Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

Thesis (Ph.D. in Epidemiology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 100-117). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves 97-110).

Bakgrund: Diabetes mellitus typ 1 är en autoimmun sjukdom som kräver daglig insulinadministrering. När ett barn behandlas med insulinpump ställs höga egenvårdskrav och föräldrarnas involvering är stor. Sjuksköterskan ansvarar för att utbilda och stötta föräldrarna i egenvård och behandling. Syfte: Syftet var att belysa föräldrars upplevelser av insulinpumpsbehandling hos barn med diabetes mellitus typ 1. Metod: En litteraturöversikt baserad på fyra kvalitativa artiklar, två kvantitativa artiklar och fyra artiklar med mixad metodansats vilka analyserades med hjälp av Fribergs analysmodell. Resultat: Resultatet belyser den förändrade vardagen och dess utmaningar som uppstår vid ett liv med ett barn som behandlas med insulinpump. Dessutom påvisas föräldrarnas transition från oro till ett accepterande av livssituationen. Föräldrarnas önskan om att få vardagen att likna den som tidigare varit, och deras upplevda förhoppningar om att förenkla vardagen illustreras. Det påvisades även prövningar i föräldrarollen och svårigheter i att hitta balans mellan ansvar och kontroll barnets självständighet. Diskussion: Resultatet diskuterades mot Orems egenvårdsteori. Teorin är generellt implementerbar vid insulinpumpsbehandling då egenvården är viktig för den metabola kontrollen. Arbetets primära resultat påvisade föräldrarnas behov av stöttning både gällande sig själva och sitt barn. Sjuksköterskan ska skapa omvårdnadsåtgärder anpassade till familjen för en ökad egenvårdsbalans, och möjliggöra att föräldrarna kan överföra egenvårdskapaciteten till barnet. / Background: Diabetes mellitus type 1 is an autoimmune disease which requires daily insulin administration. When a child is treated with insulin pump, the demands on self-care is high and the parents’ spend a lot of time to support their child. Nurses are responsible for the education and support related to self-care. Aim: The aim of the study was to highlight parents’ experiences of a child treated with insulin pump therapy. Method: A literature review based on four qualitative articles, two quantitative articles and four articles with mixed methods. These were analyzed by a model by Friberg.  Results: The result highlights the changing everyday-life and its challenges which arise in life with a child treated with an insulin pump, as well as the parents’ transition from concern to acceptance of their life situation. The parents’ wishes to normalize their life, as well as their hopes of simplifying their everyday-life was desired. The result also showed the difficulties of the parenting role and finding the balance between responsibility and control related to the child’s independence. Discussion: The result was discussed in the light of Orem’s self-care theory. The theory is generally implementable to insulin pump therapy since self-care is important for metabolic control. The primary result of the review demonstrated the parents’ need for support both for themselves and for their child. The nurse shall make self-care actions adapted to the family for an increased self-care balance and enable parents’ to transfer self-care capacity to the child.

Orientador: Ricardo de Lima Zollner / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T20:34:25Z (GMT). No. of bitstreams: 1 Malaguti_Carina_M.pdf: 3081251 bytes, checksum: 464b9eb4c3ea569832e54a9ac80854a6 (MD5) Previous issue date: 2007 / Resumo: O camundongo NOD é utilizado como modelo experimental por desenvolver diabetes mellitus tipo 1 (DM-1) espontâneo similar ao diabetes mellitus humano resultando na destruição das ilhotas, orquestrada pelos linfócitos T que induzem a liberação de citocinas, entre elas a IL-1, promovendo o processo inflamatório. A diacereína possui propriedades antiinflamatórias, inibindo IL-1. Entretanto, os mecanismos envolvidos na modulação imunológica ainda estão incompletamente compreendidos. No presente estudo, soro, pâncreas, ilhotas e células mononucleares esplênicas de animais tratados com diferentes doses (5, 10 e 50mg/kg/dia) de diacereína e o grupo controle o qual recebeu solução salina, foram isolados para investigar a expressão de IL-1ß, IFN-?, IL-12 e TNF-a e a relação com o início do diabetes, aspectos morfológicos e a dose-dependência da diacereína. Os resultados mostraram o aumento do RNAm de células esplênicas e ilhotas e a diminuição da concentração no soro de IL-1 em 10mg/kg/dia de diacereína, comparado com os outros grupos e aumento da concentração de IFN-? no soro do grupo de 50mg/kg/dia. Esses resultados sugerem que a diacereína interfere na instalação do diabetes e a freqüência, pela modulação de citocinas pró-inflamatórias como IL-1ß, IFN-?, IL-12 e TNF-a. Além disso, os dados sugerem regulação pós-transcricional de IL-1ß pela diacereína / Abstract: The NOD mice is used as a experimental model of spontaneously develop type1 diabetes mellitus (DM1) similar to human disease resulting in the destruction of the islet, orchestrated by T lymphocytes that induce a cytokines release, among then the IL-1, promoting inflammatory process. Diacerhein has antiinflammatory