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Tratado de Pediatria - Nelson. Um livro sobre evolucao. Understanding Earth, 7th edition. Figure 1. Selection of productions for systematic review Seven studies were published in journals in the area of psychology9,10,11,12,13,14,15 and seven in the nursing area16,17,18,19,20,21, The articles were published in five journals in the area of psychology conqualis A19,15, B,12,14, B and one was not identified, 10 and in five in the area of nursing, with the qualis A,22, A,17,19,20, and B The information on the subject of the journals refers to the last triennial evaluation of Capes for the area of Psychology.
The period of adolescence was approached in 12 studies as a transition phase permeated by conflicts and immaturity10,11,12,13,14,15,16,17,19,20,21, In eight papers9,10,11,12,14,15,20,21 the authors focused on the way in which adolescents deal with DM1, using the concepts of: resilience9, anxiety14, confronting the disease15, quality of life and self-esteem20, psychoanalysis11, psychosocial aspects12 and therapeutic itinerary In the articles analyzed, qualitative research9,12,13,16,17,18,19,21,22 predominated, while only two studies were quantitative14,20 and three quantitative-qualitative10,11, The participants of the analyzed studies were of both sexes and with ages varying between 9 and 21 years.
Three of the works16,18,20 justified the election of the age group considering the provisions of the World Health Organization16 and the Statute of the Child and Adolescent18,20, the others did not present a justification. One article presented criteria, but did not identify whether they were inclusion or exclusion2,1doce had only the inclusion criteria9,10,11,12,13,14,15,16,17,18,20,22 and one pointed out the criteria of inclusion and exclusion The criteria forwarded by the papers were: participants should present cognitive conditions to respond to the investigation9,10,20, be in treatment at least a year ago13,17,18,22, not present chronic complications11, present difficulty in following the treatment21and agree to participate in the research15, Only one of the articles does not mention the ethical aspects that should be followed in research with human beings Regarding the data collection, the qualitative research used a semi-structured interview9,12,13,16,17,18,19,22, an in-depth interview21, field observation21 and a map of the five fields9.
The quantitative-qualitative investigations used an interview for clinical characterization, 10 application of a questionnaire on difficulties for the supervision of therapeutic behaviors10 and Design of the Human Figure and the Person with Diabetes11, mapping of daily activities15 and a semi-structured interview Nine investigations were developed with adolescents with DM1 in health services9,10,15,16,18,19,20,21,22, three with adolescents in health services and associations of people with diabetes11,14,17, one with adolescents in the holiday camp12 and one work did not specify a place for data collection The three comparative studies between adolescents with and without DM1 looked for adolescents without DM1 in schools, care institutions and through indications11,14, Eight articles contained information on the period and the city where the data were collected10,15,16,17,18,19,22, three of which consisted only of the city12,20,21 and in three of them the information was not described9,13, The qualitative works analyzed the data through categorization, 13,17,22 content analysis9,12,16,18,19, The quantitative articles were used for descriptive statistics, 14,20test parametric14,20 and non-parametric tests.
Regarding the main results presented by the articles selected for this review, Pires10, Alencar16 and Fragoso18, identified that the difficulties faced by adolescents with DM1 were related to face the diagnosis, the application of insulin, to maintain a healthy diet and the need to change the lifestyle.
Alencar et al. In contrast, social support was highlighted as an important factor in the confrontation of the disease by Heleno et al. These authors observed that social support, as well as affective bonding, self-esteem, optimism and altruism act as a protective factor contributing to resilience processes in adolescents with DM1.
To deal with the changes coming from the treatment of DM1, Fragoso et al. In that way, Imoniana13 identified that some adolescents considered that routine was not affected due to DM1.
Quality of life and self-esteem were evaluated positively by the adolescents in the Novato, Grossi and Kimura study The studies presented by Ballas, Alves and Duarte11, Santos and Enumo15 and Ballas, Alves and Duarte14 carried out comparative analyzes between groups of adolescents with and without DM1.
The results found by these studies indicated that there were no statistically significant differences in terms of anxiety traits, daily activities, design of the human figure and person with diabetes.
The articles present the importance of social support and of the affective bond in the confrontation of the disease, also functioning as protective factors. In review of the scientific production on resilience, social support was associated with all the research found. Regarding the concept of resilience addressed in the works, only one was in the field of psychological processes, others in the field of nursing.
The articles pointed out that the period of transition of parental care for self-care was characterized as a factor that can be decisive in subsequent resilience processes. It was identified that the increase in autonomy was directly associated with worsening metabolic control, putting in projection a tenuous relationship between protective factors such as social support and autonomy and risk factors such as low adherence to treatment and increased blood glucose Adolescence emerges in studies as a "problematic" stage, permeated by tensions that can hinder the treatment of diabetes.
For example, Pires10 stated that the emotional conflicts characteristic of this period can lead to poor adherence to treatment, since the diagnosis of DM1 aggravates the feeling of non-belonging and exclusion experienced by adolescents.
Second Leal and Facci24, adolescence little by little consolidated itself as a phase of life, a universal phenomenon, being studied from an individual perspective associated with biological maturity. It was then identified a crystallized conception of adolescence in twelve of these publications, a negative view of this stage of life that seems to be anchored in adult life as a referential of stability.
Berni and Roso25 affirmed that adolescence has particularities in relation to the contexts of life and cultural and temporal aspects, so studies should be cautious in the definitions that are proposed universal and static.
In the case of adolescents with DM1, the chronic patient emerges as a non-normative influence, considering that it is not part of the natural biological development of the individual, and thus demands a reorganization of the subject so that it adapts to this new condition.
The works analyzed in this review, in a general way, brought aspects of that phase of human development, but they did not work with the conceptualization and representations of it by the different fields of knowledge. From the conception according to which adolescence is a polysemic field, it was considered important to deconstruct the crystallized perspective on it and the problematization of its conceptualization, due to its particularities at a biological, psychological, social and historical level.
By bringing this critical view, professionals can attack the networks of meaning that cross each individual and not reduce the problems faced throughout the treatment as exclusive to the period of adolescence. It was perceived in the selected articles that responsibility for oppositional behaviors, conflicts or non-acceptance of the disease that arise is attributed to the period of adolescence.
It is not taken into account that human development is marked by a continuous process of changes, including gains and losses, as well as by the interaction of the subject with culture6. In addition, one must consider the chronic illness that suddenly surpasses the life of the subject being necessary to attribute new meanings to their experiences. In this way, the stigmatizing view of the adolescent is also a decontextualized view of the individual. The articles that were proposed to analyze the experiences and experiences of adolescents with DM1 found similar results, these were: difficulties in relation to following the diet and making the measurement and application of insulin, fear of complications derived from the disease, issues related to acceptance and non-acceptance, importance of family support, friends, health professionals and adaptation to changes.
It is understood then that if a teenager has adhered to the treatment at a given time, this does not mean that the adolescent remains in the treatment. Given this, professional accompaniment is necessary in order to strengthen the protective factors that surround the adolescent.
Considering the studies gathered here, twelve were conducted with adolescents assisted by health services of the public network, which indicates that the investigated public may be circumscribed in a specific socioeconomic class.
Despite not being a fact discussed in all articles, it is possible that the context in which these adolescents are inserted has implications for the patient's experience, in the treatment management, even differentiating them from adolescents from other social classes.