Achados da fundoscopia e alterações do pé diabético em pacientes do Hospital Universitário Onofre Lopes/UFRN

Trabalho com o objetivo de identificar as alterações do pé diabético causadas pelas lesões microangiopáticas e das lesões do fundo de olho secundárias aretinopatia diabética. Métodos:76 pacientes com Diabetes Melito tipos 1 e 2atendidos no ambulatório de Oftalmologia e Cirurgia Vascular do HUOL/UFRN, Natal, RN, no período de novembro de 2004 a janeiro de 2005, com queixas relativas a alterações da retinopatia diabéticae/oudo pé diabético. Em todos os pacientes foi realizado exame clínico geral, vascular e oftalmológico. Na avaliação específicado pé diabético deu-se ênfase paraa investigação do status vascular pela Classificação de Fontaine para Doença Arterial Obstrutiva Periférica, biomecânica,e teste do monofilamento de Semmes-Weinstein. O exame oftalmológico constou de refração e fundoscopiaatravés da qual identificou-se as formas clínicas da retinopatia diabética. Os dados foram submetidos à análise estatística das variáveis primárias que consistiu em caracterizar o grupo quanto a idade, tempo de doença, nível de glicose A segunda estratégia da análise dos dados constituiu na realização de testes de associação entrealgumas variáveis secundárias selecionadas. O software utilizado para os testes estatísticos foi o Statistica Versão 5, 1997.Resultado: Dos 76 pacientes diabéticos 97% tinham idade superior a 40 anos. O tempo de doença65% tinham mais de 10 anos. Com relação à glicose 72,72% apresentaram níveis de glicose em jejum acima de 100mg/dl. 55,26% apresentavam algum grau de retinopatia diabética contra 44,74% que não apresentavamesses sinais. Com as alterações do pé diabético, identificou-se 59,93% com lesões com área de predominância isquêmica, enquanto 41,07% tinham ausência de sinais. 58,82% apresentaram área de predominância neuropática, e 41,18% sem sinais de neuropatia. Dos com retinopatia diabética 78,57% tinham comprometimento isquêmico no pé e 47,62% tinham algum grau de neuropatia diabética. Observou-se que a retinopatia diabética não proliferativa, nos seus diversos graus de comprometimento apresentou-se com percentuais em torno de 80% junto às lesões do pé diabético, seja isquêmico ou neuropático. Dos pacientes que tinham retinopatia 60,46% tinham alterações biomecânicas dos pés. Conclusão: Concluiu-se que a RDNP leve foi mais freqüente nas lesões do pé diabético isquêmico, enquanto a RDNP severa mostrou-se mais presente no pé diabético neuropático

Incidência e fatores de risco da retinopatia diabética em pacientes do Hospital Universitário Onofre Lopes, Natal-RN

Estudar a incidência e fatores de risco (tempo de doença e presença de hipertensão arterial sistêmica) para retinopatia diabética em 1002 pacientes encaminhados pelo Programa de Diabetes do Hospital Universitário Onofre Lopes no período de 1992 – 1995. Métodos: Estudo retrospectivo de pacientes com diagnóstico de diabetes mellitus encaminhados ao Setor de Retina do Departamento de Oftalmologia pelo Programa de Diabetes do Hospital Universitário e submetido, sob a supervisão do autor, a exame oftalmológico, incluindo medida da acuidade visual corrigida (tabela de Snellen), biomicroscopia do segmento anterior e posterior, tonometria de aplanação e oftalmoscopia binocular indireta sob midríase(tropicamida 1% + fenilefrina 10%). Foi realizada análise dos prontuários referente ao tempo de doenças e diagnostico clínico de hipertensão arterial sistêmica. Resultados: Dos 1002 diabéticos examinados (em 24 deles a fundoscopia foi inviável), 978 foram separados em 4 grupos: sem retinopatia diabética (SRD), 675 casos (69,01%); com retinopatia diabética não proliferativa (RDNP), 207 casos (21,16%); com retinopatia diabética proliferativa (RDP), 70 casos (7,15%); e pacientes já fotocoagulados (JFC), 26 casos (2,65%). Do total, 291 eram do sexo masculino (29%) e 711 do sexo feminino (71%). Os 4 grupos foram ainda avaliados quanto ao sexo, a faixa etária, a acuidade visual, tempo de doença, presença de catarata e hipertensão arterial sistêmica e comparados entre si. Com relação ao tipo de diabetes, 95 eram do tipo I (9,4%), 870 pacientes eram do tipo II (86,8%), e em 37 casos(3,7%) o tipo de diabetes não foi determinado. Conclusões: Comprovou-se que os pacientes com maior tempo de doença tinham maior probabilidade de desenvolver retinopatia diabética, e que a hipertensão arterial sistêmica não constituiu fator de risco em relação à diminuição da acuidade visual nos pacientes hipertensos