properties, inhibiting IL-1. However, the mechanisms involved in immune modulation are still incompletely understood. In the present study, serum, pancreas islets and spleen mononuclear cells from animals treated by different doses (5, 10 and 50mg/kg/day) and the group control which received solution saline, were isolated to investigate the IL-1ß, IFN-?, IL-12 and TNF-a expression and relationship with diabetes onset, morphological aspects and diacerein dose dependence. The results demonstrate upregulation of mRNA spleen cells and islets and downregulation of serum concentration of IL-1 in 10mg/kg/day diacerein treated group compared with others groups and increase of IFN-? serum concentration for 50 mg/kg/day group. These results suggest that the diacerhein interfere with the diabetes onset and frequency by modulation of pro-inflammatory cytokines as IL-1ß, TNF-a, IFN -? and IL- 12. Furthermore, the data suggest a post-transcriptional downregulation for IL-1ß by diacerhein / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

O diabetes mellitus tipo 1 é uma doença crônica, complexa, de difícil controle e tratamento doloroso. As dificuldades referentes ao diabetes são mais evidentes na adolescência, período de transição da dependência parental para uma vida mais autônoma, permeada por alterações físicas, nas relações com a família, amigos e sociedade, as quais podem repercutir na adesão ao tratamento e no controle metabólico. Identificar os fatores que interferem na qualidade de vida dos adolescentes permite intervenção adequada da equipe de saúde visando o controle adequado da doença. O objetivo geral desse estudo foi avaliar a qualidade de vida relacionada à saúde e autoestima de adolescentes com diabetes mellitus tipo 1. Estudo quantitativo, transversal, realizado de março a novembro de 2013. A amostra foi composta por 83 adolescentes, com idade entre 10 e 18 anos, matriculados no Programa de Educação em Diabetes em São Luís-MA, que responderam a três instrumentos: o Instrumento de Qualidade de Vida para Jovens com Diabetes (IQVJD) composto pelos domínios Satisfação, Impacto e Preocupações; a Escala de Autoestima de Rosenberg (EAR) e um formulário de dados sociodemográficos, clinicolaboratoriais e de tratamento. Os dados foram analisados por estatística descritiva e regressão logística univariada e multivariada por meio do Oddsratio (OR), com intervalo de confiança de 95% e nível de significância de 5% (p<0,05). Realizou-se a análise de confiabilidade do instrumento, por meio do alfa de Cronbach. Os escores médios do IQVJD Total e os domínios Satisfação, Impacto e Preocupações foram respectivamente, 111,34±18,46; 35,25±9,86; 52,81±9,19 e 23,27±6,73. Esses escores estiveram abaixo do ponto médio do IQVJD, caracterizando boa QVRS. Os fatores associados à QVRS no domínio Satisfação foram escolaridade, início dos sintomas, glicemia pré-prandial, estado de saúde, atividade física, renda familiar e pressão arterial, ensino fundamental I, ensino fundamental II, ensino médio incompleto e LDL colesterol, permanecendo na análise multivariada associação com o estado de saúde, grupo social, ensino fundamental II, renda familiar e glicemia pré-prandial. Ao domínio Impacto foram associadas as variáveis sexo, estado de saúde e glicemia pré-prandial e após análise multivariada permaneceram associados sexo, início dos sintomas e estado de saúde. No domínio Preocupações foram associadas renda familiar, colesterol total, tempo de tratamento e glicemia pré-prandial e após a análise multivariada permaneceu associada apenas a glicemia pré-prandial. As variáveis associadas ao IQVJD Total foram glicemia pré- prandial, estado de saúde, atividade física e sexo, após análise multivariada permaneceram associados glicemia pré-prandial e estado de saúde. As variáveis associadas ao Estado de Saúde referido foram início dos sintomas, hiperglicemia, triglicerídeos e atividade física, início dos sintomas, cor da pele, triglicerídeos e LDL colesterol e após análise multivariada apenas cor da pele permaneceu associada. Os adolescentes com melhor autoestima estavam no grupo melhor QVRS no domínio Satisfação, Preocupações e IQVJD Total. Espera-se que esses resultados contribuam com o planejamento de ações desenvolvidas pelos profissionais de saúde responsáveis pelo cuidado aos adolescentes com DM1, particularmente com a equipe de saúde do Programa de Educação em Diabetes do município de São Luís-MA / Type 1 diabetes mellitus is a complex chronic illness that is difficult to control and whose treatment is painful. The difficulties related to diabetes are more evident during adolescence, a transition period from parental dependence to a more autonomous life, permeated by physical alterations, in the relations with the family, friends and society, which can influence the treatment compliance and metabolic control. Identifying the factors that interfere in the adolescents\' quality of life permits appropriate intervention from the health team with a view to appropriate control of the disease. The general objective in this study was to assess the health-related quality of life and self-esteem of adolescents with type 1 diabetes mellitus. Quantitative, cross-sectional study, developed between March and November 2013. The sample consisted of 