Aspectos relacionados à dificuldade do controle glicêmico em pacientes com Diabetes Mellitus tipo 2 na Atenção Básica / Aspects related to the difficulty of glycemic control in patients with type2 diabetes mellitus in Primary Health Care

A diabetes mellitus representa um dos problemas de maior prevalência e mortalidade na população geral. Apesar de ter mecanismos de controle acessíveis a toda população, desde o diagnóstico até o acompanhamento, ainda é muito grande o percentual de pacientes sem o devido controle glicêmico. Esse trabalho teve como objetivo identificar quais os aspectos que estão relacionados com a dificuldade de controle em pessoas com diabetes mellitus tipo 2 que estão sob tratamento e acompanhamento por equipes de saúde da família em uma unidade de saúde do município de Itajaí/SC. A pesquisa utilizou abordagens qualitativas, com coleta de dados realizada através de entrevistas individuais e roteiro semiestruturado, com pessoas diagnosticadas com diabetes mellitus tipo 2, em tratamento e que não conseguem controlar o nível glicêmico. A análise de dados foi realizada, por meio da técnica de análise de conteúdo temático, na qual emergiram seis categorias: representação da doença; alimentação; atividade física; medicamentos; fatores emocionais; e relação médico-paciente. Os resultados apontam que a organização da atenção às pessoas com diabetes mellitus, seguindo os atributos da integralidade, longitudinalidade e coordenação do cuidado, podem interferir de forma positiva no autocuidado nos aspectos que dificultam o controle glicêmico das pessoas com diabetes mellitus tipo 2

Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study

OBJECTIVE: To examine the impact of stimulant treatment during childhood and high school on risk for substance use, dependence, and abuse by young adulthood. METHODS: A total of 147 clinic-referred hyperactive children were followed approximately 13 years into adulthood (mean: 21 years old; range: 19-25). At adolescent (age 15) and adult follow-up, probands were interviewed about their use of various substances and duration of stimulant treatment. RESULTS: Duration of stimulant treatment was not significantly associated with frequency of any form of drug use by young adulthood. Stimulant-treated children had no greater risk of ever trying drugs by adolescence or any significantly greater frequency of drug use by young adulthood. Stimulant treatment in high school also did not influence drug use in adulthood except for greater use of cocaine. This difference was no longer significant after controlling for severity of attention-deficit/hyperactivity disorder and conduct disorder in childhood, adolescence, and adulthood. Stimulant treatment in either childhood or high school was not associated with any greater risk for any formal Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised drug dependence or abuse disorders by adulthood. Treatment with stimulants did not increase the risk of ever having tried most illegal substances by adulthood except for cocaine. Subsequent analyses showed that this elevated risk was primarily mediated by severity of conduct disorder by young adulthood and not by stimulant treatment in childhood. CONCLUSION: This study concurs with 11 previous studies in finding no compelling evidence that stimulant treatment of children with attention-deficit/hyperactivity disorder leads to an increased risk for substance experimentation, use, dependence, or abuse by adulthood