The purpose of this study was to examine the levels of depression in adolescent with diabetes (type 1), non-insulin dependent diabetics (type 2) and the general adolescent population.

Submitted by Fernanda Ciolfi (fernanda.ciolfi@puc-campinas.edu.br) on 2016-04-06T19:54:16Z No. of bitstreams: 1 Vanessa Marques Gibran Victorio.pdf: 3683968 bytes, checksum: ecd76cc22be836555ddbe6f02f5cf33a (MD5) / Made available in DSpace on 2016-04-06T19:54:16Z (GMT). No. of bitstreams: 1 Vanessa Marques Gibran Victorio.pdf: 3683968 bytes, checksum: ecd76cc22be836555ddbe6f02f5cf33a (MD5) Previous issue date: 2016-02-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Type 1 Diabetes Mellitus (DM1) is a chronic health condition characterized by excess blood glucose and deficient production of insulin by the pancreas, requiring daily intake of insulin for metabolic control. Metabolic control is affected by psychosocial variables, especially during adolescence, a phase in which individuals are at the risk of stress responses. The way adolescents deal with stress partially depends on their coping repertoire. Adaptive coping strategies enable better glycemic control and adherence to treatment, which is based on medication and self-care behavior, such as following a specific diet, blood sugar monitoring and exercising. Considering the characteristics of this development phase and DM1, this study analyzed the relationships among stressors, coping and treatment adherence in adolescents with DM1 based on the Motivational Theory of Coping. Ten adolescents participated in the study, five of each sex, aged between 12 and 15 years old, with a medical diagnosis of DM1, attending elementary/middle school (7) or high school (3). A sociodemographic questionnaire including the Brazil Economic Classification Criteria, the Diabetes Self-Care Activities Measure (DSCA), the Questionnaire on Stress in Patients with Diabetes (QSD-R), the Adolescent/Child?s Self-Report Responses to Stress (RSQ-Pediatric Diabetes- DPed) with linguistic validation authorized by the authors, together with the Coping Diabetes Scale for Adolescents (COPE-DIA), especially developed for this study, were individually applied. Data were collected in the Associa??o de Diabetes Juvenil [Juvenile Diabetes Association] facility in Birigui, SP, Brazil and at the adolescents? homes. Data analysis was quantitative using non-parametric statistics and qualitative with the description of two cases. Behavior with greater adherence, verified through DSCA, were Blood glucose monitoring and Medication taking (insulin and/or pills). According to the QSD-R, Stress caused by hypoglycemia was considered the most significant stressor by most adolescents, followed by Therapeutic Regime and Somatic Complaints. The most frequent stressors, according to the two instruments that assessed diabetes stressors, were linked to diabetes treatment and feelings of guilt for not complying with medical recommendations. According to RSQ-D-Ped, the adolescents dealt with DM1 by using the following coping strategies: Involuntary Engagement (Excitement and Rumination) and Secondary Control Coping (Positive Thinking, Acceptance, Distraction and Cognitive Restructuring). According to COPE-DIA, stressors were more frequently considered a challenge than a threat to the individuals? basic needs for Relationship, Competence and Autonomy, presenting the following coping strategies: Search for Information, Search for Support, Problem-Solving, Isolation (related to the need of Relationship), Escape, Delegation and Helplessness (related to the need of Competence). Anger was the most frequently reported emotional response. Coping seems to affect the relationship between the therapeutic regimen and exercise. This analysis of motivational variables involved in the process of treatment adherence among adolescents with diabetes provided prescriptive data for future interventions directed to this population. This study also contributed to the field of research proposing a more developmentalist analysis of variables relevant for treatment adherence in this age group. / O Diabetes Mellitus Tipo 1 (DM1) ? uma condi??o cr?nica de sa?de caracterizada pelo excesso de glicose no sangue e produ??o deficiente de insulina pelo p?ncreas, exigindo a ingest?o di?ria de insulina para o controle metab?lico. Este ? afetado por vari?veis psicossociais, especialmente durante a adolesc?ncia, que ? uma fase de risco para rea??es de estresse. A forma como o adolescente lida com o estresse depende, em parte, de seu repert?rio de enfrentamento. As estrat?gias de enfrentamento [EE] adaptativas permitem um melhor controle glic?mico e maior ades?o ao tratamento. Este ?ltimo est? baseado em medicamentos e comportamentos de autocuidado, como o seguimento de dieta alimentar, o monitoramento da glicemia e a realiza??o de atividades f?sicas. Considerando as caracter?sticas dessa fase de desenvolvimento e do DM1, esta pesquisa analisou as rela??es entre estressores, o enfrentamento da doen?a e a ades?o ao tratamento, em adolescente com DM1, a partir da Teoria Motivacional do Coping. Participaram 10 adolescentes, 5 de cada sexo, com idade entre 12 e 15 anos e diagn?stico m?dico de DM1; cursavam o Ensino Fundamental (7) e o Ensino M?dio (3). Foram aplicados, individualmente, um Question?rio Sociodemogr?fico, com o Crit?rio de Classifica??o Socioecon?mica Brasil, o Question?rio de Atividades de Autocuidado (QAD), o Question?rio de Estresse Face ? Diabetes-R (QSD-R), o Adolescente/Child?s Self-Report Responses to Stress (RSQ-Pediatric Diabetes- D-Ped), com valida??o lingu?stica autorizada, e a Escala de Coping do Diabetes para Adolescentes (COPE-DIA) especialmente elaborada. Os dados foram coletados na Associa??o de Diabetes Juvenil (ADJ), na cidade de Birigui/SP e nas resid?ncias dos adolescentes. A an?lise de dados foi quantitativa, atrav?s de an?lise estat?stica n?o param?trica, e qualitativa, com descri??o de dois casos. Os comportamentos do QAD com maior ades?o foram: Monitoramento da glicemia e Uso de Medica??o (insulina e/ou comprimidos). O Estresse Face ? Hipoglicemia foi considerado o estressor mais significativo pela maioria dos adolescentes, seguido do Regime Terap?utico e das Queixas Som?ticas, no QSD-R. Considerando os dois instrumentos que avaliaram os estressores do diabetes, foram mais frequentes aqueles ligados aos cuidados com o tratamento do diabetes e ao sentimento de culpa pelo n?o cumprimento das orienta??es m?dicas. Os adolescentes lidavam com o DM1 com EE de Engajamento Involunt?rio (Excita??o Emocional e Rumina??o) e Engajamento de Controle Secund?rio (Pensamento Positivo, Aceita??o, Distra??o e Reestrutura??o Cognitiva), segundo o RSQ-D-Ped. Pelo COPE-DIA, avaliaram os estressores mais como um desafio do que amea?a ?s suas necessidades b?sicas de Relacionamento, Compet?ncia e Autonomia, apresentando EE de Busca de Informa??o, Busca de Suporte, Resolu??o de Problemas, Isolamento (relativos ? necessidade de Relacionamento), Fuga, Delega??o e Desamparo (relativos ? necessidade de Compet?ncia). A rea??o emocional de raiva foi a mais frequente. O coping parece afetar a rela??o entre o regime terap?utico e a atividade f?sica. Essa an?lise das vari?veis motivacionais envolvidas no processo de ades?o ao tratamento em adolescentes com diabetes forneceu dados prescritivos para futuras interven??es com essa popula??o. Contribui tamb?m para a ?rea de pesquisa, ao propor uma an?lise mais desenvolvimentista das vari?veis relevantes ? ades?o ao tratamento nessa faixa et?ria.