Modelo institucional do processo de estruturação de empresas de desenvolvimento de software: um estudo de múltiplos casos

Some authors have shown the need of understanding the technological structuring process in contemporary firms. From this perspective, the software industry is a very important element because it provides products and services directly to many organizations from many fields. In this case, the Brazilian software industry has some peculiarities that distinguish it from other industries located in developed countries, which makes its understanding even more relevant. There is evidence that local firms take different strategies and structural configurations to enter into a market naturally dominated by large multinational firms. Therefore, this study aims to understand not only the structural configurations assumed by domestic firms but also the dynamic and the process that lead to these different configurations. To do so, this PhD dissertation investigates the institutional environment, its entities and the isomorphic movements, by employing an exploratory, descriptive and explanatory multiple cases study. Eight software development companies from the Recife's information technology Cluster were visited. Also, a form was applied and an interview with one of the main firm s professional was conducted. Although the study is predominantly qualitative, part of the data was analyzed through charts and graphs, providing a companies and environment overview that was very useful to analysis done through the interviews interpretation. As a result, it was realized that companies are structured around hybrids business models from two ideal types of software development companies, which are: software factory and technology-based company. Regarding the development process, it was found that there is a balanced distribution between the traditional and agile development paradigm. Among the traditional methodologies, the Rational Unified Process (RUP) is predominant. The Scrum is the most used methodology among the organizations based on the Agile Manifesto's principles. Regarding the structuring process, each institutional entity acts in such way that generates different isomorphic pressure. Emphasis was given to entities such as customers, research agencies, clusters, market-leading businesses, public universities, incubators, software industry organizations, technology vendors, development tool suppliers and manager s school and background because they relate themselves in a close way with the software firms. About this relationship, a dual and bilateral influence was found. Finally, the structuring level of the organizational field has been also identified as low, which gives a chance to organizational actors of acting independently

A formação e o desenvolvimento de arranjos cooperativos sob a ótica da imersão social e da economia dos custos de transação: um estrudo de caso na Coopercam e na Unipesca

The current study analyzes the birth and development of two strategic alliances established between shrimp producers in Rio Grande do Norte: the Unipesca and the Coopercam. To achieve this aim, two approaches which, at first sight, could be considered contradictory were used: the Transactional Costs Economy and Embeddedness. The first approach is fundamentally based in the studies of Williamson (1985; 1991; 1996; 1999; 2000; 2002). Embededness, on the other hand, went through the review of a series of authors, such as Burt (1992), Granovetter (1973; 1985), Uzzi (1997), Gulati (1994; 1995; 1997; 1998; 1999; 2000), Nielsen (2005), Ring (2002), Ring and Van de Ven (1994), Zafirovski (2002), among others. To analyze the birth and development of the cooperatives in this study, Gulati s work (1998) was used. This study shows the steps to be studied for a better comprehension of an alliance: the decision of starting an alliance and the choice of the partners, the decision about the governance structure, the evolution of the alliance and the development of the companies which established this partnership. To carry this study out, a study case accordingly to Yin s proposal (2001) was adopted. Semi-structured interviews with pre-defined plots were conducted in two phases: in the beginning of 2006 and in the beginning of 2007. The subjects from the research were, in 2006, representative members of the main associations and corporations, besides the shrimp producers from the state, when the context of the activity was set. In the second phase, in 2007, representative members from the two cooperatives that were listed above were interviewed the president from Coopercam and the marketing manager from Unipesca. Besides these two members, directors from two important organizations in each of these cooperatives were also interviewed, giving out the necessary information for the research. Secondary data was also collected from the Brazilian Association of Crab producers website, as well as from news from important newspapers in RN, such as Tribuna do Norte. The primary data was analyzed in terms of quality, accordingly to the documental analysis technique. Thus, through the data that was collected, it can be concluded that the reasons that motivated the companies to cooperate can be explained in terms of the transactional costs economy. However, the choice of partners is more connected to aspects approached by the social embededness. When aspects related to development and evolution were analyzed, it could be seen that both aspects from TCE and Embededness were vital to explain the development of the cooperatives mentioned

