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- Responding to grief-related needs in older adults: Protocol for a community-based matched-care trial (GriefDiff)Publication . Neto, David Dias; Coelho, Alexandra; Barbosa, Miguel; Albuquerque, Sara; Dias Neto, David ManuelBackground Prolonged grief disorder (PGD) affects a significant proportion of bereaved people and may be especially burdensome in later life, when cumulative losses, health problems, and reduced social resources can hinder adjustment. Grief support is often reactive, and many older adults do not access timely, appropriate care. GriefDiff will study a differentiated, community-based model that matches intervention intensity and format to individual risk and relational needs. Methods GriefDiff is a mixed-methods (QUAN→QUAL) protocol. The quantitative component is a three-arm, tiered, parallel-group superiority randomised controlled trial delivered in community settings across Portugal, in collaboration with a national grief association. Eligible participants are Portuguese adults aged ≥60 years, bereaved 1–12 months, with a significant emotional bond to the deceased. After consent, participants complete a grief-risk tool and a mutuality-based relational-needs screener. Stratified block randomisation allocates participants to Information and Grief Literacy (IGLiteracy; one group session plus bi-weekly SMS reminders), an Individual Self-Help Program (ISelfHP; older-adult web app with optional offline materials and brief telephone guidance), or Moderated Self-Help Groups (MSHGroups; manualised weekly groups). Assessments occur at baseline, 3 months (post) and 6 months (follow-up). The primary outcome is prolonged grief symptoms; secondary outcomes are depression and anxiety. Target sample is N=324 (108/arm). Analyses will follow an intention-to-treat approach and will use mixed-effects models for repeated measures with fixed-sequence gatekeeping. Qualitative focus groups will compare matched versus non-matched allocations to clarify perceived fit, identify barriers, and inform future implementation strategies for differentiated grief care. Discussion Developing scalable, differentiated community responses will help address a growing societal challenge while meeting the needs of older adults. By evaluating programme effectiveness and refining the screening procedure, this study aims to inform the development and implementation of needs-based grief care in community settings
- Psychometric properties of the Spontaneity Assessment Inventory-Revised (SAI-R): The 3-factor hypothesisPublication . Martins, Paulo; Gonzalez, António-José; Lima, Margarida Pedroso de; Rosado, António; Gonzalez, António JoséSpontaneity and its connections to mental health and wellbeing are a central issue in both theory and practice of psychodrama, and the specialized literature sometimes even associates the presence of pathology to a lack of spontaneity. This paper describes spontaneity in Moreno’s theory, its assessment, its association with other measures and concepts, and scientific advances in the field. Specifically, we present results obtained with the English and Portuguese-language versions concerning its assessment. The main purpose of this work was to study the spontaneity measure (SAI-R) in a 3 first-order factors version for a Portuguese sample of 439 subjects, divided into two independent samples. The mean age of participants was 25.6 years (SD = 10.2), and ages ranged between 18 and 64 years. Data was collected through an online platform of a Portuguese market research company. The results revealed that the 3-factor model has acceptable validity for items 1 (“Creative”) and 7 (“Euphoric”), confirming the composite reliability, the convergent validity, but not the discriminant validity. Through multi-group analysis, the model proved to be stable. Notwithstanding the need for complementary studies, including clinical samples, the SAI-R is a short and valid instrument in clinical and non-clinical contexts when evaluating spontaneity.
