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.

Made available in DSpace on 2016-04-04T18:29:41Z (GMT). No. of bitstreams: 1 Renato Marchi.pdf: 1336693 bytes, checksum: bcdd5e2f052a29bb390cf3fc87b8af07 (MD5) Previous issue date: 2008-02-12 / Bipolar disorder (BD) is associated with ps ychosocial and family relationships disturbing, mortality and economic burden high rates . The treatment aims the acute episodes and prevents new episodes. There are high rates of non-adherence in BD. The objective of this study was to develop and validate a clinical rating scale capable to predict the patient compliance to treatment in BD in both gend ers. The procedure involved the search in pertinent scientific literature for reports of factors of non-adherence of bipolar patients, analysis of patients during pilot studies and contact with professionals who deal with those patients in order to develop a comprehensive list of possible symptoms. This procedure was followed by items' selection and testing of the preliminary form of the clinical rating scale. The scale was analyzed statistically. Reliability study showed a high level of internal consistency. Factor analysis revealed five factors related to the clinical treatment: behaviors and beliefs of the patient, therapeutic alliance, therapeutic procedures, association of psychotherapy interventions and adverse effects of drug therapy. Predictive validation showed that items' factors were able to measure the non - adherence to treatment. It was concluded that the Clinical Rating Scale to Predict the Compliance to Treatment in Bipolar Disorder can be considered a valid instrument to predict the patient compliance to medical treatment . / O Transtorno Bipolar do Humor (TBH) est? associado a altas taxas de desajustes psicossociais e familiares, mortalidade e preju?zos econ?micos. O tratamento visa o controle de epis?dios agudos e preven??o de novos epis?dios. As taxas de n?o - ades?o ao tratamento s?o altas em TBH. Este trabalho teve por objetivo elaborar e validar uma escala de avalia??o clinica , capaz de indicar a probabilidade de ades?o ao tratamento medico clinico dos pacientes bipolares de ambos os g?neros. O procedimento foi constitu?do de levantamento dos fatores ligados a n?o-ades?o ao tratamento em TBH na literatura pertinente, analise de pacientes bipolares durante estudo piloto, analise por juizes, sele??o dos itens e aplica??o da escala em sua fase inicial, para subseq?ente an?lise psicom?trica. A analise de precis?o do instrumento evidenciou n?vel satisfat?rio de consist?ncia interna. Extra?ram-se cinco fatores de acordo com a analise fatorial explorat?ria, ligados ao tratamento medico clinico: atitudes e cren?as do paciente, alian?a terap?utica, procedimentos terap?uticos, associa??o de interven??es psicoter?picas e efeitos adversos dos psicof?rmacos. A valida??o preditiva revelou que os itens referentes a tais fatores medem a n?o-ades?o ao tratamento. Conclui -se que a ECPAT-TBH pode ser considerada um instrumento v?lido para prever a ades?o ao tratamento m?dico.

Made available in DSpace on 2014-12-17T14:47:07Z (GMT). No. of bitstreams: 1 SamillyMDL_DISSERT.pdf: 2432551 bytes, checksum: 39a06155ddac056ef776f3527c721cf7 (MD5) Previous issue date: 2014-08-01 / The therapeutic adherence is still a big problem among people with venous ulcers (VU) because the treatment is long, expensive and demand changes in lifestyle. In this context, this study aims to examine treatment adherence and quality of life (QOL) of people with VU assisted at primary health care. This is an analytical, cross-sectional study with a quantitative approach to treatment and data analysis. The study had the scenario 13 Family Health Units and 02 Units Mixed of Natal. The target population consisted of 44 persons with UV indicated by the teams of the Family Health Strategy between February and April 2014. Three instruments were used: an instrument to characterize the sociodemographic, health and care aspects, the Multidimensional Scale of Adherence Therapy composed of the dimensions: healthy lifestyle, compressive therapy and neurovascular monitoring and the Charing Cross Venous Ulcer Questionnaire (CCVUQ) that evaluates QOL in persons with VU composed by the domains: Total Score, Social Interaction, Domestic Activities, Aesthetics and Emotional State. The study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, CAAE: 07556312.0.0000.5537. The data concerning the sociodemographic characteristics showed that there was a predominance of females (65.9%), age range as of 60 years (59.1%) and income of up to 1 minimum wage (81.8%). With the characterization of health, it was evident that most people reported chronic