Do tratamento das reclamações à gestão da insatisfação: o comportamento de empresas hoteleiras mediante a insatisfação de seus clientes

Consumer dissatisfaction, when properly handled, is a significant information source for the manager. Studies in this area allow broadening the understanding of certain customer attitudes and behaviors, such as loyalty, repurchase intention or satisfaction and trust increase. Above and beyond supporting consumer feedback, dissatisfaction can provide significant opportunities for organizational learning. Starting from dissatisfied customer information, companies can detect service flaws and develop new products. This work presents the results of an investigation on the behavior of businesses belonging to the hotel sector in Natal, RN, through the dissatisfaction of their customers. We have sought to map the main problems presented by customers to hotels, in the perception of managers and employees, as well as to understand both the process of dissatisfactionrelated data collection, analysis, and processing, and the utilization of such information by businesses. Beyond this, we have compared the habits of organizations to the company reaction approaches described in the literature: Complaint Handling, Complaint Management, and Dissatisfaction Management. The used methodology has been based on case study. Data was collected via indepth interviews with managers and employees in six hotels, two independent ones and four belonging to national and international hotel networks. We have also made use of documents provided by the organizations, such as guest complaint registers and reports from satisfaction surveys on which content analysis was subsequently performed. The results of the investigation point to a high level of awareness in the companies concerning the importance of consumer dissatisfaction. Even though the maximum grade in the procedure scale is not achieved, it has been observed that answer to dissatisfaction is given in planned and systematic form, geared towards consumer satisfaction and improvement of products and processes. Hotel businesses still have to look into other possibilities for mapping consumer dissatisfaction, which implies, among other aspects, articulation with a range of public and private organizations in such a way as to guarantee sustainability of touristic activities in the long term

Relações interorganizacionais e confiança no setor da carcinicultura: um estudo de caso na camanor produtos marinhos

This study investigated how the types of confidence based on competence and good will act in the formation and maintenance of cooperation relationships between the Camanor and its partners (Aquatec, Purina, Caçuá, Uvifrios and Malta / Cleyton). It used organizational approaches on networks based primarily on studies of Powell (1987, 1990), Das and Teng (2000, 2001), Child (2001) and Contractor and Lorange (2004) which have described the advantages that cooperative relationships can provide, as well as their limits as alternative governance structures. Confidence has been considered an important factor affecting the actions and development of organizations involved in networks or in strategic alliances (ZAHEER; HARRIS, 2006) and is the most appropriate control mechanism in these situations (SYDOW, 1998). Confidence is seen from two different approaches: the economic and the sociological (ZAHEER; HARRIS, 2006). To facilitate the understanding of confidence some typologies have been created, as proposed by Barney and Hansen (1994), Lane (1998), Das and Teng (2000), Child (2001) and Wever, Martens and Vandenbempt (2005). This study made use of the case study as proposition of Yin (2005). Semi-structured interviews were held with pre-determined routes, in a single stage performed in early 2008. The research subjects were owners and / or responsible for Camanor and its business partners (Aquatec, Purina, Caçuá, Uvifrios and Malta / Cleyton). Also secondary data were collected in several sites related to the industry and enterprises studied, in addition to data collected by previous studies conducted by CARCINEREDES (2006). The primary data were analyzed using the analysing technique of the content proposed by Bardin (1994). Regarding the secondary data, they were qualitatively analyzed according to documentary analysis technique (BARDIN, 1994). Thus, through the data collected, could be concluded that although there is confidence based on good faith in relationships(UZZI, 1998; OF; TENG, 2001), their presence does not determine the formation and / or maintenance of a partnership, serves only in order to facilitate the relationship, making them more flexible. The confidence based on competence (DAS; TENG, 2001) influenced the formation and maintenance of relations studied. Because whether or not to form a relationship with another organization it is used the perception of the partner acts, namely the reputation (image) as decision basis. And it is through the verification of the performance of the partner activities that will determine the continuation of the partnership