- Correlates of active commuting to school among portuguese adolescents: An ecological model approachPublication . Loureiro, Nuno; Loureiro, Vânia; Grao-Cruces, Alberto; Martins, João; Matos, Margarida Gaspar de; Gaspar de Matos, MargaridaActive commuting to and from school can be an important contribution to improving health in adolescents. This study aimed to analyze the influence of multilevel variables of the ecological model in the active commuting of a representative sample of Portuguese adolescents. The 2018 Health Behaviour in School-Aged Children questionnaire was applied to 5695 adolescents with an average age of 15.5 years old (SD ± 1.8), 53.9% of whom were girls. The associations were studied by applying chi-square tests and multivariate logistic regression models. In this study, 36.5% of the participants reported walking or cycling to school. Active commuting to school was directly associated with age (OR = 1.2; p < 0.05), strong family support (OR = 1.2; p < 0.05), a moderate to low financial level of the family (OR = 1.3; p < 0.05) and living near the school (OR = 2.4; p < 0.05). The results revealed that an adolescent’s choice to travel to and from school using an active mode of transportation increased with strong family support. As a result, promotion campaigns should consider the adolescent’s family context.
- Bullying, mental health, and the moderating role of supportive adults: A cross-national analysis of adolescents in 45 countriesPublication . Kim, Samuel Seunghan; Craig, Wendy Marion; King, Nathan; Bilz, Ludwig; Cosma, Alina; Michal, Cosma; Qirjako, Gentiana; Matos, Margarida Gaspar De; Augustine, Lilly; Šmigelskas, Kastytis; Pickett, William; Gaspar de Matos, MargaridaObjectives: Relationships with supportive adults during adolescence may be a protective factor that lowers the risks associated with bullying. The current study aimed to examine the moderating role of supportive adults in the associations between bullying involvement (in-person and cyber) and mental health problems (psychological symptoms and low life satisfaction). Methods: Data from 45 countries and regions taking part in the 2017/18 Health Behaviour in School-Aged Children study (N = 230,757) were used. Multivariable Poisson regression models were used to estimate relative risks of bullying on mental health. Effect estimates were compared across the number of supportive adults to examine a possible cumulative protective effect of relationships with supportive adults. Results: Bullying involvement was consistently associated with poor mental health across the 45 countries. Risk of mental health problems associated with bullying involvement was greatest among students reporting relationships with multiple supportive adults. This was true for all indicators of bullying involvement.Conclusion: Bullying remains a prevalent and harmful experience for youth worldwide. Merely having supportive adults is not sufficient in protecting youth from experiencing the mental health risks associated with bullying.
- Refugees, migrants and covid-19: qualitative analysis of the aparttogether/who studyPublication . Guedes, Fábio Botelho; Gaspar, Susana; Cerqueira, Ana; Gaspar, Tania; Tomé, Gina; Branquinho, Cátia; Calado, Pedro; Marques, Maria Emília; Derluyn, Ilse; Verelst, An; Skovdal, Morten; Matos, Margarida Gaspar deO presente estudo tem como principal objetivo perceber quais são as condições que os migrantes e refugiados a viver em Portugal identificam como sendo as mais importantes para lidar com a pandemia da COVID-19, assim como perceber de que forma conseguirão ajudar outros migrantes e refugiados a lidar com a pandemia. Trata-se de um estudo qualitativo com análise de conteúdo, integrado no estudo internacional ApartTogether em colaboração com a Organização Mundial de Saúde. Responderam ao questionário 330 indivíduos, com uma média de idades de 35,25±11,21 anos, dos quais 62% (n=183) são do género feminino. Os resultados indicam que as condições identificadas pelos indivíduos migrantes ou refugiados como importantes para ajudar a lidar com a pandemia da COVID-19 são a proximidade com a família e amigos, os pensamentos positivos e o facto de manterem ou conseguirem trabalho, assim como apoio financeiro (uma vez que muitos perderam o emprego na pandemia e face às medidas de confinamento). O apoio emocional e as situações de voluntariado/doação de alimentos e produtos essenciais foram referidas como condições criadas por migrantes ou refugiados para ajudar terceiros a lidar com a pandemia. É importante ter em conta as populações migrantes e refugiadas aquando da delineação de planos e estratégias para a prevenção e combate à pandemia da COVID-19. É igualmente necessário ter presente as características e as necessidades específicas desta população, para o combate das desigualdades sociais.
