Estudo quanti-qualitativo realizado no Centro Educativo de Enfermagem para Adultos e Idosos, em 2004, com os objetivos de identificar os fatores que influenciam o comportamento de pessoas diabéticas acerca dos cuidados essenciais com os pés, com vista à prevenção do pé diabético e verificar a discrepância entre conhecimento e comportamento acerca destes cuidados essenciais com os pés. O referencial metodológico baseou-se no modelo Predisponing, Reinforcing and Enabling Causes in Educational Diagnosis and Evoluation – PRECEDE. Participaram 55 pessoas diabéticas, que atenderam os critérios de inclusão e exclusão. Utilizou-se para a coleta de dados formulário, questionários e entrevista semiestruturada. Em relação ao diagnóstico social e epidemiológico obtivemos que a maioria dos sujeitos é do sexo feminino; na faixa etária de 60 a 79 anos; com diabetes do tipo 2; o tempo de diagnóstico variou de 6 a 10 anos; com grau de instrução e poder aquisitivo baixos; e condições de moradia satisfatórias. Quanto ao tratamento, todos os sujeitos referiram seguir um plano alimentar; 65% realizavam atividade física; 74,5% utilizavam agente oral e 36,4% insulina. No que se refere as comorbidades 70,9% apresentavam hipertensão arterial; 50,9% catarata; 23,6% retinopatia; 30,9% doença vascular periférica e 63,4% obesidade. Os valores de glicemia, colesterol, triglicérides e hemoglobina glicada A1c estavam acima do limite superior do método. As alterações neuropáticas, circulatórias e dermatolocais mais significativas foram: o ressecamento, a fissura, o dedo em garra; a acentuação do arco plantar; a elevação do dorso plantar; os calos; a cãibra, o adormecimento; o formigamento; a ausência de sensibilidade; a alteração da mobilidade articular; as varizes; o edema; a onicomicose; a unha encravada e corte inadequado das unhas. Em relação ao diagnóstico comportamental e educacional houve discrepância entre o comportamento e o conhecimento em relação aos cuidados essenciais com os pés. Os comportamentos adequados foram: secagem dos espaços interdigitais; uso de calçados macios e confortáveis; não utilização de bolsa de água quente; verificação do calçado antes de usá-los; não andar descalço. Os conhecimentos corretos mostraram que os sujeitos reconhecem a importância: do exame diário dos pés; do corte de unhas adequado; de lavar os pés diariamente; de não andar descalço e de secar os espaços interdigitais. A análise qualitativa dos dados possibilitou identificar três categorias analíticas a percepção das pessoas diabéticas frente às complicações nos pés advindas do diabetes, o significado da descoberta e vivência do diabetes; e a influência dos referentes sociais. Estas categorias nos permitiram identificar as crenças comportamentais e normativas que influenciam o comportamento de pessoas diabéticas acerca dos cuidados essenciais com os pés. Entre as crenças encontramos: retardo na cicatrização de feridas; o diabetes leva ao desequilíbrio emocional, psicológico e físico; o homem é mais descuidado que a mulher; a amputação é o fim da vida; a expressão pé diabético é uma alerta constante;hidratar os pés é coisa de mulher; grupo de educação em diabetes como fonte de aprendizado; os pares ajudam e encorajam e a família (cônjuge, filhos, parceiros) interfere positiva e negativamente. / This quanti-qualitative study was carried out at a Nursing Education Center for Adults and Elderly in 2004 and aimed to identify what factors influence diabetic patients’ essential foot care behavior, with a view to diabetic foot prevention, as well as to verify the discrepancy between knowledge and behavior related to essential foot care. The methodological reference framework was based on the PRECEDE model - Predisposing, Reinforcing and Enabling Causes in Educational Diagnosis and Evaluation. Study participants were 55 diabetes patients who met inclusion criteria. Data were collected by means of forms, questionnaires and semistructured interviews. In terms of social and epidemiological diagnosis, most subjects were women between 60 and 79 years old; type 2 diabetes patients; diagnosis time ranged from 6 to 10 years; education level and purchasing power were low; and housing conditions were satisfactory. All subjects mentioned they