Introdução: As doenças crônicas que envolvem tratamento clínico e cirúrgico podem comprometer a qualidade de vida. Poucos estudos analisam a qualidade de vida de pacientes com distúrbios do desenvolvimento sexual (DDS). O objetivo foi avaliar a qualidade de vida de pacientes com DDS com o diagnostico etiológico estabelecido, seguidos até a idade adulta em um único centro terciário. Pacientes e Métodos: 144 pacientes adultos com DDS (56 pacientes com DDS 46,XX - 49 com sexo social feminino e 7 com o sexo social masculino, bem como, 88 pacientes com DDS 46,XY - 54 com sexo social feminino e 34 com sexo social masculino). Instrumento: A avaliação da qualidade de vida foi realizada através do questionário WHOQOL-Bref. Resultados: Os pacientes com DDS 46,XX e 46,XY apresentaram escores de qualidade de vida semelhante e comparáveis aos escores da população brasileira geral. Os pacientes com DDS do sexo social masculino tiveram melhores escores no domínio psicológico do que os pacientes do sexo social feminino, da mesma forma que a população geral brasileira. Dentro do grupo DDS 46,XY, também os pacientes com o sexo social masculino tiveram melhores escores de qualidade de vida em comparação aos do sexo social feminino. Para avaliar o impacto na qualidade de vida dos pacientes com DDS 46,XY criados no sexo social feminino, foi comparado os escores de qualidade de vida nos pacientes registrados no sexo social masculino com aqueles dos pacientes registrados no sexo social feminino e que mudaram para o sexo social masculino. Ambos os grupos apresentaram escores semelhantes de qualidade de vida. Comparou-se ainda, a qualidade de vida de pacientes com DDS 46,XY com deficiência de 5alfa-RD2 e pacientes com DDS, devido à defeitos na secreção ou ação da testosterona. Ambos os grupos apresentaram qualidade de vida semelhante entre si para as questões gerais e nos quatro domínios. A maioria das variáveis que influenciaram a qualidade de vida foram saúde geral, sentimentos positivos e espiritualidade, religião e crenças pessoais, cada um deles contribuindo com 18% da variabilidade da pontuação da qualidade de vida geral. O desempenho sexual teve pouca interferência na qualidade de vida geral, explicando apenas 4% da variabilidade deste escore. O tratamento tardio foi associado negativa e significativamente com pior qualidade de vida geral. Conclusão: Esta larga coorte de pacientes adultos com DDS, que foi seguida por uma equipe multidisciplinar em um único centro terciário, teve boa qualidade de vida na idade adulta. Ressalta-se que o tratamento tardio comprometeu a qualidade de vida dos pacientes com DSD, ao passo que o desempenho sexual teve pouca influência na qualidade de vida geral / Objective: Chronic diseases involving medical and surgical treatment may compromise the quality of life. Few studies have focused on the quality of life of patients with disorders of sex development (DSD). The aim was to evaluate quality of life in DSD patients with defined diagnoses followed until adulthood in a single tertiary centre. Patients and Methods: 144 Adult DSD patients (56 patients with 46,XX DSD - 49 with female social sex and 7 with male social sex as well as 88 patients with 46,XY DSD - 54 with female social sex and 34 with male social sex). Measurements: Quality of life using WHOQOL-Bref questionnaire Results: Both 46,XX and 46,XY DSD patients had similar quality of life scores on the WHOQOL-Bref, comparable to the scores of the Brazilian general population. Male social sex DSD patients had better scores on the psychological domain than female social sex DSD patients, as found in the Brazilian general population. In addition, among the 46,XY DSD group, the male social sex patients had better quality of life compared to the female social sex patients. To estimate the impact on quality of life of patients with DDS 46, XY raised in females social sex, we analyzed the quality of life scores of patients raised with male social sex with those patients registered with female social sex who changed to male social sex. Both groups had similar quality of life. We also evaluate the impact of testosterone in the quality of life of patients with 46,XY DSD with 5alfa-RD2 deficiency and patients with DSD due to testosterone secretion or action defects. Both groups showed similar quality of life. The most influencing variables on quality of life of all group of patients were general health, positive feelings and spirituality, religion and personal beliefs, each of them contributing with 18% of the variability of the general quality of life score. There was a positive and significant correlation between sexual performance and general quality of life, although it explained only 4% of the variability of the general quality of life score. Late treatment was associated negatively and significantly with poorer overall quality of life. Conclusion: This large cohort of adult DSD patients, which was followed by a multidisciplinary team in a single tertiary centre, had good quality of life in adulthood; in addition, late treatment compromised the quality of life of DSD patients, whereas sexual performance had little influence on quality of life

INTRODUÇÃO: A endomiocardiofibrose (EMF) é uma miocardiopatia de padrão restritivo de etiologia desconhecida, prevalente em regiões tropicais. Caracteriza-se por espessamento fibroso do endocárdio e miocárdio subjacente, comprometendo ponta e via de entrada de um ou de ambos os ventrículos. Sua etiopatogenia é pouco conhecida e muitos autores a associam à doença infecciosa cardíaca ou sistêmica, à eosinofilia prévia e/ou à carência nutricional. O prognóstico em geral é grave e a ressecção cirúrgica da lesão é indicada aos pacientes com insuficiência cardíaca refratária a tratamento clínico, em classe funcional III ou IV (NYHA). Os estudos anatomopatológicos até o momento foram realizados em material de autópsia ou de biópsia endomiocárdica. OBJETIVOS: Este estudo retrospectivo se propõe a (1) descrever os três aspectos morfológicos da lesão endocárdica (fibrose, infiltrado inflamatório e vasos) utilizando microscopia óptica comum e técnicas imunoistoquímicas, assim como correlacioná-los aos dados clínicos, laboratoriais e de imagem dos pacientes (2) comparar os aspectos morfológicos de espécimes de ressecção cirúrgica com os de autópsia a fim de verificar se os primeiros podem ser empregados para diagnóstico histológico da doença; e (3) discutir a patogenia da EMF e realizar pesquisa de agentes infecciosos cardiotrópicos em amostra endomiocárdica incluída em parafina por técnica de biologia molecular. MÉTODOS: Foram utilizadas amostras de ressecção cirúrgica endocárdica incluídas em parafina provenientes de 31 pacientes com diagnóstico clínico e cineangiocardiográfico de