83 adolescents, between 10 and 18 years of age, enrolled in the Diabetes Education Program in São Luís-MA, who answered three instruments: the Quality of Life Instrument for Young People with Diabetes (QoLIYD), which includes the domains Satisfaction, Impact and Concerns: Rosenberg\'s Self-Esteem Scale (SES) and a formwith sociodemographic, clinical-laboratory and treatment data. The data were analyzed through descriptive statistics and univariate and multivariate logistic regression through the odds ratio (OR), with a 95% confidence interval and 5% significance level (p<0.05).The reliability analysis of the instrument was performed through Cronbach\'s alpha. The mean scores for the Total QoLIYD and the domains Satisfaction, Impacts and Concerns were, respectively, 111.34±18.46; 35.25±9.86; 52.81±9.19 and 23.27±6.73. These scores were inferior to the midpoint on the QoLIYD, characterizing a good HRQoL. The factors associated with HRQoL in the Satisfaction domain were education, symptoms onset, pre-prandial glucose, health condition, physical activity, family income and arterial pressure, primary education I, primary education II, unfinished secondary education and LDL cholesterol. In the multivariate analysis, associations continued with the health condition, social group, primary education II, family income and pre-prandial glucose. In the Impact domain, the associated variables were sex, health condition and pre- prandial glucose and, after the multivariate analysis, the associations with sex, onset of symptoms and health condition were maintained. In the Concerns domain, the associated variables were family income, total cholesterol, length of treatment and pre-prandial glucose and, after the multivariate analysis, only the association with pre-prandial glucose was maintained. The variables associated with the Total QoLIYD were pre-prandial glucose, health condition, physical exercise and sex. After the multivariate analysis, the associations with pre-prandial glucose and health condition were maintained. The variables associated with the referred Health Status were onset of symptoms, hyperglycemia, triglycerides and physical exercise, onset of symptoms, skin color, triglycerides and LDL cholesterol and, after the multivariate analysis, only the association with skin color remained. The adolescents with better self-esteem were found in the group with the best HRQoL in the Satisfaction and Concerns domains and in the Total QoLIYD. These results are expected to contribute to the planning of actions by the health professionals responsible for care to adolescents with DM1, particularly to the health team of the Diabetes Education Program in São Luís-MA

Bakgrund: Diabetes mellitus typ 1 (DMT1) är en vanligt förekommande sjukdom där stor del av behandlingen är egenvård. Personen behöver anpassa livet efter sjukdomen, under samtidig utvecklingsrelaterad transition kan det bli en utmaning. Ett personcentrerat förhållningssätt ökar personens delaktighet i vården och kan stärka relationen mellan person och sjuksköterska. Syfte: Beskriva erfarenheter av att leva med diabetes mellitus typ 1 hos unga vuxna (18-40 år). Metod: En litteraturöversikt baserad på 14 artiklar med kvalitativ design som analyserades induktivt utifrån Fribergs femstegsmodell. Resultat: Unga vuxna med DMT1 hade en uttalad rädsla och oro att utveckla komplikationer på grund av sjukdomen. Att vara ung vuxen med diabetes och befinna sig i transiton till vuxenlivet påverkade självbilden. Rutiner ansågs vara nödvändiga för god kontroll av sjukdomen men var svåra att implementera i vardagen och bidrog till att personen kände sig annorlunda. Stöd och kunskap var centralt för utförandet av god egenvård, en positiv syn på livet underlättade hantering och acceptans av sjukdomen. Slutsats: Personer med DMT1 har olika erfarenheter hur det är att leva med sjukdomen. Sjuksköterskor behöver arbeta personcentrerat för att på bästa sätt kunna hjälpa personer med DMT1. / Background: Diabetes mellitus type 1 (DMT1) is a common disease in which a large part of treatment is self-care. The person needs to adapt life after the disease, during simultaneous development-related transition can be a challenge. A person-centered approach increases the person's involvement in healthcare and can strengthen the relationship between the person and a nurse. Aim: To describe the experiences of living with diabetes mellitus type 1 in young adults (18-40 years). Method: A literature review based on 14 articles of qualitative design that were inductively analyzed based on Friberg's five-step model. Results: Young adults with DMT1 had a pronounced fear and concern to develop complications due to the disease. Being a young adult with diabetes and being in transition to adulthood influenced self-esteem. Routines were considered necessary for proper control of the disease but were difficult to implement in everyday life and contributed to the person feeling different. Support and knowledge were central to the performance of good self-care, a positive view of life facilitated management and acceptance of the disease. Conclusion: People with DMT1 have different experiences of living with the disease. To help the person with DMT1 in the best way nurses need to work person-centered.