followed a food plan; 65% did physical activity; 74.5% used an oral agent and 36.4% insulin. With respect to comorbidities, 70.9% suffered from arterial hypertension; 50.9% cataract; 23.6% retinopathy; 30.9% peripheral vascular disease and 63.4% obesity. Glucose, cholesterol, triglycerides and glycated hemoglobin A1c levels exceeded upper limits. The most important neuropathic, circulatory and dermatological alterations were: dry skin, fissure, claw toe; plantar arch accentuation; plantar dorsum elevation; calluses; cramp, numbness; formication; lack of sensitivity; articular mobility alteration; varicose veins; edema; a onychomycosis; ingrown nails and inadequate nail cutting. What the behavioral and educational diagnosis is concerned, we found a discrepancy between essential foot care behavior and knowledge. Adequate behavior included: drying the area between toes; using soft and comfortable shoes; not using hot-water bottle; checking shoes before wearing them; not walking barefoot. Correct knowledge showed that the participants recognize the importance of: daily foot examination; adequate nail cutting; washing feet daily; not walking barefoot and drying the skin between toes. Qualitative data analysis allowed us to identify three analytic categories: diabetes patients’ perception of foot complications as a result of diabetes, the meaning of discovering and living with diabetes; and the influence of social relations. Through these categories, we managed to identify the behavioral and normative beliefs that influence diabetes patients’ essential foot care behavior. These beliefs include delayed wound healing; diabetes leads to emotional, psychological and physical unbalance; men take less care than women; amputation means the end of life; the term diabetic foot is a constant alert; only women hydrate their feet; diabetes education group as a source of learning; peers help and encourage and the family (husband/wife, children, partners) interfere positive and negatively.

Orientador: Maria Beatriz Puzzi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T10:25:05Z (GMT). No. of bitstreams: 1 Dinato_MarceloMattose_M.pdf: 4803476 bytes, checksum: eb9d2db304929302cdd47c38064634bb (MD5) Previous issue date: 2010 / Resumo: Grande parte das úlceras diabéticas em extremidades inferiores tem difícil cicatrização, representando a causa mais comum de amputação não traumática no mundo. Para pacientes sem resposta à terapêutica clássica como desbridamentos, curativos e antibioticoterapia sistêmica, pode ser excelente indicação a terapia celular. O propósito deste estudo foi avaliar a eficácia de implantes autólogos de células da pele (fibroblastos e queratinócitos) cultivadas "in vitro" e aplicadas com cola de fibrina autóloga em úlceras cutâneas crônicas de 5 pacientes diabéticos (4 DM2 e 1 DM1) com diagnóstico variando de 9 a 34 anos. Foram tratadas 6 úlceras de 4,0 a 36.62 cm2 de tamanho com duração de 4 meses a 20 anos, localizadas em membros inferiores, sem resposta a diversos tratamentos convencionais. Observou-se cicatrização completa em 5 úlceras (83,3%) entre 21 e 120 dias, sendo que a média dos Índices de Cicatrização das Úlceras (ICU) foi de 62%, 75%, 78% e 83%, no 30º; 60º; 90º e 120º dias de evolução, respectivamente. Existe uma correlação entre a velocidade de cicatrização, o tamanho da úlcera e o seu tempo de duração. Não ocorreram reações adversas decorrentes do tratamento. Concluiu-se que, a terapia celular (queratinócitos-fibroblastos) associada à cola de fibrina autóloga mostrou-se uma opção terapêutica eficaz, autóloga, de realização ambulatorial minimamente invasiva que acelerou significativamente o processo de cicatrização das úlceras diabéticas crônicas / Abstract: A great part of diabetic ulcers on the lower extremities have difficult healing and represent the most common cause of amputation worldwide. For patients unresponsive to the classical therapy with debridement, dressings and systemic antibiotic therapy, cell therapy may be an excellent indication. The objective of this study was to assess the efficacy of autologous skin cell (fibroblasts and keratinocytes) implants cultivated in vitro and applied with autologous fibrin glue to chronic skin ulcers of 5 diabetic patients (4 