Factors Predicting Adherence to Artistic-Singing Groups for Older Adults and their Role as Moderators of the Intervention Outcomes.

OBJECTIVES: Group singing (GS), as an art-based intervention, has demonstrated a wide range of biopsychosocial benefits in older adult participants. However, the factors that predict the adherence of older adults to these programs and that moderate the intervention outcomes were not yet studied, which is the aim of this study. METHODS: A randomized controlled trial was developed to test the efficacy of a GS intervention, from which pre-post intervention data was collected and analyzed. Participants: 149 retired older adults (M = 76.66, SD = 8,79 years old) users of a social care institution. RESULTS: Principal component analysis of responses to a pre-intervention assessment yielded 10 factors. General well-being (GWB), negative mood and loneliness, blood pressure, and the participants' years of formal education predicted the number of sessions attended by the participants. GWB moderated the intervention's outcomes on life satisfaction, social identification, and systemic inflammation. CONCLUSIONS: Years of education, well-being, negative mood and loneliness, and blood pressure at baseline predicted participants' adherence to a singing group artistic intervention. CLINICAL IMPLICATIONS: For future artistic interventions with older adults, screening for participants' characteristics such as formal education, health and well-being before the intervention is important as it allows predicting adherence and tailoring more adjusted and cost-effective interventions.

Judging Pharmaceutical Environmental Risk by its Cover? The Effects of Prescription Medication and Disease Severity on Environmental Risk Perception.

Recent wastewater analyses performed in care homes for the elderly showed high levels of water pollution resulting from pharmaceutical waste. The way people perceive the environmental risk of pharmaceuticals can contribute to reversing this problem, but the factors that influence risk perception remain relatively unknown. The aims of the study are two-fold. We first focused on exploring the levels of knowledge regarding environment/water pollution due to pharmaceutical residues from the groups responsible for prescribing (health professionals), handling (staff), and consuming pharmaceuticals (residents) in care homes for the elderly. Second, we assessed the environmental risk perception of pharmaceuticals based on two main factors: prescription medication (nonprescribed versus prescribed) and disease severity (milder versus severe disease), accounting for their level of knowledge (deficit versus sufficiency of knowledge). The study was designed based on correlational research. Data were collected in homes for the elderly located in three Southwestern European countries (N = 300), using self-report surveys. Current knowledge was perceived to be low and the need to know more was perceived to be high, across all groups. As hypothesized, results indicated that to assess the environmental risk, participants made use of information that was unrelated to pharmaceutical persistence, bioaccumulation, and toxicity (PBT). Prescribed pharmaceuticals and/or medication used to treat severe diseases were perceived as being more hazardous for the environment. Simple main effects analysis comparing between knowledge levels confirmed that this effect occurred mostly when participants had knowledge deficit for disease severity but not for prescription medication. These misconceptions might discourage taking an active role in reducing the impact of pharmaceutical residues in the environment.

Sing4Health: protocol of a randomized controlled trial of the effects of a singing group intervention on the well-being, cognitive function and health of older adults.

BACKGROUND: Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants. METHODS: We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention. PARTICIPANTS: 140 retired older adults (> 60 years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n = 70) and a control (n = 70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation. DISCUSSION: Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants. TRIAL REGISTRATION: NCT03985917 . Registered 14th June 2019 (retrospectively registered).

Lay people and experts' risk perception of pharmaceuticals in the environment in Southwestern Europe.

This study aims to contribute to the risk management of pharmaceuticals in the environment, illustrating risk perceptions of lay people and experts from Southwestern Europe (Portugal, Spain, and France). The psychometric paradigm was applied to assess risk regarding four hazards: pharmaceuticals in the environment (i.e., broadly framed), pharmaceuticals in treated wastewater, pharmaceuticals in drinking water, and pharmaceuticals in crops. Two factors explained most of the variance of risk assessments: dread and unknown. The dread factor combined immediacy and severity of effects, and the old nature of hazards. Pharmaceuticals in crops and drinking water scored higher in this factor, as did experts and French respondents. The unknown factor differentiated between the assessments of lay people and experts. Lay people assessed the hazards as being more known by those who were exposed but less known by science; and exposure was perceived as more voluntary and the risk as more controllable. Even though pharmaceutical residues are present in much higher concentrations in treated wastewater, risk assessments were overall higher for drinking water and crops. Moreover, data also revealed risk management preferences: whereas lay people preferred technological and awareness-type measures, experts preferred measures to improve the disposal of pharmaceutical waste and health-type measures.

Psychosocial drivers for change: Understanding and promoting stakeholder engagement in local adaptation to climate change in three European Mediterranean case studies.