Bakgrund: I Sverige finns idag 7-8000 barn och ungdomar med typ 1-diabetes. Sjukdomen är kronisk och innebär dagliga blodsockerkontroller för ställningstagande till insulindosering, matintag och fysisk aktivitet. Vid 18 års ålder flyttar ungdomar sina diabeteskontroller från barn- till vuxenklinik vilket innebär nya kontakter, rutiner och ökat egenansvar. Syfte: Att beskriva hur ungdomar med typ 1-diabetes upplever övergången från barn- till vuxenklinik. Metod: En kvalitativ innehållsanalys där data samlades in via ett frågeformulär med öppna frågor. Resultat: Resultatet beskrevs utifrån tre huvudkategorier: ”ovisshet”, ”oförberedd” och ”bemötande”. Ungdomarna kände sig oroade inför övergången från barn- till vuxenklinik. De uppgav att de ville vara mer delaktiga och få tidigare och tydligare information om de förändringar som skulle ske i och med klinikbytet. De tog även upp vikten av att på ett tidigt stadium bygga upp en personlig relation till personalen på vuxenkliniken. Slutsats: Det är viktigt att förbereda ungdomar med typ 1-diabetes inför övergången till vuxenklinik i god tid. Personal från vuxenklinik behöver därför komma in tidigare i förberedelsefasen och träffa ungdomarna redan på barnkliniken för att oro ska kunna minimeras. / Background: Currently there are 7-8000 children and adolescents with type 1- diabetes in Sweden. Diabetes type-I is a chronic disease and require daily blood glucose tests to determine insulin-doses, food intake and physical activity. The transition from pediatric- to adult clinic occurs at the age of 18. This leads to new health care professionals, routines and increased self-management. Purpose: Describe the experience of the transition from pediatric- to adult clinic at young people with diabetes type-I. Method: A qualitative content analysis was used and data were collected by questionnaires with open questions. Results: From the analysis of the data three main categories were identified; “uncertainty”, “unprepared” and “treatment”. The adolescents felt worried about the transition from pediatric to adult clinic. They wanted to receive earlier information in advance about the changes that would occur at the adult clinic. They indicated the importance of early, personal relationship with the staff at the adult clinic. Conclusion: It´s important to prepare the adolescents in a timely manner. The staff from the adult clinic should therefore be involved in the adolescents before the transition in order to create a personal relationship and to reduce uncertainty and ill-being.

