RESUMOObjetivos: Traduzir para o português, adaptar culturalmente e avaliar as propriedades psicomé-tricas do Summary of Diabetes Self-Care Activities Questionnaire − SDSCA. Materiais e méto-dos: O processo seguiu as normas internacionais para adaptação e avaliação das propriedades psicométricas. O alfa de Cronbach (a) foi utilizado para avaliar a consistência interna (correlação interitens) e a confiabilidade (teste-reteste e correlação interavaliador). Resultados: A correlação interitens variou de a = 0,09 a a = 0,86. Na avaliação teste-reteste, a menor correlação foi para o item "ingerir doces" (a = 0,15) e a maior, para os itens sobre o uso do cigarro (a = 1,00). As correlações interavaliador variaram de a = 0,29 a a = 1,00. Conclusões: O questionário adaptado apresentou propriedades psicométricas semelhantes às do SDSCA. Sua versão para o Brasil fornece um questionário confiável e válido para avaliar a aderência ao autocuidado nos diabéticos em nosso meio. Arq Bras Endocrinol Metab. 2010;54(7):644-51 Descritores Diabetes melito; autocuidado; estudos de validação; tradução (processo) ABSTRACT Objectives: To translate into Portuguese, perform cross-cultural adaptation and to evaluate the psychometric properties of the Summary of Diabetes Self-Care Activities Questionnaire − SDS-CA. Materials and methods: The process followed the international guidelines for the adaptation and evaluation of psychometric properties. The Cronbach's alpha (a) was determined to evaluate the internal consistency (inter-itens correlation) and the reliability (test-retest and interevaluator correlation). Results: The inter-itens correlation showed values of a = 0.09 to a = 0.86. In the test-retest evaluation, the lowest correlation was obtained for the item "eat sweets" (a = 0.15) and the highest correlation was obtained for the items concerning smoking (a = 1.00). The inter-evaluator correlations varied from a = 0.29 to a = 1.00. Conclusions: The adapted questionnaire showed psychometric properties similar to those of the SDSCA. Its Brazilian version provides a reliable and valid questionnaire to evaluate diabetic patient adherence to self-care in our community. Arq Bras Endocrinol Metab. 2010;54(7):644-51 Keywords Diabetes mellitus; self care; validation studies; translating (process) INTRODUÇÃOA aderência ao tratamento no diabetes melito (DM) é um fator essencial para controle da glicemia e redução da incidência das complicações (1-3). Para o tratamento do DM, além do uso da medicação, são necessárias diversas atividades de autocuidado como o seguimento de um plano alimentar, a monitorização da glicemia e a realização de atividades físicas. Essas atividades são vis-

The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health.

BackgroundTo determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors.MethodsThis was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years.ResultsOverall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01).ConclusionsOur results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.

BackgroundTo determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.MethodsThis was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).ResultsOverall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).ConclusionsA majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.

Objective: To provide epidemiological information about thyroid cancer (TC) in the Metropolitan area of Florianopolis and investigate some factors that could be associated with this type of cancer. Method: This study analyzed data of patients who had TC diagnosed and underwent surgical treatment in 2000 and 2005. Epidemiological factors about patients, tumors and surgical procedures were evaluated. Results: In 2000 and 2005, an increasing incidence of TC at a rate of 132.33% was detected. The increased rate was mainly observed for tumors measuring less than 1 cm (p = 0.004). Results also showed an increase in the number of multifocal tumors (p = 0.02) and in the rate of total thyroidectomy (p = 0.002). Conclusions: The increasing incidence of TC in the Metropolitan area of Florianopolis is probably due to more invasive thyroid nodule management. Future studies are necessary to establish potential predicting factors for papillary thyroid microcarcinoma aggressiveness, as well as predictors of follicular lesion malignancy to identifying more accurately the appropriate therapy approach. Arq Bras Endocrinol Metab. 2009;53(4):453-60. KeywordsThyroid neoplasm; incidence; early diagnosis rEsUMO Objetivo: Fornecer informações epidemiológicas acerca do câncer de tireoide (CT) na Grande Florianópolis e avaliar fatores que possam estar associados a tal neoplasia. Métodos: A população de estudo incluiu pacientes, com diagnóstico de CT, submetidos a tratamento cirúrgico em 2000 e 2005. Foram avaliados fatores epidemiológicos referentes aos pacientes, características das lesões e procedimentos cirúrgicos realizados. Resultados: Durante o período de estudo, detectou-se um aumento na incidência do CT correspondente a 132,33%. Verificouse um incremento estatisticamente significativo dos tumores menores de um centímetro (p = 0,004), da proporção de tumores multicêntricos (p = 0,02) e de tireoidectomias totais (p = 0,002). Conclusões: A maior incidência do CT na Grande Florianópolis está possivelmente associada a uma conduta mais intervencionista na abordagem de nódulos tireoidianos. Estudos futuros se fazem necessários para o estabelecimento de critérios preditivos da agressividade dos microcarcinomas papilíferos e de malignidade das lesões foliculares no sentido de identificar com acurácia a melhor opção terapêutica. Arq Bras Endocrinol Metab. 2009;53(4):453-60.