DM2 and 1 DM1) who had been diagnosed between 9 and 34 years before. There were 6 ulcers from 4.0 to 36.62 cm2 in size, with onset between 4 months and 20 years before, located on the lower limbs and unresponsive to several conventional treatments. Complete healing was observed in 5 ulcers (83.3%), after 21 to 120 days and the average of ulcer healing indices (UHI) were 62%, 75%, 78% and 83%, on the 30th, 60th, 90th and 120th days, respectively. There is a correlation between healing time, ulcer size and duration. No adverse reactions derived from the treatment occurred. It was concluded that cell therapy (keratinocytes, fibroblasts) associated with autologous fibrin glue proved to be an effective therapeutic option, minimally invasive and performed on an outpatient basis, that has significantly accelerated the healing of chronic diabetic ulcers / Mestrado / Clinica Medica / Mestre em Clinica Medica

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-01-05T10:19:14Z No. of bitstreams: 1 lucianadonascimentocampissi.pdf: 2290736 bytes, checksum: f85ace5a49af039ecef38e258539073a (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2017-01-31T10:34:04Z (GMT) No. of bitstreams: 1 lucianadonascimentocampissi.pdf: 2290736 bytes, checksum: f85ace5a49af039ecef38e258539073a (MD5) / Made available in DSpace on 2017-01-31T10:34:04Z (GMT). No. of bitstreams: 1 lucianadonascimentocampissi.pdf: 2290736 bytes, checksum: f85ace5a49af039ecef38e258539073a (MD5) Previous issue date: 2016-08-12 / A detecção precoce do diabetes mellitus e suas complicações constituem verdadeiros desafios para a saúde pública. Em um sistema público organizado hierarquicamente como o SUS (níveis primário, secundário e terciário) temos na Atenção Primária a entrada no sistema de saúde. Logo torna-se fundamental que o rastreio do DM e suas complicações sejam efetivos, de modo a evitar perdas funcionais e aposentadorias precoces. Uma das complicações mais temíveis do diabetes mellitus é a neuropatia diabética, condição altamente prevalente e responsável por cerca de 70% dos casos de amputação não-traumática. Assim, o rastreio da neuropatia diabética pode reduzir os impactos pessoais, familiares e sociais dessa condição crônica. Objetivo: elaborar um teste de triagem simples e de fácil aplicação para detecção precoce da neuropatia diabética pelo enfermeiro da Atenção Primária à Saúde. Método: Estudo transversal no qual foram avaliados 269 prontuários de pacientes diabéticos atendidos no Centro Hiperdia/Juiz de Fora-MG. Foram tabulados dados demográficos, clínicos e neurológicos da população avaliada no período de 2010 a 2014. Resultados: Sessenta e dois por cento dos diabéticos eram do sexo feminino; a média idade foi de 58,7 anos e o Índice de Massa Corporal teve média de 30,6; o tempo médio de diagnóstico do diabetes mellitus foi de 11,5 anos e a hemoglobina glicada (HbA1c) foi igual a 9,1 %. Queimação nos pés (64,9%), parestesia (83,8%), dormência (73%) e dor neuropática (54,1%) foram os sintomas mais prevalentes. Os sintomas foram preditores ruins para o diagnóstico de neuropatia diabética provável. Por outro lado, as alterações das sensibilidades térmica e dolorosa e a ausência do reflexo Aquileu foram as anormalidades mais frequentemente relacionadas com a presença de neuropatia diabética. / Early detection of diabetes mellitus and its complications are real challenges for Public Health. In a public system hierarchically organized as SUS (primary, secondary and tertiary levels), primary care is the entry into the health system. It is essential the effective screening of DM and its complications to avoid functional loss and early retirements. One of the most feared complications of diabetes mellitus is the diabetic neuropathy, a highly prevalent condition that accounts for about 70% of the cases of non-traumatic amputation. Therefore, the screening of diabetes mellitus can reduce personal, social and familial impacts of this chronic condition. Objective: to develop a screening test of simple application for early detection of diabetes mellitus by the nurse in primary care. Method: a cross-sectional study was made with data of 269 subjects based on medical records of diabetic patients attended at Hiperdia Center/Juiz de