A importância das redes de relacionamento para se formar uma parceria : um estudo de caso na ALESAT

This paper consists in a study case at the Alesat company, which aims at analyzing how the networks from the former companies Ale and Sat influence the formation of partnerships. The study was based on literature by Burt (1992), Granovetter (1973), Uzzi (1997), Contractor and Lorange (1988), Gulati (1998), Child and Faulkner (1998), and others, to verify how important the social relations were between the companies to the formation of a strategic alliance. The research method we adopted analyzed the first partnership between Ale and Sat and the last one that ended up with the merger of the companies resulting in a new company, Alesat. Semi-structured interviews were conducted in 2008 with the council board of the company. Secondary data were also collected from specific web sites from the area, such as ANP, Sindicom and Fecombustíveis, as well as from important newspapers in the market. The primary data were analyzed through the content analysis technique from Triviños (1987). The secondary data were analyzed through the documental analysis technique from Richardson (1985). This way, through the data collected, it can be concluded that the social ties between the companies were important in the partnership, and among the reasons that made the companies get together, the key one was the fact that the union would make possible to the companies act in regions in which they didn t have too much market share, making them a bigger player nationally wise

Inserção de fornecedores locais como fonte de desempenhos em custos de transação e legitimidade: estudo de caso na cadeia produtiva do petróleo e gás do Rio Grande do Norte

The inclusion of local suppliers in production chains has considerable impact on its performance, but most notably in its main actors. The results of this process may be of different kinds and can be analyzed from economic or institutional approaches. This study aimed to verify the existence of different performances of Petrobras due to the inclusion of local suppliers in the oil and gas production chain in the state of Rio Grande do Norte, from the viewpoints of transaction costs and the Institutional Theory. In order to this, were made the characterization of the PROMINP, the description of its actions and results, the mapping of its institutional context of reference, and identification of results obtained by Petrobras in terms of transaction costs and legitimacy. The theoretical framework is based on authors dealing with industrial concentration, as like Marshall, Krugman, Porter and Schmitz, from the sociological perspective of neoinstitucional theory, as like DiMaggio and Powell and Scott and Meyer, and transaction costs, as like Williamson. This is a qualitative research, with data collection done by consulting secondary fonts and semi-structured interviews with nineteen actors of three groups, namely: actors involved in actions of the program, representatives of enterprises and representative of Petrobras. To analyze the content was used the Suchman s model (1995) for categories associated with strategies of legitimation and fourteen variables associated with the three variables assets specificity, bounded rationality and opportunism (Williamson, 1995, 1989) in the case of transaction costs. The results indicate that PROMINP has achieved its objectives by encouraging the increased participation of local companies in the oil and gas production chain, reflecting in the economic development of the state. The Redepetro/RN, fostered and built upon the interaction of the participants, is presented as a solution of continuity to the participation of enterprises in the chain, after the closure of the actions of the program. PROMINP demands responses to coercive, legislative and regulatory pressures of the organizational field, whose institutional context of reference is wide. From the point of view of legitimacy, through strategies to gain cognitive legitimacy and maintaining pragmatic legitimacy, Petrobras can manipulate the environment, ensuring the compliance of the constituents to their technical and institutional demands. Enterprises, in turn, respond to the demands through compliance with technical demands, mainly through the certification of processes, and cultural changes. There aren t clear gains related to the transaction costs, however, gains in legitimacy can be seen as a cumulative capital that can serve as a competitive differential that generates economic gains. In terms of theoretical findings, it was found that, due to its explanatory power for actions that are difficult to explain only in economic terms, Institutional Theory may be used as theoretical support concurrent with other theories. TCE model has limitations in explaining the program actions. In the case, it s emphasized that Petrobras doesn t seek only economic efficiency, but has in its mission the commitment to social development.