- Playback theatre: Group, stories, and stage as elements of changePublication . Gonzalez, António-José; Xavier, Tiago; Amarante, Nuno; Barros, Rita; Amaral, Beatriz; Bernardino, Miriam; Lima, Margarida; Gonzalez, António JoséPlayback Theatre (PT) is a modality of improvised theatre that uses the personal narratives of the audience as the basis for dramatic representations. There have been empirical studies on its benefits at both the individual and group levels. The aim of this study was to understand the subjective experiences of participants in a PT group and to explore the therapeutic qualities of this method. An intervention was organized, consisting of 12 weekly PT sessions in a closed group. Ten participants agreed to participate in a Focus Group session, which was recorded and transcribed. Thematic Analysis of the interview found three main themes: the Therapeutic Dimension of the experience, the role of Story Sharing in terms of group creation, cohesion, and empathy, and the Stage dimension that allowed for materialization, interpretation, and perspective taking concerning the personal narratives. Data suggest that PT can be a useful and important tool, with an intimate relationship with psychotherapeutic practice, enabling encounter, creation, sharing of subjectivities, and construction of new meanings.
- Pressure ulcer risk profiles of hospitalized patients based on the Braden Scale: A cluster analysisPublication . Gaspar, Susana; Peralta, Miguel; Budri, Aglécia; Ferreira, Carlos; Gaspar de Matos, Margarida; Gaspar de Matos, MargaridaThe aim of this work is to identify the pressure ulcer risk profiles of hospitalized patients with reference to Braden Scale subscales. Methods: A total of 2996 hospitalized Portuguese participants were screened using the Braden Scale. A hierarchical and nonhierarchical cluster analysis was conducted, with ethical approval. Five risk profiles (clusters) based on the first risk assessments were identified. Regarding the Braden Scale total score, two profiles with high risk and three profiles with low risk of pressure ulcer development were identified. All clusters were statistically significantly different in terms of sociodemographic and clinical variables. When the first and the last risk assessments were compared, all the clusters improved the Braden Scale total score on the last risk assessment, except Cluster 4 (low‐risk category). Clusters 3, 4 and 5, which were classified as low risk, decreased in several Braden subscales at the last risk assessment.Conclusions: The classification of low risk may misguide the early identification of patients with individual risk factors. Increasing the awareness of health care professionals for the importance of risk assessment of each Braden subscale is necessary for pressure ulcer prevention. We recommend the implementation of strategies for early identification of patients at risk at local and national levels.
- Changes in cannabis consumption during the global COVID-19 lockdown: The International COVISTRESS StudyPublication . Salles, Juliette; Yrondi, Antoine; Marhar, Fouad; Andant, Nicolas; Dorlhiac, Raimundo Avilés; Binh, Quach; Jiao, Jiao; Antunes, Samuel; Ugbolue, Ukadike Chris; Guegan, Julien; Karine, Rouffiac; Pereira, BrunoIntroduction: COVID-19 lockdown measures have been sources of both potential stress and possible psychological and addiction complications. A lack of activity and isolation during lockdown are among the factors thought to be behind the growth in the use of psychoactive substances and worsening addictive behaviors. Previous studies on the pandemic have attested to an increase in alcohol consumption during lockdowns. Likewise, data suggest there has also been a rise in the use of cannabis, although it is unclear how this is affected by external factors. Our study used quantitative data collected from an international population to evaluate changes in cannabis consumption during the lockdown period between March and October, 2020. We also compared users and non-users of the drug in relation to: (1) socio-demographic differences, (2) emotional experiences, and (3) the information available and the degree of approval of lockdown measures.Methods: An online self-report questionnaire concerning the lockdown was widely disseminated around the globe. Data was collected on sociodemographics and how the rules imposed had influenced the use of cannabis and concerns about health, the economic impact of the measures and the approach taken by government(s).Results: One hundred eighty two respondents consumed cannabis before the lockdown vs. 199 thereafter. The mean cannabis consumption fell from 13 joints per week pre-lockdown to 9.75 after it (p < 0.001). Forty-nine respondents stopped using cannabis at all and 66 admitted to starting to do so. The cannabis users were: less satisfied with government measures; less worried about their health; more concerned about the impact of COVID-19 on the economy and their career; and more frightened of becoming infected in public areas. The risk factors for cannabis use were: age (OR = 0.96); concern for physical health (OR = 0.98); tobacco (OR = 1.1) and alcohol consumption during lockdown (OR = 1.1); the pre-lockdown anger level (OR = 1.01); and feelings of boredom during the restrictions (OR = 1.1).Conclusion: In a specific sub-population, the COVID-19 lockdown brought about either an end to the consumption of cannabis or new use of the drug. The main risk factors for cannabis use were: a lower age, co-addictions and high levels of emotions.