EMF, operados no InCor entre 1991 e 2005. As amostras foram coradas por técnicas convencionais (HE, tricômico de Masson, Verhoeff e reticulina) e submetidas a reações imunoistoquímicas para fibras colágenas tipo I, III e IV, para células inflamatórias (CD3, CD20, CD68) e para endotélio de linfáticos (D2-40). Amostras de nove corações de autópsia de pacientes com o mesmo diagnóstico serviram de controle positivo da doença. A pesquisa de agentes infecciosos foi feita por reação de cadeia de polimerase e reação de transcrição reversa de cadeia de polimerase (PCR e RT-PCR) em amostras endomiocárdicas incluídas em parafina, para T. gondii e para vírus cardiotrópicos (enterovirus, adenovirus, influenza A e B, citomegalovirus, parvovirus B19 e herpes simples). Para identificar alterações vasculares intramiocárdicas, procedeu-se à revisão de prontuários clínicos dos pacientes e de 16 cineangiocoronariografias. RESULTADOS: Foi observado intenso espessamento endocárdico ventricular à custa de fibrose hialina superficial escassamente celular, com fibras colágenas tipos I e III, predominando o tipo I sobre o III. O colágeno tipo IV foi identificado na membrana basal de vasos. Na porção profunda da lesão endocárdica observou-se escasso infiltrado inflamatório crônico com macrófagos, linfócitos T e B em menor número. O infiltrado estava distribuído ao redor de vasos proliferados com intensas alterações estruturais na parede e com participação de linfáticos. No miocárdio superficial identificou-se miocardite \"borderline\" (critério de \"Dallas\"). Foram obtidos ácidos nucléicos em quantidade suficiente para a reação de PCR/RT-PCR em 12/36 (33%) amostras. Genomas de agentes infecciosos foram identificados em 6/12 (50%) pacientes. Dois casos foram positivos para enterovirus (EV), dois para citomegalovirus (CMV), um para ambos (CMV e EV) e um para T. gondii. Não foram observadas diferenças histopatológicas entre as amostras cirúrgicas e as de autópsia. Foram detectadas alterações vasculares à cineangiocoronariografia em 9/16 (56%) pacientes. Não houve correlação anatomoclínica definida entre os múltiplos dados comparados. CONCLUSÕES: Os resultados indicam que na EMF ocorre processo inflamatório crônico mantido por rede vascular anômala rica em linfáticos localizada na profundidade da lesão endocárdica. A rede vascular provavelmente contribui para a manutenção da placa fibrótica e deve ser considerada como fator importante na patogenia da doença. O diagnóstico anatomopatológico pode ser feito com segurança em material de ressecção cirúrgica. A análise molecular do endomiocárdio possibilitou a detecção de alta incidência de genomas de agentes infecciosos cardiotrópicos. Seu significado, contudo, permanece controverso. / BACKGROUND: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy of unknown etiology prevalent in tropical regions. The disease involves the inflow tract and apex of either one or both ventricles and is characterized by a fibrous thickening of the endocardium and the underlying myocardium. Although its etiology remains unknown, most authors believe it could be related to systemic or heart infection/parasitism, previous blood eosinophilia or malnutrition. Surgical resection of the thickened endocardium is recommended to patients with advanced heart failure of functional class III or IV, New York Heart Association (NYHA). The gross and histological features of the heart have been comprehensively studied in autopsies and endomyocardial biopsies. Studies in surgical samples, however, are still lacking. AIMS: This study was conducted to evaluated: (1) the histomorphological changes of EMF as seen in surgical specimens by means of routine histological and immunohistochemical methods in an attempt to correlate them with clinical symptoms and coronary angiographic features; (2) to compare histological data between surgical and autopsy samples, and (3) to discuss probable pathogenetic mechanisms of the disease, as well as to investigate cardiotropic infective agents by means of molecular analysis of endomyocardial surgical samples. METHODS: We collected all available clinical records and endomyocardial surgical samples from 31 patients with EMF who had been submitted to surgery between 1991 and 2005 at InCor. The diagnosis was based on clinical, hemodynamic and angiocardiographic findings. The surgical samples were fixed in 10% formalin, submitted to standard processing, and stained with H&E, Masson\'s trichrome, reticulin and elastic stains. Immunohistochemical methods were employed to detect collagen fibers type I, III, and IV, inflammatory cells (CD3, CD20, CD68) and lymphatic vessels\' endothelium (D2-40). Nine samples from autopsied hearts of EMF patients were used as a positive control group. Polymerase chain reaction (PCR) and reverse transcription-PCR were used retrospectively to search for genomes of T. gondii and cardiotropic viruses (enterovirus, adenovirus, influenza A e B, cytomegalovirus, parvovirus B19 and herpes simplex) in the surgical material. All clinical and surgical reports were reviewed, including follow-ups and 16 coronary cineangiocardiographies. RESULTS: Ventricular endocardium was thickened by superficial acellular hyaline collagen fibers type I and III. Type-IV collagen fibers were seen only around vessels. Focal chronic inflammatory infiltrate with T-lymphocytes, macrophages and a few B-lymphocytes was seen around blood vessels with a peculiar pattern of vascular changes and numerous lymphatics within the endocardium. The superficial myocardium showed borderline myocarditis (Dallas criteria). RNA and DNA were successfully extracted from 12/36 samples. Infective agents were detected in 6/12 (50%) patients; two of them were positive for cytomegalovirus (CMV), two for enterovirus (EV), one for both (CMV and EV) and one for T. gondii. No histopathological differences between surgical samples and autopsy fragments were observed. Vascular blush or neovascularity was detected in 9 of the 16 coronary cineangiocardiographies reviewed. Clinicopathologic characteristics are associated neither with infective genomes in the endocardium nor with vascular blush. CONCLUSIONS: Results indicate that there is an non especific chronic inflammatory process maintained by an anomalous vascular net rich in lymphatics situated deep within the endocardium. This angiolymphatic web probably contributes to the maintenance of the fibrotic plaque and might be considered an important pathological finding concerning in the pathogenesis of EMF. Histopathological changes as seen in surgical material are diagnostic of EMF. Molecular analysis of the endomyocardium revealed high incidence of cardiotropic infective agents, but their role in the pathogenesis of the disease is still controversial.