Stakeholder engagement in the processes of planning local adaptation to climate change faces many challenges. The goal of this work was to explore whether or not the intention of engaging could be understood (Study 1) and promoted (Study 2), by using an extension of the theory of planned behaviour. In Study 1, stakeholders from three European Mediterranean case studies were surveyed: Baixo Vouga Lagunar (Portugal), SCOT Provence Méditerranée (France), and the island of Crete (Greece) (N = 115). Stakeholders' intention of engaging was significantly predicted by subjective norm (which was predicted by injunctive normative beliefs towards policy-makers and stakeholders) and by perceived behavioural control (which was predicted by knowledge of policy and instruments). Study 2 was conducted in the Baixo Vouga Lagunar case study and consisted of a two-workshop intervention where issues on local and regional adaptation, policies, and engagement were presented and discussed. A within-participants comparison of initial survey results with results following the workshops (NT1 = 12, NT2 = 15, NT3 = 12) indicated that these were successful in increasing stakeholders' intention of engaging. This increase was paired with a) an increase in injunctive normative beliefs towards policy-makers and consequently in subjective norm, and to b) a decrease in perceived complexity of planning local adaptation and an increase in knowledge regarding adaptation to climate change.

When Is Congruency Helpful? Interactive Effects of Frame, Motivational Orientation, and Perceived Message Quality on Fruit and Vegetable Consumption.

Health messages framed to be congruent with people's motivational orientation have been shown to be generally effective in promoting health behavior change, but some inconsistencies have been found. This study tested whether the perceived quality of a health message moderated the congruency effect in the domain of fruit and vegetable (FV) consumption. Undergraduate participants (N = 109) read a health message promoting FV intake in which the frame (gain vs. loss) was either congruent or incongruent with their approach/avoidance motivational orientation. Perceived message quality and intention to increase FV intake were assessed after message exposure, and self-reported FV intake was assessed one week later. A significant interaction between congruency and perceived message quality was found on both intention and FV intake. When messages were congruent, higher intentions and FV intake were observed when perceived message quality was high, but the reverse pattern was observed when perceived message quality was low. The findings support the potential utility of using congruently-framed messages to promote fruit and vegetable consumption, while also underscoring the necessity of using high-quality messages in order for congruency to influence health-related behaviors.

Emphasizing the losses or the gains: Comparing situational and individual moderators of framed messages to promote fruit and vegetable intake.

Health messages are a commonly used way to promote changes in dietary habits but their efficacy could be enhanced by strategies such as the way in which the presented arguments are framed. This study aimed to test the effectiveness of framed messages (gain vs. loss) on behavioural intention and fruit and vegetable (FV) intake, comparing predictions based on prominent theoretical perspectives on message framing (function of the health behaviour and recipients' motivational orientation) and by further exploring the role of baseline intentions as a potential moderator of the framing effects. Undergraduate students (N = 180) completed the three assessment points in time. At baseline, individual moderators (motivational orientation and intentions) and fruit and vegetable intake were assessed. One week later, participants were randomly assigned to the loss or gain-framed message and indicated their intentions for FV intake the following week. A week later, FV intake over the previous week was assessed. The gain-frame was not conducive, per se, to higher intentions or behaviour. Having intention as the outcome, only baseline intentions moderated the effects of message frame. When considering FV intake as the outcome, both motivational orientation and baseline intentions moderated the effects of message frame, with the loss-frame promoting higher FV intake among individuals who were prevention-oriented and had higher baseline intentions. Findings suggest that the success of framed messages for FV intake depends upon the recipient's characteristics, such as motivational orientation, baseline intentions, and cultural background, with implications for health communication interventions.

Formative research on HAPA model determinants for fruit and vegetable intake: target beliefs for audiences at different stages of change.

Theoretically driven health communications are needed to promote fruit and vegetable intake among people at different stages of change. The Health Action Process Approach, a clearly specified model and good predictor of fruit and vegetable intake, was used as a framework to guide a formative research for the development of health messages targeting individuals at either a non-intentional or intentional stage of change. A mixed-method approach was used, combining eight focus groups (n = 45) and a questionnaire (n = 390). Target beliefs for people at both stages were identified under five theoretical constructs (risk perception, outcome expectancies, action planning, coping planning and self-efficacy). Highlighting health problems due to low fruit and vegetable consumption, health benefits, weight reduction and pleasure and enhancing self-efficacy to increase fruit and vegetable intake are the main guidelines for designing messages to non-intenders. For intenders, messages should reassure them of their ability to maintain adequate fruit and vegetable consumption, outline specific plans for increased consumption, identify barriers such as preparation, forgetting or being tired and unwilling to eat fruits and vegetables and suggest strategies to overcome them, such as presenting some practical examples on how to include fruits and vegetables when eating out.