diseases (63.6%), sleep more than 6 hours (81.8%), present pain (81.8%), denying alcoholism (86 4%) and smoking (77.3%) and showed a number greater than or equal to 1 (77.3%) recurrences. Concerning the therapeutic adherence was found that in the dimension compressive therapy there poor adherence. No associations between the domains of adherence and sociodemographic and health variables were found. Was observed, however, better adherence among individuals without pain and with higher schooling. When analyzed the averages of the dimensions of therapeutic adherence with the care characteristics there was statistical significance between: adherence to compression therapy and guidance for use of compressive therapy (p = 0.002) and guidance for regular exercise (p = 0.026). Considering the mean of total score of CCVUQ (mean 51.47, SD 18.33) it is observed that the overall QOL of respondents has approximate value of the median of the scale (50). The mean of the domain Social Interaction (mean 44.23, SD 21.38) and Domestic Activities (mean 45.70, SD 23.21) were those who reported better QOL. There were weak correlations but significant between adherence to healthy lifestyle and Domains Total Score (p = 0.012), social interaction (p-value = 0.048), Aesthetics (p-value = 0.025) and Emotional State (0.017) of CCVUQ. From the data analysis it is concluded that among people with UV, there poor adherence to compressive therapy. Furthermore, we found no statistically significant association between treatment adherence and sociodemographic and health characteristics. It is added that there was a correlation between the healthy lifestyle dimension and domains CCVUQ / A ades?o terap?utica ainda ? um grande problema entre pessoas com ?lceras venosas (UV), uma vez que a presen?a dessa les?o demanda um tratamento longo, dispendioso, e altera??es no estilo de vida. Nesse contexto, este estudo tem como objetivo geral analisar a ades?o ao tratamento e a qualidade de vida (QV) das pessoas com UV atendidas na aten??o prim?ria ? sa?de. Trata-se de estudo anal?tico, transversal, com abordagem quantitativa de tratamento e an?lise de dados. O estudo teve como cen?rio 13 Unidades de Sa?de da Fam?lia e duas Unidades Mistas da cidade de Natal. A amostra foi composta por 44 pessoas com UV indicadas pelas equipes da Estrat?gia Sa?de da Fam?lia entre fevereiro e abril de 2014. Utilizaram-se tr?s instrumentos: instrumento de caracteriza??o dos aspectos sociodemogr?ficos, de sa?de e assistenciais; a Escala Multidimensional de Ades?o Terap?utica, composta pelas dimens?es: estilo de vida saud?vel, terapia compressiva e vigil?ncia neurovascular; e o Charing Cross Venous Ulcer Questionnaire (CCVUQ), que avalia QV em pessoas com UV atrav?s de quatro dom?nios: Intera??o Social, Atividades Dom?sticas, Est?tica e Estado Emocional, al?m de gerar um Escore Total. A pesquisa obteve parecer favor?vel do Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, CAAE: 07556312.0.0000.5537. Os dados referentes ? caracteriza??o sociodemogr?fica demonstraram que houve predomin?ncia do sexo feminino (65,9%), da faixa et?ria a partir de 60 anos (59,1%) e renda de at? 1 sal?rio m?nimo (81,8%). A caracteriza??o de sa?de evidenciou que a maioria das pessoas relatou doen?as cr?nicas associadas (63,6%), sono maior que 6 horas (81,8%), presen?a de dor (81,8%) e mais de uma recidiva (77,3%). A maior parte negou etilismo (86,4%) e tabagismo (77,3%). Em rela??o ? ades?o terap?utica verificou-se pior ades?o na dimens?o terapia compressiva. N?o foram encontradas associa??es entre os dom?nios da ades?o e as vari?veis sociodemogr?ficas e de sa?de. Observou-se, no entanto, melhor ades?o entre os indiv?duos sem dor e com maior escolaridade. Ao analisar a rela??o das dimens?es da ades?o terap?utica com as caracter?sticas da assist?ncia observou-se associa??o entre: ades?o ? terapia compressiva e orienta??es para uso de terapia compressiva (p-valor = 0,002) e para exerc?cios regulares (p-valor = 0,026). Considerando a m?dia do escore total do CCVUQ (m?dia 51,47 e DP 18,33) observa-se que a QV geral dos pesquisados tem valor aproximado ao da mediana da escala (50). Os participantes apresentaram melhor qualidade de vida nos dom?nios Intera??o Social e Atividades Dom?sticas. Verificaram-se correla??es significativas, por?m fracas, entre ades?o ao estilo de vida saud?vel e o Escore Total (p = 0,012), Intera??o Social (p = 0,048), Est?tica (p = 0,025) e Estado Emocional (p = 0,017) do CCVUQ. A partir da an?lise dos dados conclui-se que a maior dificuldade de ades?o entre as pessoas com UV refere-se ? terapia compressiva. Observou-se correla??o apenas entre a dimens?o estilo de vida saud?vel e os dom?nios do CCVUQ