A doença de Wilson é um distúrbio da excreção biliar de cobre devido a um defeito na proteína ATP7B. Em caráter pioneiro na América do Sul, seqüenciou-se o gene ATP7B em 60 pacientes brasileiros pertencentes a 46 famílias; os resultados foram relacionados com aspectos demográficos e fenotípicos. Detectaram-se 25 mutações, 12 das quais novas. A 3402delC (34,8%) e a L708P (14,1%) ocorreu em 58,3% das famílias de São Paulo e em 44,4% das de Minas Gerais, respectivamente. As substituições novas, pesquisadas por RFLP ou PCR alelo-específica, não ocorreram em 60 indivíduos controle; portanto, não são polimorfismos comuns. O estudo comparativo de haplótipos dos portadores da L708P da coorte atual e de Gran Canaria sugeriu um efeito-fundador comum para ambos os grupos. O fenótipo variou amplamente para genótipos idênticos / ATP7B protein. As the first study of its kind in South America, the ATP7B gene was sequenced and the results were related to demographic and phenotypic aspects of 60 Brazilian patients, from 46 distinct families. Twenty-five mutations were detected, 12 of which are novel. The 3402delC (34.8%) and the L708P (14.1%) occurred in 58.3% of the families from Sao Paulo and in 44.4% of those from Minas Gerais, respectively. The novel substitutions were shown not to be common polymorphisms by RFLP or allele-specific PCR studies performed in 60 control subjects. Haplotype analysis comparing carriers of the L708P from this cohort study with patients from Gran Canary suggests the same founder-effect for both groups. Phenotype varied widely for identic genotypes.

Estudo transversal do universo de pré-escolares (1544) de creches filantrópicas de Santo André, SP, Brasil, para estimar por antropometria seu crescimento e estado nutricional. Observou-se que o crescimento alcançado no conjunto está acima do referencial CDC/NCHS. Não se encontrou desnutrição, mas sim sobrepeso e obesidade, respectivamente em 16,8 e 10,8% das crianças, com tendência crescente com a idade. Entre os fatores de risco para esta condição encontrou-se o sexo feminino e o peso de nascimento mais elevado. Estes resultados apontam para a presença de uma etapa adiantada de transição epidemiólogica nutricional inclusive na população de pré-escolares de baixa renda deste Município / Cross sectional study of the universe (n=1544) of preschool children attending to philanthropic daycare centers of Santo André (SP- Brazil), to evaluate by anthropometrics their growth and nutritional status. The attained growth by the whole group was above the CDC/NCHS reference. There was no undernutrition but overweight and obesity with a prevalence of 16,8 and 10,8%, respectively, with a trend to increase with age. Higher birth weight and feminine gender were risk factors for these nutritional problems. The results pointed out an advanced step of nutritional transition, affecting the children between 2 and 6 years of age, of low income families, in this Municipality

Os objetivos deste estudo foram identificar os fatores de risco para complicações pulmonares pós-operatórias em pacientes laringectomizados por carcinoma espinocelular de laringe, assim como os fatores de risco para apresentação de metástases pulmonares e os fatores de risco para apresentação de segundo tumores primários em pulmão destes pacientes no período de 1985 a 1996. O estudo consistiu em uma análise retrospectiva de 291 pacientes admitidos no Hospital do Câncer A. C. Camargo, no período de 1985 a 1996, portadores de carcinoma espinocelular de laringe, submetidos a tratamento cirúrgico com intenção curativa seguido ou não de radioterapia. Foram analisados as variáveis demográficas, as comorbidades, a localização do sítio primário, o estadiamento clínico, o tratamento do tumor primário e do pescoço, o tratamento radioterápico, a diferenciação celular, as margens cirúrgicas, as recidivas locais, as recidivas regionais, a presença de complicações maiores, de complicações menores, as metástases pulmonares e a presença de múltiplos tumores primários pulmonares. O teste de associação do qui-quadrado foi utilizado para análise univariada descritiva das diversas variáveis comparando-se os grupos com complicação pulmonar e sem complicação pulmonar. A análise multivariada através da regressão logística foi utilizada na determinação dos fatores de risco para apresentação de metástases pulmonares e múltiplos tumores primário pulmonares. A incidência de complicações pulmonares foi de 31,3%, foram identificados como fatores de risco para complicações pulmonares somente a epiglote (p=0,004; RR 2,1), tendo a variável gênero associação marginal (p=0,081; RR 2,8). As metástases pulmonares tiveram incidência de 7,2%, na análise univariada foram identificados como fatores de risco o estadiamento N (p=0,032), diferenciação histológica (p=0,004), margens cirúrgicas (p=0,017) e recidivas locoregionais (0,002). Os múltiplos tumores primários pulmonares apresentaram incidência de 3,1% e na análise univariada foram identificados como fatores de risco o estadiamento N (p=0,048) e sítio aritenóide (p=0,001). Na análise multivariada foram significativos somente a diferenciação histológica: moderamente diferenciado (p=0,007; RR 2,9) e pouco diferenciado (p=0,032; RR 4,0); e as margens cirúrgicas: exíguas (p=0,003; RR 6,4) para apresentação de metástases pulmonares e múltiplos tumores pulmonares. Este estudo demonstra a importância do estadiamento clínico como fator de risco para complicações pulmonares, metástases à distância e múltiplos tumores primário em pulmão. Os fatores de risco determinantes para aparecimento de metástases pulmonares e múltiplos tumores primários pulmonares foram a diferenciação histológica