Intervention and mediation effects of a community-based singing group on older adults' perceived physical and mental health: the Sing4Health randomized controlled trial.

ObjectiveTo examine short- and long-term effects of a group singing program on older adults' perceived physical and mental health levels, and also investigate subjective well-being (life satisfaction, positive/negative affect and hedonic balance), body balance and serum biomarkers (C-reactive protein and erythrocyte sedimentation rate) as putative mediating mechanisms, controlling for the cognitive status of the participants. Design: The randomized controlled trial included 149 participants (60 to 95 years), allocated to an immediate intervention group (IG) or a wait-list active control group (WLG). The intervention comprised 34 sessions of group singing during 4-months. Main outcome measures: Self-report measures of physical health, anxiety, stress, and depression. Blinded assessments were conducted at baseline, post-intervention (4 months) and follow-up (6 months). Results: Participants in the IG reported a lower decline in perceived physical health after the intervention, as compared to the WLG. These benefits were maintained at follow-up. Singing-related changes in physical and mental health outcomes were mediated via an increase in positive affect. Moderation results showed that participants with very low cognitive functioning reported more anxiety and depression symptoms after the intervention. Conclusions: These findings provide further understanding on the psychological and physical mechanisms and effects of group singing in older adults.

School Social Behavior Scales: an adaptation study of the Portuguese version of the social competence scale from SSBS-2.

This study analyses the psychometric proprieties of a Portuguese version of the social competence scale from the School Social Behavior Scales (SSBS-2, Merrell, 2002). It is a rating instrument of children and adolescents behavior, to be used by teachers and other school personnel. This scale includes 3 subscales: self-management/compliance, peer relations and academic behavior. In our first sample, 175 teachers rated 344 students from grade 1 through 12. On the second sample 13 teachers rated 251 3rd and 4th grades students. The results from the Portuguese adaptation support the multidimensional structure of the social competence scale from the SSBS-2, although an alternative model demonstrated a better fit to the data than the model originally proposed by the author. The scale showed good internal consistency and good intercorrelations between subscales, as well as between subscales and the total scale. The final model was well replicated in the second sample. These results encourage us to pursue the SSBS-2 Portuguese adaptation, in order to provide a useful and validated instrument for the assessment of social competence and for educational interventions.

Sing4Health: Randomised controlled trial of the effects of a singing group program on the subjective and social well-being of older adults.

Group singing may be an optimal intervention strategy to promote active ageing and well-being; however, evidence with experimental validity is scarce. This study aims to fill this gap by analysing the effects of a 34-session singing group programme (SGP) on participants' subjective and social well-being and the mediating roles of social identification with the singing group and of self-esteem. An RCT with intervention (n = 89) and active waiting-list control (n = 60) conditions was conducted, and a mixed method quantitative and qualitative data collection and analysis were performed. Participants were mostly elderly day-care centre users (M = 76.66 years old; SD = 8.79) with low average levels of education and income. Structured measures of life satisfaction, positive and negative affect, self-esteem, loneliness, social identification and social well-being were collected, as well as interviews on the perceived benefits of participating in the SGP. Results showed significant effects of the SGP on the positive affect, social well-being and marginally on the self-esteem of the participants. The observed effects were sustained at the follow-up. Qualitative analysis corroborated the quantitative results. Mediation analysis showed indirect effects of social identification with the singing group on loneliness and social identification with the social care institution group; and of self-esteem on positive and negative affect.

Factor V Leiden and prothrombin G20210A in Portuguese women with recurrent miscarriage: is it worthwhile to investigate?

OBJECTIVE: To compare the prevalence of factor V Leiden (FVL) and prothrombin (PT) G20210A mutations in Portuguese women with unexplained recurrent miscarriage (RM) and a control group of parous women. MATERIALS AND METHODS: FVL and PT G20210A analysis were carried out in 100 women with three or more consecutive miscarriages and 100 controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal losses). RESULTS: Overall, the prevalence of FVL and PT G20210A was similar in women with RM (5 and 3%) compared with controls (5 and 1%) OR 1.36 (CI 95% 0.45-4.08). In RM embryonic subgroup, PT G20210A was observed in 1.3% of women and FVL prevalence (2.6%) was inclusively lesser than that of controls. Both polymorphisms were more prevalent in women with fetal losses than in controls, although statistical significance was not reached due to the small size of the >10 weeks' subgroup. CONCLUSION: These data indicate that neither FVL nor PT G20210A is associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with embryonic RM and negative personal thromboembolic history.