Relação entre ciclo de vida do produto turístico e estratégias de cooperação na faixa litorânea urbana do município de Natal

Tourism in the Northeast of Brazil was introduced as an alternative economic development for the Region by federal promoting policies that focused primarily in structuring the local geographic area. With the completion of these structuring actions, mass tourism expanding the area, as well as spread actions based on cooperation and formalization of governance institutions. This study aimed to examine the relationship between the life cycle of the tourism product 'Coastal Cities of Natal and the cooperation strategies in a historical perspective. Thus was submitted to the life cycle of the tourism product 'Coastal Cities of Natal ; the major projects of tourism development were mapped, the existing cooperation strategies were characterized, and investigated the influence of the cooperation actions for the current stage of product. The specific theoretical support to tourism was built on the perspective of the Theory of Population Ecology, System of Tourism and Touristic Product Life Cycle. Regarding to cooperation the theoretical foundation addressed issues of strategy, New Forms and Collective Efficiency. The survey consisted of a causal descriptive study, using a case study. We used the qualitative and quantitative methodological approaches, and data collected by consulting of secondary data and semistructured interviews with twelve staff working in tourism in Natal. Results showed that the life cycle graph of product 'Coastal Cities of Natal is moving from one stage of growth to a stage of maturity, with a primary upward trend and with crises that are up over the graph. They have been mapped six of tourism development projects of relevance to the product: The Politics of Mega Projects, PRODETUR/NE, Municipalization National Program of Tourism, Regionalization Program, Urbanization Project Beach do Meio and Actions for the Promotion of Destiny. They have been identified sixty-four participating players in process of tourism development, which twenty were considered relevant to the respondents. The main strategies identified for cooperation were the consortium, collective strategy and clusters. Results indicated that co-operation strategies were adopted so that the benefits were obtained at the collective level, dedicated to the strengthening of Natal Destiny and its products. The main reasons were the need of cooperative marketing, international market entry and actions inducing the state. Finally, it was concluded that strategies for cooperation related to product life cycle 'Coastal Cities of Natal' as that work in the consolidation of projects for development of tourism, when the efficiency of collective action is achieved

A dinâmica do campo organizacional e a adoção de estratégias na carcinicultura do RN

This study aimed to understand the relations inside the organizational Structuring of the shrimp Field - the shrimp agribusiness placed in Rio Grande do Norte State and the strategies adopted by its players. In order to achieve that, semi-structured interviews were conducted with samples of various organizations that act in the field, like cooperatives, associations, enterprises of different links in the chain, universities and state agencies. The interviews built up a large collection of secondary data. As expected, it was found that Field and strategies are related in a recursive way: the configuration of the field, a result from his own biography, has decisively influenced the strategies adopted by its actors, who, as evolved, eventually caused further changes in the Field and outlines the plot of this area of interaction. It was found, for example, that after thirty-five years of its genesis, the Field of shrimp RN still has a low level of institutionalization, which helps to understand the difficulty of its actors in establish strategies based on partnerships and cooperation; Those actions are so necessary to alleviate the effects of the crisis that devastated the industry since 2004. It was noticed, however, that this level of institutionalization is a result, beside other factors, the very strategies that field actors are embracing along its trajectory. Thus, this study hopes to have contributed both to the necessary revival of the agency to institutional phenomenon, cited by Oliver (1991), and to meet the need for more contextualized approaches to organizational strategies (MINTZBERG, 1987; CLEGG, 2004; WHITTINGTON, 2004; 2006; SARAIVA and CARRIERI, 2007). It is an exploratory study that needs further investigation in order to get deep in this research. In this sense, others methodologies and theoretical perspectives need to be used, especially those relating to the seizure of the disputes and discursive aspects of power, as salient in the field investigated. Moreover, in terms of "practical actions", it is suggested that, as soon as possible, the main actors of the field (cooperatives, companies, and state entities in class) can be able of agglutinate efforts to support the shrimp field in RN State and make sustainable actions, which can promote the development of activity in a global view. On the apse of shrimp activities everybody wanted to be the "father of the child," Now, someone has to "stay in the goal."