Fora-MG. Demographic, clinical and neurological data of the population evaluated between January of 2010 to December of 2014 were statistically analyzed. Results: sixty-two percent were female; the average age was 58.7 years and body mass index average was of 30.6 kg/cm2; the average time of diagnosis of diabetes mellitus was 11.5 years and glycated hemoglobin (HbA1c) was 9.1%. Burning sensation in the feet (64.9%), paresthesia (83.8%), numbness (73%) and neuropathic pain (54.1%) were the most prevalent symptoms, but the symptoms were bad predictors for the diagnostic of probable diabetic neuropathy. On the other hand, abnormalities of thermal sensitivity and pain as well as the absence of ankle jerk reflex were most often related to the presence of diabetic neuropathy.

Úlcera de membros inferiores é uma das complicações do diabetes melito que acomete aproximadamente 15% dos portadores da doença e resultam em elevada taxa de mortalidade. São feridas de difícil resolução, em geral, refratárias aos diversos tipos de tratamentos. Um dos principais aspectos que contribuem para sua cronicidade é a modificação no comportamento de fibroblastos. O objetivo do estudo foi comparar in vitro modificações no comportamento de fibroblastos derivados de ferida de membro inferior de indivíduos diabéticos com fibroblastos derivados de pele normal, quanto a proliferação celular e a capacidade de contração de modelo tridimensional de matriz de colágeno povoado por células, além de investigar o perfil de expressão gênica diferencial dessas células. Para tanto, foram cultivados fibroblastos provenientes de tecido de granulação de feridas de membro inferior de pacientes com diabetes do tipo 2 (FFD) e de pele normal (FC). Foram verificadas anormalidades morfológicas no grupo FFD compatíveis com senescência celular; menor contração da matriz de colágeno povoado por fibroblastos do grupo FFD (redução de 23% da área original) comparado ao grupo FC (redução de 30% da área original p<0,001). Pela técnica de microarray foram identificados 143 genes diferencialmente expressos, em sua maioria hipoexpressos, no grupo FFD, dentre os quais, destacam-se aqueles relacionados a processos de senescência e apoptose celular, bem como déficit na síntese e contração de fibras colágenas / Lower limbs ulcer is one of the complications of diabetes mellitus that affects approximately 15% of the patients and results in high mortality. Wounds that is difficult to heal, generally refractory to many treatments. One of the main aspects that contribute to disease chronicity is the change in the fibroblast behavior. The aim of this study was to compare changes in the in vitro fibroblasts behavior from diabetic leg ulcer with fibroblasts derived from normal skin as to cell proliferation and contraction capacity of a threedimensional fibroblasts populated collagen lattice, as well as to investigate the pattern of differential gene expression in these cells. For this purpose, fibroblasts were cultured from granulation tissue of lower limb ulcer in patients with type 2 diabetes (FFD) and from normal skin (FC). Morphological abnormalities compatible with cellular senescence were observed in the FFD. Reduced matrix contraction in fibroblasts populated group (FFD reduction of 23% from the original area) compared to FC (30% reduction from the original area) - (p <0.001). Using DNA microarray 143 differentially expressed genes were identified, most of them were underexpressed in FFD group, among which are those related to senescence and apoptosis, as well as deficits in the synthesis and contraction of collagen fibers

Tissue biopsy and swab culture are the gold standards for diagnosing tissue infection; these tests require significant time, diagnostic costs, and resources. Towards earlier and specific diagnosis of infection, a non-destructive, rapid, and mobile detection device is described to distinguish bacterial species via light scatter spectra from the surface of an infected tissue, reagent-free. Porcine skin and human cadaveric skin models of wound infection were used with a 650 nm LED and an angular photodiode array to detect bacterial infections on the tissue surface, which can easily be translated to a typical CMOS array or smartphone. Tissue