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2011

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1.1
1.2
1.3
1.4
1.5
1.6

.1
.3
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. 7
. 10

2
2.1
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2.2
. 13
2.2..
. 13
2.2..
. 16
2.3
. 18
2.4
. 21

3
3.1
3.2

. 22
. 23

4
4.1
4.2

. 24
. 26

5
5.1 : -
5.1.
5.2.
5.2
5.3

. 29
. 30
. 31
. 32
. 32

5.4
5.5

. 33
.34

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6
6.1
6.2
6.3
6.4
6.5

. 38
. 39
.40
. 43
. 45

7

7.1
7.2
7.3
7.4
7.5
7.6 -
7.7
7.8
7.9
7.10
7.11
7.12

. 47
. 48
. 49
.50
. 51
. 52
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. 56
. 58
. 59
. 60
. 61

8
-

8.1
8.2
8.3
8.3.
8.3.
8.4

. 63
. 65
. 67
. 68
. 70




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5.5

The Diabetes Quality of Life Measure (D.Q.O.L.)


Diabetes Quality of Life Measure (D.Q.O.L.)26
Diabetes Control and Complications Trials
(D.C.C.T) 80.
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Diabetes-Specific Quality of Life Scale (D.S.Q.O.L.S)26 64
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Ana Paula Silva de Faria Roseney Bellato La vida cotidiana de la quien vivencia
condicion cronica de la diabetes37.
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1. - ., ., , -medical city, 3,
1997, 2004.
2. , , , 18,
1999, .. .
3. , , 2008,
www.vita.gr .
, ..
4. .,
, 1996.
5. Roche Diagnostics , www.sugarfree.gr
6. , .., 2007.
7.
www.NovoNordisk.gr , 27/02/2007
8. , , 2005, www.medweb.gr
9. , www.mednet.gr
10. Prashant Magar- Buzzle Author www.buzzle.com
11. University of Portsmouth, Information and Study Skills www.port.ac.uk July 2001
12. www.sugarfree.gr
13. http://jfladies.blogspot.com/2008/01/blog_spot_1432.html
26/01/2008
14. Fayers Peter M. & Machin David Quality of life, analysis and interpretation,
University Studio Press, 2006.
15. ., ,
, 2001.
16.
.,

(2007),

http://epapanis.blogspot.com/2007/09/blog_post_5311.html
17. Flanagan J.C., A Research Approach to improving our quality of life., American
Psycologist, 33, pp: 138-147.
18. Young K. J & Longman A.J., Quality of life and persons with melanoma: A pilot
study, Cancer Nurs, June 1983: 6(3):219.
19. . - ,
, 2003.
20. Jahoda M., Current concepts of positive mental health, Basic Books, New York,
1958.
21. ., -
, , ,
, 18(3):254-260, 2001.
22. . ,
, 24 (. 1): 6-10, 2007.
23. http://el.wikipedia.org eWho (1948)
24. - ., ,
, 18 (3), 2001.

25. ., ., -
, , 18(3):218-222, 2001.
26. Polonsky W. Understanding and assessing diabetes- Specific quality of life,
American Diabetes Association, Diabetes spectrum, 13(36), 2000.
27. Bradley Clare, Handbook of psychology and diabetes, Psycology press,
Amsterdam, 1994.
28. .,
- 2006-2007.
29. (2010) http://edu4adults.blogsrot.com/2010/03/blogpost_1742.html#ixzzl80anIEpn
30. Bird M., Hammerley M., Gomm R., & & Woods P. (1999).
, , (. . ). :

31. - ., - ,
-medical city, 1997, 2004,
2007.
32. Dickoff J, James P.A., Theory of theories, Nursing Research, 17:197-203, 1968.
33. Glasser B.G., Theoretical sensitivity, Mill Valley. California Press, 1978.
34. Glasser B.G., Strauss A.L., The discovery of grounded theory: strategies for
qualitative research, Chicago, Aldine, 1967.
35. , www.diabetes.org.cy
36. Elisabeth Kbler-Ross On Death and Dying, 1969, el.wikipedia.org
37. Ana Paula Silva de Faria & Roseney Bellato, La viada cotidianca de la quien
vivencia condicion eronica de la diabetes., www.scielo.br
38. Social Issues for the type I diabetes www.diabetes-info.co.ul/managingdiabetes/social-issues.html
39.
www.iatronet.gr
40. Worthing B. - , vol.8,
5, .18.
41. Aslander Wendy,

II.
www.socialworktoday.com/archive/090208p18.shtml, 2005
42. ., http://atcare.gr
14/04/2010