Diabetes can affect the structure and function of the foot, resulting in severe limitation of mobility and reduction of life expectancy. Early warning signs include limited joint mobility (LJM), soft tissue changes, high plantar pressure (HPP), high pressure time integrals (P/TI) and plantar callus. These abnormalities were examined in 216 young people with diabetes and 57 controls. The fingers, toes, ankle subtalar and first metatarsophalangeal joints shows reduced motion and the plantar aponeurosis was thicker in diabetic subjects. Skin thickness was the same for diabetic and control subjects. LJM in the feet was more common in males and older subjects. Subtalar and finger LJM was associated with early sensory nerve changes and finger LJM was associated with retinopathy and higher HbAtc. Thicker plantar aponeurosis was associated with male gander and larger feet. High peak pressure, high P/TI and callus were no more common in diabetic subjects than controls. However, high P/TI and callus were associated with early sensory nerve changes in young people with diabetes. Diabetic subjects with callus were significantly older than those without callus. Those with HPP had higher body mass index and less motion at the first MTP joints than those without HPP. Although plantar callus, HPP and high P/TI were no more common in young people with diabetes these abnormailities may be complicated by diabetes. Cushioning, custom orthoses or both in combination significantly reduced peak pressure and P/TI in diabetic subjects. / Doctor of Philosophy (PhD)

School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure. / text