e as margens cirúrgicas / Objective: To identify the risk factors to postoperative pulmonary complications in laryngeal cancer patients submitted to surgical treatment, the risk factors to development of lung metastasis and second lung primary tumor. Patients and Methods: Retrospective study of a cohort of 291 patients admitted at Hospital do Câncer A.C.Camargo from January, 1985 to December 1996. All patients were submitted to some kind of laryngectomy with curative intent as part of treatment of a proven laryngeal cancer, followed or not by radiotherapy. The following variables were analized: demographic, comorbidities, primary site, clinical stage, primary and neck surgical treatment, histopathologic differentiation grade, surgical margins, recurrences, postoperative pulmonary complications, lung metastasis and second lung primary tumor. The univariate and multivariate analysis were utilized to built the model to predict the risks factors and the factors of prognostic significance. Results: The overall pulmonary complications incidence were 31,3%, epiglottis were identified as significant single risk factor to pulmonary complications (p=0.004; RR 2,1). Lung metastasis had 7,2% incidence to this, the risk factors were N stage (p=0.032 ), histopathologic differentiation grade (p=0.004), surgical margins (p=0.017) and locoregional recurrence (p=0.002). The second lung primary tumor incidence were 3,1%, univariate analysis showed N stage (p=0,048) and arithenoid site (p=0,001) as significant risk factors. The multivariate analysis showed the histopathologic differentiation: moderate grade (p=0.007 RR 2,9) and poor grade (p=0.032 RR 4,0) and surgical margins: close (p=0.003 RR 6,4) as prognostic factors to deveopment of lung metastasis and second lung primary tumor. Conclusions: This study showed the clinical stage importance as risk factor to development of postoperative pulmonary complication, lung metastasis and second lung primary tumor in laryngectomy cancer patients. The prognostic factors associated with lung metastasis and second lung primary tumor were the histopathologic differentiation and the surgical margins

The purpose of the current study was to investigate the relationship between Borderline Personality Disorder (BPD) symptoms and childhood experiences, and to explore the role of Early Maladaptive Schemas and core beliefs as variables possibly mediating this relationship. Previous research with clinical samples has established a strong link between childhood maltreatment and adult BPD (& other PD) symptoms in clinical samples. However, difficulties with these studies limit the specificity of results. For example, BPD has been shown to be highly comorbid with other axis I and axis II psychiatric conditions. Given that studies examining the relationship between BPD and childhood maltreatment generally fail to control for these comorbid conditions, the specificity of their results must be questioned. Furthermore, it has been well established that childhood familial environment is strongly related to childhood maltreatment. Again studies examining the relationship between BPD and childhood maltreatment have generally failed to concurrently assess childhood familial environments, hence opening the possibility that the relationship between BPD and childhood maltreatment may be due to family functioning rather than childhood maltreatment per se. Finally, studies linking childhood maltreatment with adult BPD have primarily utilized clinical samples. However, the primary use of clinical samples to examine the aetiology of disorders in this context ignores the vast literature showing adequate psychological functio ning for the majority of individuals exposed to childhood maltreatment. Hence, the primary aim of the current study was to examine the relationship between childhood maltreatment and adult BPD symptoms in a primarily non-clinical sample whilst statistically controlling for commonly comorbid axis I and axis II symptomatology and concurrently measuring childhood familial functioning. It was a secondary aim of the current study to examine the mediating effects of beliefs on the relationship between childhood factors (i.e., childhood maltreatment & childhood familial functioning) and adult BPD symptomatology. That is, cognitive-behavioural theorists argue that personality disorders may be triggered by adverse childhood experiences leading to maladaptive beliefs (or schemas) related to the self, others, and the world, and it is these beliefs which lead to the behavioural disturbances evident in personality disorders. One hundred and eighty-five primarily non-clinical participants completed questionnaires measuring a variety of axis I and axis II symptoms, early maladaptive schemas and core beliefs, as well as retrospective reports of family functioning and childhood maltreatment. Results showed a significant relationship between childhood factors and adult BPD symptomatology. For example, the largest correlation between BPD symptoms and a childhood factor was .27 (for childhood emotional abuse). Furthermore, early maladaptive schemas and core beliefs were found to mediate the relationship between childhood factors and adult BPD symptomatology thus supporting cognitive-behavioural theories of personality disorders. However, early maladaptive schemas and core beliefs were also found to mediate the relationship between childhood factors and other Axis I and Axis II symptoms. Hence, it was concluded that while there was some support for a cognitive mediation hypothesis for BPD symptoms, future research is needed in exploring the specificity of the cognitive mediation hypothesis for BPD.

