dewey\'s concept of growth and of educational experience. So we search to analyze the existing bibliography, mainly about the legislation that introduced the regimen in teaching public system of the State of São Paulo, doing a comparison with some of the Dewey\'s work, the most important reference of this study. Reading Dewey very seriously, it was possible to understand that some presuppositions of the continued progression, for example, all children can learn wider proper conditions, as well as each child has a rhythm of learning are based on Dewey\'s concept of democratic education. Therefore, the problem isn\'t continued progression but the way it was introduced without enough preparation of the teachers and of the educational system as a whole. The continued progression can\'t be conceived as a goal in itself, but as a instrument of the democratization process of teaching and learning.

Introdução: Freqüentemente a progressão da doença coronariana aterosclerótica é observada por angiogramas seqüenciais e atribuída ao aumento da incidência de eventos coronarianos.O significado prognóstico desta progressão em pacientes randomizados e submetidos a diferentes formas terapêuticas ainda é pouco conhecido. Este estudo compara a progressão da aterosclerose nas artérias coronárias nativas de pacientes submetidos a tratamento clinico, cirúrgico ou através da angioplastia. Métodos: 611 pacientes portadores de DAC multiarterial estável com função ventricular preservada, foram estudados e submetidos de maneira randomizada, a três formas terapêuticas habituais. Após cinco anos de evolução, 392 pacientes (64%) foram submetidos à cinecoronariografia. A progressão da doença foi definida como surgimento de estenose de, pelo menos, 20% de obstrução em um segmento arterial, admitido previamente como normal. A progressão foi avaliada nas artérias nativas que correspondem a DA, CX, CD dos três grupos terapêuticos. Resultados: 392 pacientes estudados, 136 eram do grupo Cirúrgico, 146 do grupo Angioplastia e 110 do grupo Clínico. Os grupos eram homogêneos em relação às características basais. A análise de progressão entre os grupos terapêuticos mostrou maior progressão da doença na artéria DA do grupo angioplastia. Entre os fatores relacionados à progressão da doença a presença de HAS influenciou significativamente (p= 0,048). Em relação à oclusão total, houve maior incidência no sexo masculino (p= 0,0078) e novo IAM (p= 0,0006). Não se observou relação estatística entre eventos coronarianos e progressão da doença na amostra estudada. Conclusão: Nessa amostra observou-se a progressão da aterosclerose independente da opção terapêutica. Todavia, encontrou-se menor progressão da doença nos pacientes do grupo cirúrgico. Exceto pela presença de hipertensão, nenhum outro fator de risco parece ter influenciado nesta condição. / Introduction: The progression of atherosclerotic in the coronary artery disease (CAD) is observed through consecutive angiograms. The prognosis of this progression randomized patients is not clear. This study compared the progression of native coronary arteries and bypass graft in patients undergoing to surgery (CABG), angioplasty (PCI), or medical strategy (MT). Methods: Six hundred eleven patients with stable multivessel CAD and preserved ventricular function were randomly assigned to the 3 therapeutic options: MT, PCI, or CABG. After a 5-year of follow-up, 392 patients (64%) underwent routine coronary angiogram. Progression was defined as stenosis of at least 20% in an artery segment previously considered normal. Progression was assessed in the native arteries irrigating the three territories, left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). Uni and multivariate analysis were performed in all therapeutic groups. Results: Of the 392 patients, 136 were to CABG, 146 PCI, and 110 MT. Baseline characteristics of three treatment were homogeneous. Analysis of progression within the three groups showed a more significant progression of atherosclerosis in the LAD territories of the PCI group. Among the factors related to the progression, there was a significant influence by hypertension (p = 0.048). Males presented a higher incidence of occlusion (p= 0.0078) and new Myocardial Infarction. (p= 0.0006). There was no statistical difference between coronary events and the development of progression in the sample studied. Conclusion: In this study, we have observed the occurrence of atherosclerosis progression, regardless the treatment option. However, we?ve found less progression of disease in patients from the surgery group. Except for hypertension, any other risk factor seems to have no influence on the increase of this condition.