- Examining life in detention: A process of survey translation and adaptation through an ecological and collaborative approachPublication . Esposito, Francesca; Di Napoli, Immacolata; Ornelas, José; Briozzo, Erica; Arcidiacono, Caterina; Esposito, Francesca; Ornelas, JoséThis paper illustrates the process we engaged in to translateand adapt a survey to examine life in an immigration deten-tion center in Italy from the perspective of the migrantsdetained therein. The process consisted of: the forward trans-lation of the original measure performed by four independenttranslators; a blind backward translation to identify misinter-pretations or incorrect cross-cultural and contextual adapta-tions; a synthesis of all translations to obtain a semifinalversion; the creation of an Expert Committee composed ofscholars, practitioners, and migrants with experience of deten-tion to assess equivalence and content validity; and, finally,pretesting with a group of 15 detained persons. Through thismulti-step process we obtained a measure capable of grasp-ing the context-specific meanings, needs and experiences thatcharacterize life in detention. The challenges and benefits of acollaborative and ecological approach to measurement trans-lation and adaption are discussed in the final section.
- What goes on in digital behaviour change interventions for weight loss maintenance targeting physical activity: A scoping reviewPublication . Encantado, Jorge; Palmeira, António L; Silva, Carolina; Sniehotta, Falko F; Stubbs, R James; Gouveia, Maria João; Teixeira, Pedro J; Heitmann, Berit L; Marques, Marta M; Conde Encantado Paulo, Jorge EduardoTo identify the core components of digital behaviour change interventions for weight loss maintenance targeting physical activity, in terms of: (i) behaviour change techniques, (ii) mechanisms of action, (iii) modes of delivery, (iv) dose and (v) tailoring/personalization. In addition, the links between these components were investigated. Methods A literature search was performed in five electronic databases: PubMed, Embase, CINHAL, PsycINFO and Web of Science. Two reviewers independently screened the identified articles and extracted data related with the study characteristics and behaviour change techniques, mechanism of action, mode of delivery, dose, and tailoring, using standardized classifications whenever available (e.g. behaviour change techniques taxonomy). Seventeen articles reporting 11 original studies were selected. Two studies were protocols, 9 studies presented results for weight change and all but one showed no significant differences between the intervention and control groups. Eight studies (73%) provided adequate information on behaviour change techniques. Five studies (45%) provided partial information about how the behaviour change techniques were linked to mechanisms of action, and only one study (0.9%) described these links for all the techniques. Around half of the studies reported the modes through which behaviour change techniques were delivered. Descriptions of dose were present in most studies, but with minimal information. The use of tailoring or personalization approaches was mentioned in eight studies (73%), but descriptions of what was tailored and how were minimal. Conclusions: The compilation of information regarding intervention components was difficult due to the lack of information and systematization in reporting across papers. This is particularly true for the reporting of the links between behaviour change techniques and the other core intervention components. This information is crucial to help us understand in the context of behaviour change interventions what works or does not work, how it works and why.