samples were inoculated with Escherichia coli, Salmonella Typhimurium, or Staphylococcus aureus and backscatter was collected from 100 degrees to 170 degrees in 10 degrees increments; each bacterial species resulted in unique Mie scatter spectra. Distinct Mie scatter spectra were obtained from epidermis (intact skin model) and dermis (wound model) samples, as well as from porcine and human cadaveric skin samples. Interactions between bacterial colonies and lipid particles within dermis samples generated a characteristic Mie scatter spectrum, while the lipid itself did not contribute to such characteristic spectrum as corroborated with body lotion experiments. The designed angular photodiode array is able to immediately and non-destructively detect tissue bacterial infection and identify the species of infection within three seconds, which could greatly improve point of care diagnostics and antibiotic treatments.

Motivation is recognised as an important factor in the treatment of any patient.1,2 Motivation is also recognised as the cornerstone of occupational therapy.2,3 In recent history there has been an increase in the number of people diagnosed with diabetes and its complications, including diabetic foot complications.4-8 Motivation has been identified as a factor contributing to the treatment outcomes of a person with diabetic foot complications, and an assessment into the level of motivation is recommended.6,9-12 A review of the literature in the field revealed that this assessment of motivation has not been sufficiently investigated. The Model of Creative Ability provides a framework within which to assess motivation and principles with which to treat a client, based on the level of motivation.1-3 The purpose of this study was thus to investigate whether occupational therapy treatment, tailored to the level of motivation, for patients with diabetic foot complications, has more positive treatment outcomes than occupational therapy that is not tailored. An experimental pre-test-post-test-design with an experimental and a control group was used to conduct the research. Change in ulcer size and change in quality of life score were the two dependant variables that were measured both pre- and post-test. Subjects were assessed using the Reintegration to Normal Living Index to obtain a quality of life score. A wound tracing was done to determine the ulcer size, and the Creative Participation Assessment was used to establish the level of motivation and thus tailor the occupational therapy treatment that the subjects received. Subjects in the experimental group then underwent three months of tailored occupational therapy, whereas subjects in the control group continued to receive occupational therapy as usual for the same time period. At the end of the three month treatment period, the subjects were reassessed using the same assessments that were used pre-test. These results were then analysed statistically, to determine if a statistically significant difference occurred between the experimental and control groups with regards to the dependant variables. In spite of the small sample size, the results of the research indicate a positive trend towards occupational therapy treatment that is tailored to a client’s level of motivation. Copyright / Dissertation (MOccTher)--University of Pretoria, 2009. / Occupational Therapy / unrestricted

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-18T14:21:17Z No. of bitstreams: 1 Mozania Reis de Matos.pdf: 2867660 bytes, checksum: ba235c77e42996f7aa6a0a4de5a2c5cd (MD5) / Made available in DSpace on 2016-05-18T14:21:17Z (GMT). No. of bitstreams: 1 Mozania Reis de Matos.pdf: 2867660 bytes, checksum: ba235c77e42996f7aa6a0a4de5a2c5cd (MD5) Previous issue date: 2015-03-03 / In practical prevention , the instruments that extend self-care are welcome. Added to this the stimulus promotion, health education and the interdisciplinary care. The Patient Interpretation of Neuropaty (PIN), is a questionnaire of Interpretation of neuropathy by patient, developed and validated in the USA and in England (UK). By means of this instrument, the patient makes the self-evaluation of your foot and health care to be carried out with it, aiming at the prevention of ulcer diabetic