Greener Schoolyards, Greener Futures? Greener Schoolyards Buffer Decreased Contact With Nature and Are Linked to Connectedness to Nature.

Children are spending less time in nature. They are not taking advantage of the benefits that are related to experiencing nature, such as the improvement of attentional capacity and stress reduction. Furthermore, they are also losing the opportunity to assess nature in a more positive way and to become more connected to nature, factors that appear to be fundamental to securing a greener future. To overcome this problem, researchers have been focusing on increasing children's contact with nature in schools and in promoting garden-based learning programs. Children spend most of their time in school, where they face many cognitive and relational demands. As such, schools might be the ideal context to increase children's contact with nature with more empirical research being needed to understand the effects that greener schools might have. The goal of this study is to explore the effects of schoolyards in children's perceived restorativeness experiences, attitudes towards nature, connection to nature, and social competences. For that, we studied children (N = 132) from three elementary schools with different schoolyards: a school with cement yard with a few trees, a school with green areas, and a school where many parts of the yard were earthen and there was a vegetable garden that the students could cultivate as part of an ongoing garden-based learning program. The results of a questionnaire confirmed that greener schoolyards were related to stronger restorative experiences. As such, children might benefit from improving their attentional capacity during breaks. Unexpectedly, the perceived restorativeness effect was stronger for children who usually had lesser contact with nature than for children who contacted more with nature. This suggests that having schools with green yards might buffer some of the effects of reduced contacts with nature outside of school. The effects of the schoolyard in children's social competences did not appear to emerge. However, children that attended the school with the greener schoolyard had more positive attitudes and were more connected to nature than children from the other two schools. This further suggests that designing greener schoolyards might be an opportunity to contribute to reversing global environmental challenges.

Parents modelling, peer influence and peer selection impact on adolescent smoking behavior: A longitudinal study in two age cohorts.

Understanding the key factors that influence smoking behavior, especially during adolescence, has a meaningful impact on public health. This study examined the impact of parent modelling, peer influence and peer selection on adolescent smoking behavior in two Portuguese cohorts followed for three years. A questionnaire was delivered in classes and schools randomly selected, three times, one per year (cohort1: time1-7th, time2-8th, time3-9th; cohort2: time1-10th, time2-11th, time3-12th graders). The sample included a total of 656 students (402 younger [time1 Mage = 13.17, SD = 0.53, 63.7% girls;] and 254 older [time 1 Mage = 16.20, SD = 0.53, 65% girls]). Longitudinal data were examined through an autoregressive cross-lagged model (ARCL). The model explained 35% of the variance in smoking behavior at T3 for the global sample (4% for the younger and 58% for the older). Over time, in both cohorts, the percentage of never smokers decreased sharply and the percentage of regular smokers increased rapidly. We observed that participants in the older cohort had higher chances of smoking if their parents smoked. Nevertheless, we did not find a parental modelling effect in the longitudinal model. Peer influence and peer selection influenced smoking behavior. However, peer selection influenced the youngest group, both processes influenced the middle age group, and only peer influence influenced the oldest. Best friend and friends had a stronger impact on the younger while friends and same grade students had a stronger impact on the older. Prevention programs should regard these differences of interpersonal influences through adolescent development and specific strategies for different age groups should be considered.

The importance of household pharmaceutical products disposal and its risk management: Example from Southwestern Europe.

The presence of pharmaceuticals in the environment is an emergent unknown environmental problem, linked to increased production and consumption of pharmaceuticals and, as such, understanding risk perception is fundamental. This study focuses on exploring causes (trust and knowledge) and effects (intention and proper individual disposal of pharmaceutical leftovers) of environmental and health risk perception. Survey data was collected in Portugal, Spain, and France (sample of 509 individuals). Data illustrated that in France, where the quantity of recycled pharmaceuticals is much higher, respondents reported a higher need for knowledge, but not a higher risk perception nor self-reported behaviour. Although previous research illustrates that higher trust correlates with lower risk perception, we found a positive correlation, which highlights the need to comprehend these variables in emergent risks. Results further confirmed a hypothesized moderated mediation model to explain proper disposal behaviour. We found an indirect effect of risk perception on behaviour through intention, which was stronger for participants with higher environmental identity. Understanding the causes and effects of risk perception of pharmaceuticals in the environment thereby contributes to improve pharmaceutical waste management processes and to promote the proper disposal of pharmaceuticals.