This research contributes a detailed personal account of a FEMEN activist. It presents an autophenomenographic analysis of cultural artefacts, including a Retrospective Diary, resulting from the activity of Yelena Myshko in FEMEN between 2012 and 2014. Previously FEMEN has been used as raw material for external analysis by press and academics to fit their individual agendas. To counteract this, Myshko’s research proposes an insider perspective on FEMEN activism. She writes herself in response to academics and FEMEN leader Inna Shevchenko who ignore the contribution of FEMEN Netherlands. Myshko merges author/researcher/researched and uses evocative storytelling to provide an introspective account of sextremism, connecting it to relevant embodiment concepts that illustrate its technology of empowerment and unintended side effects.   Through an autophenomenographic analysis of her personal experience, Myshko suggests how FEMEN employs sextremism to create soldiers of feminism. Her research proposes that sextremism is an attitude, a way of life and technology of resistance. For Myshko, sextremism embodies feminist polemic that turns against patriarchy through topless protest. Through personal accounts she illustrates how she internalized this aggressive femininity during physical and mental training. Myshko argues that in protest FEMEN activists communicate to the public and mobilize new activists through feminist snap. In addition, Myshko observes that sextremism produces visual activism that internalizes feminist polemic and transforms it into figurative storytelling. Myshko explains how she reproduced sextremism through body image that made her assertive and empowered her in action.   In turn Myshko demonstrates how personal accounts of sextremist embodiment and problems encountered as a woman in the world reproduce FEMEN’s fight in the media. Myshko analysis interviews with the press where she pinpoints topical feminist issues, making FEMEN real and relevant in Western society. Myshko observes that the media appropriated the spectacle created by FEMEN Netherlands but often distorted it and bend the news to fit its own agenda. In addition, the media criticized FEMEN Netherlands for cross-passing national values and power symbols. For Myshko, sextremism is empowering but also destructive. It promotes an unapologetic self-critical attitude that accumulates collateral damage in battle. The sporadic and restrained relationships between activists does not allow intimacy. Because of the eye of the media, tenderness is perceived as weakness and is not aloud. The combination of criticism, media scrutiny and police persecution hurt Myshko’s feelings. These unresolved feelings of hurt led to resentment and disengagement from FEMEN.

This dissertation explores how middle managers use their micro-strategising practices of agency and sense-making to shape strategic outcomes during and after strategic change implementation within an enabling and/or constraining organisational social structure. The researcher examined this phenomenon through the theoretical lenses of strategy-as-practice perspective and sense-making. The qualitative case-study research design with an interpretivist, social constructionist paradigm captured the lived organisational social reality of the administrative middle managers over time at a for-profit educational brand of a private higher education (PHE) provider. A thematic data analysis approach integrated manual coding with electronic coding to analyse data gathered through an emergent research design of text messages and e-mail journals over a four-month period. Data-driven inductive coding was synthesised with structural deductive coding in response to the research questions. The dissertation concludes that administrative middle managers use micro-level strategising practices of retrospective and prospective cognitive and emotional sense-making and the practical coping of agency, or embodied sense-making, to navigate a complex and contradictory organisational socio-cultural context that is both enabling and constraining. A further contribution of the current study speaks to the embedded practices between the two discrete levels of organisation and individual, which has been interpreted through the contradictions following the equivocal signals that these two main levels demonstrate. The porous inter-dependency between the two levels of organisation and individual creates an inter-woven entity where the strands of individual and organisational action are difficult to pull out and name distinctly, without unravelling the tapestry that is the organisational entity. These contributions affirm the intellectual puzzle which sought to understand and/or restore the balance of the individual within an organisational socio-cultural context to attain organisational security and equilibrium after organisational change. The findings of this current study is not generalisable to the other seven educational brands of the PHE provider. / Boithuto bona bo shebana le tsela eo ka yona baokamedi ba mahareng ba sebedisang ditlwaelo tsa ketso ya meralo e menyane (micro-strategising) ya diejensi le ketso ya moelelo ho bopa diphetho tsa meralo nakong ya le kamora ho kenngwa tshebetsong ha phetolo ya moralo kahare ho sebopeho se dumellang le/kapa se thibelang sa setjhaba. Mofuputsi o hlahlobile mohopolo ona ka leihlo la thiori ya moralo-jwalokaketso le ketso ya moelelo. Sebopeho sa