foot. Thus, the aim of the present study is to translate and validate the questionnaire of interpretation of neuropathy for the Portuguese and assess the degree of understanding of the patients on the questions of (PIN). Participated in this study 100 patients at the outpatient clinic of foot insensitive of the Institute of Orthopedics and Traumatology, University of Sao Paulo. Were used parametric and non-parametric tests in the analysis of data.The values obtainedwith the BrazilianversionPINare verysimilar to the valuesof the original versions, theUSAandtheUK.We think it isa valuabletool providingthe patientobserveneuropathicchangesthat increase the risk of ulcers on the feet. The questionnairetranslated and validatedfor the Portuguese language, soit seemsto be a reliableandapplicabletool to evaluate theself-careof the patientat the same timethat allows thehealthcare professionalto designeffective measuresforprevention ofdiabetic footulcer, resulting in a betterprognosisandquality of life ofdiabetes patientswithND. / Nas práticas de prevenção, os instrumentos que ampliem o autocuidado são bem vindos. Soma-se a isto o estimulo a promoção, a educação em saúde e o atendimento interdisciplinar. O PatientInterpretationofNeuropaty (PIN), é um questionário de Interpretação da Neuropatia pelo Paciente, desenvolvido e validado nos USA e na Inglaterra(UK). Por meio deste instrumento o paciente faz a auto avaliação do seu pé e dos cuidados de saúde a serem realizados com ele, visando à prevenção da úlcera de pé diabético. Sendo assim o presente estudo tem como objetivo traduzir e validar o questionário de interpretação da neuropatia para o português e avaliar o grau de compreensão dos pacientes sobre as indagações do (PIN). Participaram deste estudo 100 pacientes do ambulatório de pé insensível do Instituto de Ortopedia e Traumatologia da Universidade de São Paulo. Foram usados testes paramétricos e não paramétricos na análise de dados. Os valores obtidos com a versão Brasileira do PIN são muito semelhantes aos valores das versões originais, dos USA e da U.K. Julgamos ser um instrumento valioso que propicia ao paciente observar alterações neuropáticas que aumentam o risco de úlcera nos pés. O questionário traduzido e validado para a língua portuguesa, parece assim ser um instrumento confiável e aplicável paraavaliar o autocuidado do paciente,ao mesmo tempo quepermite ao profissional de saúde desenhar medidas efetivas para prevenção da úlcera de pé diabético,ocasionando um melhor prognostico e qualidade de vida dos portadores de diabetes com ND.

Bakgrund: Diabetiska fotsår, ”Diabetes foot ulcer” (DFU) är ett globalt hot mot personer med diabetes på grund av de komplikationer som kan uppkomma som en efterföljd av diabetes. Neuropati är en vanlig följdsjukdom till diabetes vilket medför risken för DFU. Neuropati orsakar nedsatt känsel i underben och fötter vilket kan medföra att patienten inte känner föremål i skorna som skaver och trycker mot fötterna som kan orsaka DFU. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskors preventionsstrategier för att reducera utvecklingen av fotsår hos patienter med diabetes. Metod: Denna studie genomfördes som en beskrivande litteraturstudie baserat på 12 vetenskapliga artiklar som bestod av fyra kvalitativa och åtta kvantitativa artiklar. Huvudresultat: Resultatet visade att sjuksköterskor är i behov av ökad kunskap genom sårvårdsutbildning efter kandidatexamen. Det framkommer att sjuksköterskornas kunskaper har en stor roll i behandlingen av DFU varav patienternas egenvårdsförmåga lyfts fram för att tillsammans finna de rätta strategierna för varje patient i sin DFU behandling. Slutsats: Fördjupad kunskap inom preventionsstrategier att reducera utvecklingen av DFU hos patienter med diabetes skulle kunna komma både patienter, sjuksköterskor och svensk hälso- och sjukvård till nytta. Kunskapen om preventionsstrategier hos sjuksköterskor i arbetet av DFU varierade inom hälso-ochsjukvårdsverksamheter världen över. Det finns flera strategier att arbeta vidare med som sjuksköterska i förebyggandet av DFU. Två viktiga aspekter inom preventionsstrategier är ökad utbildning för grundutbildade sjuksköterskor inom sårvård av DFU.Patientutbildning inom egenvård i