Orientadores: André Moreno Morcillo, Sofia Helena Valente de Lemos Marini / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T07:15:25Z (GMT). No. of bitstreams: 1 Paulino_MariaFernandaVantiMacedo_D.pdf: 859715 bytes, checksum: bad0e20560ef4c2889c917c721da0ff8 (MD5) Previous issue date: 2012 / Resumo: Objetivo: avaliar o crescimento e a composição corporal de crianças e adolescentes, com diabetes tipo 1 (DM1). Sujeitos e métodos: estudo de uma coorte de 44 pacientes com DM1 acompanhados em média por 4 anos, comparados a um grupo controle. Avaliou-se peso, estatura, índice de massa corporal (IMC), massa gorda (MG%), índice de massa gorda, cintura e razão cintura/altura. Resultados: no sexo feminino, na primeira avaliação a MG% das pacientes foi menor, enquanto na segunda, a média da cintura das pacientes foi maior que a dos controles. No sexo masculino, a altura dos pacientes foi menor na primeira avaliação, enquanto o IMC foi maior na segunda. Não foram observadas diferenças entre as variações dos escores z de altura, peso, IMC e da MG% ou na distribuição desses escores entre as duas avaliações em ambos os grupos. A análise multivariada mostrou diferença no IMC e na razão cintura/altura dos dois sexos e também na cintura das meninas. Conclusão: os pacientes apresentaram crescimento adequado, porém diferiram na composição corporal durante o período do estudo / Abstract: Objective: the aim of this study was to evaluate the growth and body composition of children and adolescents with type 1 diabetes mellitus (T1DM). Subjects and methods: a cohort of 44 patients with T1DM were followed for approximately four years and compared with a control group. Weight, height, body mass index (BMI), body fat percentage (BF%), fat mass index, waist circumference (WC) and waist-height ratio were determined. Results: in females, in the first evaluation, BF% was lower in patients, while, in the second, mean WC was higher in patients than in controls. In males, height was lower in the first, while BMI was higher in the second. We did not find any differences among the changes in height, weight, BMI z-scores and BF% or in the distribution of those z-scores between the two evaluations, in both groups. Multiple regression analysis found differences in BMI and waist-height ratio in both sexes and also in WC in females. Conclusion: the patients had adequate growth but showed discrepancy in their body composition during the study / Doutorado / Pediatria / Doutora em Saúde da Criança e do Adolescente

Orientador: Ricardo de Lima Zollner / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T11:47:48Z (GMT). No. of bitstreams: 1 Figueiredo_Daniellade_M.pdf: 3504963 bytes, checksum: 2a5ced4957aa0233b6b6f5417ad31dc3 (MD5) Previous issue date: 2014 / Resumo: A procura por novos fármacos a partir de plantas medicinais tem motivado a busca alternativa de substâncias com potencial antiinflamatório que possam auxiliar no tratamento das doenças inflamatórias, como no caso do diabetes mellitus tipo1. Como ferramenta para estudar essas substâncias que modulam a inflamação, é comum o uso de animais com propensão a desenvolver a doença, como os camundongos NOD (diabéticos não obesos). Dentre os constituintes das folhas de Passiflora alata Curtis, conhecido popularmente por maracujá doce, os flavonóides são compostos que podem atuar como antioxidantes e antiproliferativos, podendo modular a expressão de substâncias reguladoras do ciclo celular promovendo, desta forma, a sua interrupção em células em proliferação. Como resultados, nós obtivemos no grupo tratado com extrato aquoso das folhas de P. alata, redução na incidência do diabetes, aumento da expressão de insulina e diminuição do infiltrado inflamatório, estresse oxidativo e células CDK6+ em ilhotas pancreáticas. Como neste modelo animal a expressão de CDK6 está presente no infiltrado inflamatório, a sua diminuição no grupo tratado sugere que componentes nas folhas de P. alata possam atuar na inibição do ciclo celular de células inflamatórias ativadas promovendo efeito antiinflamatório e, consequentemente, diminuição na incidência do diabetes tipo 1. Visto os efeitos antiinflamatórios e consequente preservação de células beta, o estudo visa investir no desenvolvimento de novas drogas com potencial de interferir na evolução da doença, atuando desta forma como suporte no tratamento do diabetes autoimune / Abstract: The search for new medicinal drugs from plants has motivated the search for alternative potential anti-inflammatory substances that may assist in the treatment of inflammatory diseases, such as type 1 diabetes mellitus. As a tool to study these substances that modulate inflammation, is common to use animals with a propensity to develop the disease, such as NOD mice (non-obese diabetic). Among the constituents of Passiflora alata Curtis leaves, known popularly as sweet passion fruit, flavonoids are compounds that can act as antioxidants and anti-proliferative, which can modulate the expression of cell cycle regulatory substances promoting in this way, the cell cycle arrest in proliferating cells. As a result, we have obtained in the treated group with P. alata leaves aqueous extract, reduction in the incidence of diabetes, increased expression of insulin and decreased inflammatory infiltrate, oxidative stress and CDK6+ cells in pancreatic islets. As in this animal model the marking of CDK6 is present in the inflammatory infiltrate, the decreased expression of this protein in the treated group suggests that components in the leaves of P. alata may act on cell cycle inhibition of activated inflammatory cells promoting anti-inflammatory effect and reduction in the incidence of type 1 diabetes. Since the anti-inflammatory effects and consequent preservation of beta cells, the study intend to investing in the development of new drugs with the potential to interfere with the course of the disease, acting as a support in the treatment of autoimmune diabetes / Mestrado / Clinica Medica / Mestra em Clínica Médica