dipatlisiso tsa phuputso ya boleng se nang le saense ya setjhaba le paterone ya kgaho ya setjhaba se hapile mokgatlo wa setjhaba wa sebele o phetsweng wa baokamedi ba mahareng ba tsamaiso nako e telele letshwaong la thuto la phaello ho mofani wa thuto e hodimo ya poraefete (PHE). Katamelo ya manollo ya pokello e amanang le thuto e ikgethang e kopantse tokiso ya tokomane ka letsoho le ka elektoniki ho manolla pokello e bokelletsweng ka sebopeho sa dipatlisiso se qalang sa melaetsa ya mongolo le di-emaili nakong ya dikgwedi tse nne. Mongolo wa qaleho o tsamaiswang ke pokello o ile wa hlahiswa ka elektoniki le mongolo o latelang dikarolo tse itseng tsa molao o akaretsang ho araba dipotso tsa dipatlisiso. Thuto e phethela ka hore baokamedi ba bohareng ba tsamaiso ba sebedisa ditlwaelo tsa mekgwa e boemong bo tlase ba ketsahalo ya moelelo boiphihlelong ka ho kgutlela morao le ho nahanela pele ka kellelo le maikutlo le ho sebetsa ho kgonehang ha mokgatlo, kapa ho fana ka moelelo boiphihlelong ho kopantsweng ho batlisisang maemo a rarahaneng le a hananang a moetlo wa mokgatlo a nolofatsang le a thibelang ka bobedi. Monehelo o eketsehileng wa thuto ya morao-rao o bua ka ditlwaelo tse keneletseng dipakeng tsa maemo a mabedi a fapaneng a mokgatlo le a motho ka mong a tolokuweng ka ho hanyetsana ho latela matshwao a ka tolokehang ka ditsela tse fapaneng tseo maemo ana a mabedi a ka sehloohong a di bontshang. Ho emelana hona ho kenellanang ho dipakeng tsa maemo a mabedi a mokgatlo le motho ka bo mong ho theha mokgatlo wa kgokahano oo ho ona dikgwele tsa motho ka bo mong le kgato ya mokgatlo di bang thata ho hulwa le ho reha ka tsela e hlakileng kantle le ho senya lesela leo e leng mokgatlo. Menehelo ena e netefatsa selotho se neng se batla ho utlwisisa le/kapa ho tsosolosa tekanyo ya motho kahare ho maemo a setso sa setjhaba sa mokgatlo ho fumana tshireletso ya mokgatlo le boikgutso kamora ho fetoha ha mokgatlo. Diphumano tsa thuto ena ya morao-rao ha di akareletswe ho matshwao a mang a thuto a supileng a mofani wa PHE / Lolu cwaningo lucubungula udaba lokuthi izimenenja ezisezikhundleni ezimaphakathi zizisebenzisa kanjani izinkambiso zazo zokwenza amaqhinga namasu emazingeni aphansi okusebenzisa ikhono lazo lokuzikhethela nokuthatha izinyathelo ngokuzimela (agency) nokwenza kuzwakale futhi kuqondakale lokho ezikwenzayo nezikushoyo (sense-making) ngenhloso yokubumba imiphumela enobuqhinga ngaphambi kokuba kuqaliswe uguquko olunobuqhinga futhi nangenkathi sekuqaliswa uguquko olunjalo olwenzeka ngaphakathi ohlakeni lwesakhiwo senhlalo esivumelayo kanye/noma esivimbelayo. Umcwaningi wakuhlaziya futhi wakuhlolisisa lokhu esebenzisa indlela yokubheka izinto ngokwethiyori yokusebenzisa iqhingasu njengenkambiso (strategyas- practice perspective) kanye nokwenza kuzwakale futhi kuqondakale lokho okwenziwayo nokushiwoyo. Idizayini yocwaningo lwesigameko olukhwalithethivu olugxile ekutheni izimenenja zibheke izinto njengoba zinjalo ngokweso lezigameko ezidlule kuzona izimenenja, ngokuqhubeka kwesikhathi, ekuxhumaneni nasekusebenzeni kwazo nabanye abantu esikhungweni semfundo ephakeme esithile esizimele esiqhuba umsebenzi wokuqeqesha ngenhloso yokungenisa imali nokwenza inzuzo, phecelezi umhlinzeki we-private higher education (PHE). Ucwaningo lwasebenzisa indlela yokuhlaziya idatha ngokucubungula nokuqopha amaphethini, okuyindlela eyadidiyela ukuhlelwa nokuhlungwa kwedatha ngesandla nangobuchwepheshe bekhompyutha ngenhloso yokuhlaziya idatha eqoqwe kusetshenziswa i-emergent research design yemiqhafazo (text messages) kanye namajenali ama-imeyili esikhathini esiyizinyanga ezine. Ukuze kuhlinzekwe ngezimpendulo emibuzweni yocwaningo kwahlanganiswa indlela yokuhlela nokuhlunga idatha esuselwa kuhlobo lwedatha eqoqiwe (inductive) kanye nendlela yokuhlunga ngokusebenzisa uhlelo olwenziwe ngaphambi kokuqoqwa kwedatha (deductive). Ucwaningo luphetha ngokukhipha umbono wokuthi izimenenja ezisezikhundleni ezimaphakathi zisebenzisa izinkambiso zazo zokuqhamuka namaqhinga namasu emazingeni aphansi okwenza izinto ziqondakale ngokusebenzisa ingqondo nemizwa mayelana nezigameko ezenzeke esikhathini esedlule, nalezo ezingahle zenzeke esikhathini esizayo kanye nokubonela kwikhono lomunye umuntu, njengoba linjalo, lokuthatha izinyathelo nokwenza izinto ngokuzimela noma ukwenza izinto ziqondakale, okuyingxenye yalokho, ngenhloso yokuchusha nokuthubeleza esimweni senhlalo-masiko esiyinkimbinkimbi futhi esiziphikisayo, esikwenza kokubili ukuvumela kanye nokuvimbela. Elinye futhi igalelo lalolu cwaningo lwamanje liphathelene nezinkambiso ezifakwe zagxila emazingeni amabili ahlukene ngokucacile phakathi kwenhlangano kanye nomuntu ngamunye, ahunyushwe ngokuphikisana okulandela izimpawu eziyindida futhi ezingaqondakali kahle eziboniswa yilawa mazinga amabili amakhulu. Ukuncikana nokuxhasana okuntekenteke phakathi kwalawa mazinga, okuyinhlangano kanye nomuntu ngamunye, kwakha uhlaka oluxhumene lapho kunzima ukutomula nokugagula ngokucacile izingxenye ezakhe izenzo nezinyathelo zenhlangano ezingxenyeni ezakhe izenzo zomuntu ngamunye, ngaphandle kokuqaqa nokuhlukanisa ingxenye ngayinye eyakhe inhlangano ebumbene. Lawa magalelo ocwaningo aqininisekisa futhi asekele indida-mqondo (intellectual puzzle) ebihlose ukuqonda kanye/noma ukubuyisa ukuzimelela komuntu ngamunye esimweni senhlalo-masiko yenhlangano ukuze kuzuzwe ukuvikeleka kwenhlangano nozinzo-kulingana (equilibrium) emva koguquko olwenzekile enhlanganweni. Imiphumelangqangi etholakale kulolu cwaningo lwamanje ayinakuthathwa njengemiphumela engaphinde isetshenziswe futhi iqondaniswe nezimo ezitholakala kwezinye izikhungo eziyisikhombisa zomhlinzeki we-PHE. / Business Management / M. Com. (Business Management)