förebyggande av komplikationer av DFU är en viktigstrategi i sjuksköterskans yrkesroll för att kunna bidra med goda förutsättningar och hälsofrämjande vård. / Abstract Background: Diabetic foot ulcer (DFU) is a global threat to people with diabetes due tothe complications that can arise as a result of diabetes. Neuropathy is a common secondary result of diabetes which carries the risk of DFU. Neuropathy causes decreased sensation in the lower legs and feet which can cause the patient not to feel objects in the shoes rubbing and pressing against the feet which can cause DFU. Aim:The purpose of the literature study was to describe nurses' prevention strategies for reducing the development of foot ulcers in patients with diabetes. Method: This study was conducted as a descriptive literature study based on 12 scientific articles consisting of four qualitative and eight quantitative articles. Main results: The results showed that nurses are in need of increased knowledge through wound care training after thebachelor's degree. It appears that the nurses 'knowledge has a major role in the treatmentof DFU, of which the patients' self-care ability is highlighted in order to jointly find theright strategies for each patient in their DFU treatment. Conclusion: Advanced knowledge of prevention strategies to reduce the development of DFU in patients with diabetes could benefit both patients, nurses and Swedish health care. The knowledge of prevention strategies among nurses in the work of DFU varied in health care activitiesworldwide. There are several strategies to continue working with as a nurse in the prevention of DFU. Two important aspects in prevention strategies are increased training for undergraduate nurses in wound care at DFU. Patient education in self-care in the prevention of complications of DFU is an important strategy in the nurse'sprofessional role in order to be able to contribute with good conditions and health promoting care.

Úlcera de membros inferiores é uma das complicações do diabetes melito que acomete aproximadamente 15% dos portadores da doença e resultam em elevada taxa de mortalidade. São feridas de difícil resolução, em geral, refratárias aos diversos tipos de tratamentos. Um dos principais aspectos que contribuem para sua cronicidade é a modificação no comportamento de fibroblastos. O objetivo do estudo foi comparar in vitro modificações no comportamento de fibroblastos derivados de ferida de membro inferior de indivíduos diabéticos com fibroblastos derivados de pele normal, quanto a proliferação celular e a capacidade de contração de modelo tridimensional de matriz de colágeno povoado por células, além de investigar o perfil de expressão gênica diferencial dessas células. Para tanto, foram cultivados fibroblastos provenientes de tecido de granulação de feridas de membro inferior de pacientes com diabetes do tipo 2 (FFD) e de pele normal (FC). Foram verificadas anormalidades morfológicas no grupo FFD compatíveis com senescência celular; menor contração da matriz de colágeno povoado por fibroblastos do grupo FFD (redução de 23% da área original) comparado ao grupo FC (redução de 30% da área original p<0,001). Pela técnica de microarray foram identificados 143 genes diferencialmente expressos, em sua maioria hipoexpressos, no grupo FFD, dentre os quais, destacam-se aqueles relacionados a processos de senescência e apoptose celular, bem como déficit na síntese e contração de fibras colágenas / Lower limbs ulcer is one of the complications of diabetes mellitus that affects approximately 15% of the patients and results in high mortality. Wounds that is difficult to heal, generally refractory to many treatments. One of the main aspects that contribute to disease chronicity is the change in the fibroblast behavior. The aim of this study was to compare changes in the in vitro fibroblasts behavior from diabetic leg ulcer with fibroblasts derived from normal skin as to cell proliferation and contraction capacity of a threedimensional fibroblasts populated collagen lattice, as well as to investigate the pattern of differential gene expression in these cells. For this purpose, fibroblasts were cultured from granulation tissue of lower limb ulcer in patients with type 2 diabetes (FFD) and from normal skin (FC). Morphological abnormalities compatible with cellular senescence were observed in the FFD. Reduced matrix contraction in fibroblasts populated group (FFD reduction of 23% from the original area) compared to FC (30% reduction from the original area) - (p <0.001). Using DNA microarray 143 differentially expressed genes were identified, most of them were underexpressed in FFD group, among which are those related to senescence and apoptosis, as well as deficits in the synthesis and contraction of collagen fibers