Estratégias competitivas genéricas nas empresas comerciais varejistas de shopping centers: um estudo a partir do modelo de Porter

Os shoppingcenters são grandes instituições repletas de empresas quecompetem entre si formas de como melhor satisfazer as necessidade dosclientes. Sendo assim, cada empresa utiliza-se de estratégias com o intuito deatingir a maior parcela de compradores possíveis sem comprometer suaexistência e sua vantagem competitiva. Este estudo está baseado na teoria dasestratégias competitivas genéricas de Porter (1980; 1985) o qual estabeleceem seu modelo que todas as empresas existentes no mercado possuam pelomenos uma das três abordagens estratégicas (diferenciação, liderança emcusto e enfoque). Desta forma, este trabalho identifica de que maneira estádistribuída as estratégia competitiva nas empresas de shoppingcenters deNatal/RN. Primeiramente buscou-se levantar a relação das estratégias destasempresas com a teoria proposta por Porter (1985) e sua alocação de acordocom os agrupamentos resultantes da combinação das estratégias. Nestemomento, foram aplicados questionários com 89 gerentes de lojas de shoppingcenters que resultou após análises estatísticas em cinco agrupamentos comabordagens válidas. Em seguida foram selecionadas as empresas quepossuíam maior afinidade com cada agrupamento e que melhor representavamos resultados dispostos em cinco clustersacerca da teoria proposta e nestaamostragem foi aplicada entrevista com os gerentes. Os resultados obtidos com as entrevistas validaram a análise dos dados encontrados nosquestionários anteriormente aplicados estando em conformidade com aproposta teoria. Identificou-se também duas modalidades de empresas queutilizavam simultaneamente mais de uma estratégia competitiva (meio-termo),sendo uma dentro e outra fora do modelo proposto pelo autor. Embora omodelo das estratégias competitivas genéricas tenha sido instituído comaspectos voltados as organizações industriais, os resultados obtidos nestetrabalho validaram a aplicação desta teoria em empresas comercias deshopping centers que vem se adequando para obter resultados financeirosmais satisfatórios e melhor posicionamento em relação à concorrência

Revitalização urbana de centros históricos: uma revisão de contextos e propostas: a Ribeira como estudo de caso

This dissertation focuses on the theme of urban revitalization in historical centers. It starts from a survey of international and national concepts and experiences about the subject, in special, the historical center of Ribeira, in Natal, Brazil. It gives more attention to local management and it is dedicated to the study of objectives and actions developed, basically, by two segments that manage works in the district. Companhia Docas do Rio Grande do Norte aims at the economical development of the state and it implies the enlargement of capacity of loading and unloading of the harbor of Natal and the Natal city counsil aims at urban preservation and revitalization. It was analysed speeches ans projects related to Ribeira and it was discovered that Natal has done very little to revitalize its historical center in the last two dacades. It analyses what seemed, or at least, should be a conflict of interests between incompatible projects, revealing both conciliatory proceedings and connivance between the participants in decision making. The conclusion directs attentions to the threat to historical building in the city and the importance of enhancing discussion about the future of our historical sites