A Randomized Trial of the Close Reading and Creative Writing Program: An Alternative Educational Method for Adult Group Care Intervention in Type 2 Diabetes Management.

OBJECTIVES: Group care for individuals with diabetes is a recognized educational practice, but techniques from narrative medicine using of literary works have never been incorporated in these programs. We designed a new educational model (i.e. the Close Reading and Creative Writing program) of group care for individuals with diabetes incorporating close reading and creative writing in group education. A randomized trial was designed to evaluate this intervention. METHODS: A total of 49 individuals with type 2 diabetes, aged <85 years and with >6 years of school education, were randomized to 2 different group care dynamics: (a) a "control group," with a classical structured educational approach currently used at our institution; and (b) an "intervention group," with introduction of literary texts, narrative skills, close reading and creative writing. Evaluation included anthropometric measures, glycated hemoglobin (A1C) and questionnaires for psychological evaluation. Individual A1C levels in the 6-year period before the trial were collected from clinical records. RESULTS: A significant reduction of A1C was observed in the intervention group, showing noninferiority in relation to the classical approach. A significant decrease in A1C was observed in relation to the 6 previous years. A significant increase in satisfaction with the therapist and group process was observed. CONCLUSIONS: This is the first randomized trial designed to evaluate a group care intervention to manage type 2 diabetes using narrative techniques. The results suggest that this may be a useful model for more highly schooled individuals, and may represent an alternative for the educational process.

Urban Green Space: Creating a Triple Win for Environmental Sustainability, Health, and Health Equity through Behavior Change.

Urbanization, costs of green space maintenance, and diminishing connection between people and nature all exert pressures on urban green space. This is regrettable as green space has the potential to create wins for environmental sustainability, health, and health equity. This paper explores this potential triple win and investigates how to increase the use of urban green space through behavior change. A narrative literature review was conducted and was supplemented with literature suggested by experts. Results show that creating well-designed green spaces and stimulating people to use them can indeed deliver this triple win. Providing accessible, attractive, well-maintained green space with room for socialization, and where people feel safe, may increase the opportunity and motivation of people to use it more often. Informing and educating people and organizing activities may increase capability (and motivation) to use green space. Since the use of green space depends on life stage, lifestyle factors and individual values, it is important to involve potential users in its design. We recommend a specific focus on those groups who may benefit most from the use of green space. More evaluation is needed to inform effective green space interventions and to assess related economic, social, and environmental benefits.

All You Need Is Facebook Friends? Associations between Online and Face-to-Face Friendships and Health.

Positive social relations are known to have a beneficial impact on health, however, little is known about the links of health with online relationships. In this study, we compare face-to-face and virtual friendships in their association with health. By building on previous results of studies conducted on the well-being of college students, we expect to find stronger associations of face-to-face friendships with health than of those established through Facebook. Furthermore, we expect to test the mediating role of social capital variables in this process. Two large-scale studies conducted in community samples (Study 1 = 350 urban residents; Study 2 = 803 urban and rural residents) showed that the number and quality of face-to-face friendships were directly associated with self-reported health status, however, the same did not occur with Facebook friendships. Moreover, the association of face-to-face friendships with health was totally mediated by bonding (mostly) but also bridging social capital. These results, replicated in both studies, were found controlling for confounding variables such as age, gender, education, living alone, self-esteem, and socioeconomic status. This pattern of results emphasizes the gains of face-to-face over online friendships for individuals' health status in community samples.

Age differences in control beliefs regarding health: control, strategy and capacity.

OBJECTIVES: A new model of perceived control has been proposed (Skinner, 1995) in which 3 types of control-related beliefs were distinguished: control, strategy and capacity. This model has not yet been applied to health issues. Hence, the main purpose of this study was to apply it to the health domain, exploring age differences in the way children and teenagers conceptualize control-related beliefs. DESIGN AND SETTING: A prospective age cohort study was carried out with older children and teenagers attending public schools in Lisbon's metropolitan area. METHOD: A newly developed instrument (HPCQ) was administered to 188 healthy participants (91 6th graders and 97 11th graders). RESULTS: Analyses of variance showed no age differences in individuals' strategy beliefs. Generally, children showed stronger capacity beliefs and a higher perceived control over their own health than teenagers. Hierarchical regression analyses showed that the belief in being a lucky person was a central predictor of control in later childhood. In adolescence, chance-related factors lost their predictive power, and effort and attributes-related beliefs remained controls' primary predictors. CONCLUSIONS: These results emphasize the heuristic value of this recent conceptualization of control-related beliefs. Moreover, they contribute to the development of more effective and reliable health-related school-based prevention/intervention programmes aiming at these particular age cohorts.