Bakgrund: Diabetiska fotsår är en vanlig komplikation bland personer med diabetes. Sårläkningsprocessen och sårbehandlingen är en komplicerad och lång process vilka spelar en central roll i patientens liv. Patientens behov av hälso- och sjukvården är stort och kan leda till en ökad belastning på samhällets funktioner och ekonomi. Sjuksköterskan behöver ha kunskaper om patientens upplevelser av att leva med diabetiska fotsår för att kunna bemöta dem på bästa sätt och ge en personcentrerad vård. Syfte: Syftet var att beskriva patienters upplevelser av att leva med diabetiska fotsår.   Metod: Denna litteraturöversikt inkluderar åtta kvalitativa artiklar och två kvantitativa artiklar som besvarar syftet. Databaserna som användes för resultatartiklarna var CINAHL Complete och Medline with Full Text.    Resultat: Resultatet identifierades av tio artiklar och delades in i tre kategorier: fysisk påverkan, påverkan på det sociala livet och psykologiska aspekter. Första kategorin visar på att patienter känner sig begränsade i rörelser, hur inaktivitet kan påverka vardagslivet samt besvärande symtom som kan upplevas. Inom den andra kategorin beskrivs känslor kring hur diabetiska fotsåren har påverkat patienternas sociala liv. Den tredje kategorin omfattar de psykologiska aspekterna av att leva med diabetiska fotsår, känsla av förlorad identitet och tankar inför framtiden.   Slutsats: Resultatet som framkommer visar på att patienter upplever olika former av fysiska och sociala begränsningar. Det gäller för sjuksköterskan att kunna vara lyhörd, öppen samt ha en helhetssyn för patientens upplevelser. Sjuksköterskan bör med andra professioner samarbeta för på bästa sätt ge patienten stöd som den kan behöva. Genom att utbilda patienten och deras närstående kan öka kunskapen om egenvården samt förebygga eventuella diabetesrelaterade komplikationer. / Background: Diabetic foot ulcers are a common complication amongst people with diabetes. Wound healing process and wound treatment are complicated and long process, and these will play a central role in the patient’s life. The patient’s need for health care is great and can lead to a great burden on society’s functions and finances. The nurse needs to have knowledge of experiences in patients living with diabetic foot ulcers in order to be able to treat them in the best way and provide person-centered care.  Aim: The purpose was to describe patients’ experiences of living with diabetic foot ulcers.  Method: This literature review included eight qualitative articles and two quantitative articles to answer the purpose. The databases used for the results articles were CINAHL Complete and Medline with Full Text. Results: The results were identified by ten articles and divided into three categories: physical impact, impact on social life and psychological aspects. The first category shows that patients feel limited in movement, how inactivity can affect everyday life and troublesome symptoms that can be experienced. The second category describes feelings about how diabetic foot ulcers have affected patients' social lives. The third category includes the psychological aspects of living with diabetic foot ulcers, feelings of lost identity and thoughts for the future.  Conclusion: The results that emerge show that patients’ experience various forms of physical and social limitations. It is important for the nurse to be able to be responsive, open and have a holistic view of the patient's experiences. The nurse should work with other professionals to best provide the patient with the support they may need. By educating the patient and their relatives can increase knowledge about self-care and prevent any diabetes-related complications.