Introdução: As doenças crônicas que envolvem tratamento clínico e cirúrgico podem comprometer a qualidade de vida. Poucos estudos analisam a qualidade de vida de pacientes com distúrbios do desenvolvimento sexual (DDS). O objetivo foi avaliar a qualidade de vida de pacientes com DDS com o diagnostico etiológico estabelecido, seguidos até a idade adulta em um único centro terciário. Pacientes e Métodos: 144 pacientes adultos com DDS (56 pacientes com DDS 46,XX - 49 com sexo social feminino e 7 com o sexo social masculino, bem como, 88 pacientes com DDS 46,XY - 54 com sexo social feminino e 34 com sexo social masculino). Instrumento: A avaliação da qualidade de vida foi realizada através do questionário WHOQOL-Bref. Resultados: Os pacientes com DDS 46,XX e 46,XY apresentaram escores de qualidade de vida semelhante e comparáveis aos escores da população brasileira geral. Os pacientes com DDS do sexo social masculino tiveram melhores escores no domínio psicológico do que os pacientes do sexo social feminino, da mesma forma que a população geral brasileira. Dentro do grupo DDS 46,XY, também os pacientes com o sexo social masculino tiveram melhores escores de qualidade de vida em comparação aos do sexo social feminino. Para avaliar o impacto na qualidade de vida dos pacientes com DDS 46,XY criados no sexo social feminino, foi comparado os escores de qualidade de vida nos pacientes registrados no sexo social masculino com aqueles dos pacientes registrados no sexo social feminino e que mudaram para o sexo social masculino. Ambos os grupos apresentaram escores semelhantes de qualidade de vida. Comparou-se ainda, a qualidade de vida de pacientes com DDS 46,XY com deficiência de 5alfa-RD2 e pacientes com DDS, devido à defeitos na secreção ou ação da testosterona. Ambos os grupos apresentaram qualidade de vida semelhante entre si para as questões gerais e nos quatro domínios. A maioria das variáveis que influenciaram a qualidade de vida foram saúde geral, sentimentos positivos e espiritualidade, religião e crenças pessoais, cada um deles contribuindo com 18% da variabilidade da pontuação da qualidade de vida geral. O desempenho sexual teve pouca interferência na qualidade de vida geral, explicando apenas 4% da variabilidade deste escore. O tratamento tardio foi associado negativa e significativamente com pior qualidade de vida geral. Conclusão: Esta larga coorte de pacientes adultos com DDS, que foi seguida por uma equipe multidisciplinar em um único centro terciário, teve boa qualidade de vida na idade adulta. Ressalta-se que o tratamento tardio comprometeu a qualidade de vida dos pacientes com DSD, ao passo que o desempenho sexual teve pouca influência na qualidade de vida geral / Objective: Chronic diseases involving medical and surgical treatment may compromise the quality of life. Few studies have focused on the quality of life of patients with disorders of sex development (DSD). The aim was to evaluate quality of life in DSD patients with defined diagnoses followed until adulthood in a single tertiary centre. Patients and Methods: 144 Adult DSD patients (56 patients with 46,XX DSD - 49 with female social sex and 7 with male social sex as well as 88 patients with 46,XY DSD - 54 with female social sex and 34 with male social sex). Measurements: Quality of life using WHOQOL-Bref questionnaire Results: Both 46,XX and 46,XY DSD patients had similar quality of life scores on the WHOQOL-Bref, comparable to the scores of the Brazilian general population. Male social sex DSD patients had better scores on the psychological domain than female social sex DSD patients, as found in the Brazilian general population. In addition, among the 46,XY DSD group, the male social sex patients had better quality of life compared to the female social sex patients. To estimate the impact on quality of life of patients with DDS 46, XY raised in females social sex, we analyzed the quality of life scores of patients raised with male social sex with those patients registered with female social sex who changed to male social sex. Both groups had similar quality of life. We also evaluate the impact of testosterone in the quality of life of patients with 46,XY DSD with 5alfa-RD2 deficiency and patients with DSD due to testosterone secretion or action defects. Both groups showed similar quality of life. The most influencing variables on quality of life of all group of patients were general health, positive feelings and spirituality, religion and personal beliefs, each of them contributing with 18% of the variability of the general quality of life score. There was a positive and significant correlation between sexual performance and general quality of life, although it explained only 4% of the variability of the general quality of life score. Late treatment was associated negatively and significantly with poorer overall quality of life. Conclusion: This large cohort of adult DSD patients, which was followed by a multidisciplinary team in a single tertiary centre, had good quality of life in adulthood; in addition, late treatment compromised the quality of life of DSD patients, whereas sexual performance had little influence on quality of life

Eventos adversos (EAs), definidos como complicações não intencionais decorrentes do cuidado prestado, são reconhecidos como um dos maiores problemas na área da saúde. Embora a maior parte dos eventos acarrete incapacitações leves, uma proporção considerável está relacionada à morte de pacientes. O atendimento de urgência é considerado importante fator de risco para o desencadeamento destas complicações. No Brasil, estudos relacionados a este tema não foram publicados até o momento. O presente estudo objetivou identificar a ocorrência de EAs em pacientes admitidos por acidente vascular cerebral (AVC) ao Pronto-Socorro de Clínica Médica (PSM) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) e determinar as categorias de EAs associadas a óbito. Este estudo caso-controle pareado envolveu 468 pacientes admitidos por AVC ao PSM-HCFMUSP no período de março de 1996 a setembro de 1999. O grupo-caso compreendeu 234 óbitos hospitalares consecutivos e o grupo-controle 234 pacientes que receberam alta, pareados pelo diagnóstico provisório e pela época de internação. Eventos adversos, detectados por revisão de prontuários, foram classificados segundo sua gravidade, causas imediatas, sistemas acometidos e categorias profissionais envolvidas no cuidado aos pacientes. A associação com óbito foi analisada por regressão logística multivariada condicional, incluindo variáveis relacionadas a aspectos demográficos, gravidade do quadro inicial e características da assistência. Nos 468 pacientes foram identificados 1.218 EAs: 932 EAs (76,5%) em 170 casos e 286 EAs (23,5%) em 125 controles. Eventos adversos major corresponderam a 54,1% do total de eventos, com 659 episódios: 538 eventos em 143 casos e 121 em 65 controles. Os procedimentos diagnósticos e terapêuticos e os cuidados de enfermagem foram responsáveis em conjunto por 55,2% do total de eventos. Em relação ao tipo de sistema afetado, 46,0% dos EAs identificados ocasionaram manifestações gerais. Eventos adversos relacionados à enfermagem e EAs médicos representaram as categorias profissionais de EAs mais freqüentes (38,4% e 31,0% do total de eventos). Uma associação significante com óbito foi encontrada em relação a EAs major, EAs médicos e infecções hospitalares, com valores de OR ajustado estimados em 3,72 (IC 95% = 1,63-8,48), 3,69 (IC 95% = 1,60-8,50) e 3,20 (IC 95% = 1,20-8,51), respectivamente. Em resumo, eventos adversos, na sua maioria graves, foram freqüentes em casos e controles, determinando predominantemente manifestações gerais. Os procedimentos diagnósticos e terapêuticos e os cuidados de enfermagem corresponderam às principais causas imediatas de EAs. Em relação à categoria profissional envolvida, os EAs relacionados à enfermagem e os eventos médicos predominaram. Eventos adversos major, EAs médicos e as infecções hospitalares associaram-se de maneira significante com óbito em pacientes com AVC admitidos ao Pronto-Socorro de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / Adverse events (AEs), defined as unintended injuries caused by medical care, are recognized as a major health problem. Although most of them lead to minimal impairments, a considerable proportion is related to patients’ death. Urgent care is considered an important AE risk factor. No related Brazilian studies were published so far. The present study aimed to identify the occurrence of AEs in patients admitted for stroke to the medical emergency department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) and to determine the AEs’ categories associated to death. This paired case-control study enrolled 468 patients admitted for stroke to the HCFMUSP medical emergency department from March 1996 to September 1999. The cases comprised 234 consecutive deaths and the controls 234 discharged patients, matched for primary diagnosis and admission period. AEs, detected by retrospective chart review, were classified with regard to their severity, immediate causes, affected systems and professional involved in patient care. The association with death was analyzed by multivariate conditional regression including variables related to demographic aspects, clinical severity on admission and care characteristics. A total of 1,218 AEs were identified in 468 patients: 932 AEs (76.5%) in 170 cases and 286 AEs (23.5%) in 125 controls. Major AEs corresponded to 54.1% of all AEs, with 659 episodes: 538 events in 143 cases and 121 in 65 controls. Diagnostic and therapeutic procedures and nursing activities accounted together for 55.2% of all events. Concerning the affected system, 46.0% of the identified AEs lead to general manifestations. Nursing and medical AEs represented the most frequent professional categories involved (38.4% and 31.0% of all events). A significant association with death was found regarding major AEs, medical AEs and nosocomial infections, with adjusted OR estimates of 3.72 (95% IC = 1.63-8.48), 3.69 (95% IC = 1.60-8.50) and 3.20 (95% IC = 1.20-8.51), respectively. In summary, adverse events, most of them severe, were frequent in cases and controls, leading mainly to general manifestations. Diagnostic and therapeutic procedures and nursing activities corresponded to the main AEs’ immediate causes. Regarding the professional involved, AEs related to nurses and physicians predominated. Major AEs, medical AEs and nosocomial infectious were significantly associated to death in stroke patients admitted to the medical emergency department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo