Contributions for the Validation of the European Portuguese Version of the Vascular Quality of Life-6 Questionnaire for Peripheral Artery Disease.

INTRODUCTION: Peripheral arterial disease (PAD) is an occlusive atherosclerotic disease of the arteries of the extremities of the body that affects more than 230 million people worldwide. The most common symptom is intermittent claudication, described as leg pain which occurs mainly while walking. The symptoms impair the ambulation and functional capacity of patients, leading to loss of mobility, disease deterioration, increased risk of other cardiovascular diseases, and lower quality of life (QoL). Therefore, the aim of this study was to perform a cross-cultural adaptation and validation of the VascuQol-6 questionnaire for the Portuguese population to obtain a quick, sensitive, and easy-to-use way to assess the QoL of Portuguese patients diagnosed with PAD. METHODS: The Vascular Quality of Life-6 Questionnaire (VascuQoL-6) was adapted and translated into European Portuguese using standard validation methodology, including 115 patients with a mean age of 64.67 (7.23) years, with PAD with IC stable for more than three months; and ABI < 0.9 at rest. VascuQoL-6, SF-36, International Physical Activity Questionnaire (IPAQ), and the PAD Knowledge Questionnaire (PADKQ) were used. Reliability, construct validity analysis through convergent and discriminant validity, known-group validity, and responsiveness analysis were tested. RESULTS: The Cronbach's alpha was 0.64 and the average inter-item correlation was 0.27, indicating acceptable internal consistency. VascuQoL-6 was positively associated with SF-36 Physical Component Summary and Mental Component Summary scores (r = 0.64, p < 0.01 and r = 0.42, p < 0.01, respectively). In turn, there was no significant correlation between VascuQoL-6 scores and the PADKQ or IPAQ. A statistically significant difference between groups according to IC severity [F(2.47) = 8.35, p < 0.001] was found. A paired samples t-test showed differences between VascuQol-6 scores before a walking program (M = 15.65, SD = 3.09), and after a walking program (M = 17.41, SD = 2.71), t(67) = 3.94, p ≤ 0.001. CONCLUSION: The VascuQoL-6 is a six-item instrument to assess the QoL associated with PAD with good psychometric properties, convergent and discriminant validity with SF-36, PADKQ and IPAQ. The instrument proved to have known group validity and responsiveness.

Latent profiles of emotion regulation among university students: links to repetitive negative thinking, internet addiction, and subjective wellbeing.

Recent years have seen a deterioration in the mental health of university students and notable surge in the need for psychological support. Due to its links to psychopathology and high-risk behaviors, difficulty in emotion regulation frequently serves as a transdiagnostic dimension. This cross-sectional study used a person-centered analytical approach (latent profile analysis; LPA) to identify groups of Portuguese university students with similar profiles of emotion regulation difficulties (N = 261; Mage = 22.5 ± 1.2 years; n = 213 female) and describe how these groups differ in their presentation of repetitive negative thinking, internet addiction, and subjective wellbeing. The analyses identified four latent profiles: 14.5% of students showed global dysregulation (the Low Emotion Regulation Profile), 23% were moderately dysregulated with elevated problems in goal-directed behavior (the Moderate Emotion Regulation Profile), 8% showed specific difficulties with low emotional awareness and clarity (the Low Insight Profile), and 54.4% showed adaptive emotion regulation (the High Emotion Regulation Profile). As anticipated, the Low Emotion Regulation Profile had the lowest subjective wellbeing and the highest prevalence of repetitive negative thinking and internet addiction. Students with a Low Insight Profile also showed low subjective wellbeing, but less repetitive negative thinking compared to the Low Emotion Regulation Profile. Our findings suggest that interventions aimed at improving health and wellbeing among university students should consider each student's unique set of emotion regulation difficulties, rather than focusing on particular strategies. Further research may help determine whether emotion regulation profiles can serve as predictive indicators of varying mental health trajectories and subjective wellbeing in university students.

Illness beliefs relation to physical activity and quality of life in patients with peripheral arterial disease.

Intermittent claudication is the most common symptom of Peripheral Arterial Disease (PAD) and is associated with decreased quality of life (QoL) due to walking impairment. The level of threat attributed to the disease affects QoL and physical activity. This study explores beliefs and illness drawings, and their relationship with quality of life and physical activity in patients undergoing conservative treatment for PAD. A cross-sectional study was carried out including 119 patients with PAD and Intermittent Claudication, in which patients were asked to freely draw their disease and 33 agreed to participate. The profile of beliefs about PAD is characterized by a low level of threat. Belief in the emotional impact of the disease, representations about the consequences and concern about the disease were associated with worse quality of life; the belief of having a high personal control over the disease was associated with more physical activity. The analysis of the disease drawings revealed three categories: extension of the disease (category 1), location and representations of the disease (category 2), and level of detail and complexity of the drawings (category 3). Greater disease extent was associated with more disease symptoms (IPQ 6) (rs = 0.399, p = .021). It is necessary to address beliefs and representations about the disease in consultations with patients with PAD. Patient drawings are a useful, practical, and free tool that does not require a lot of time and can facilitate the approach of health professionals to patient training and education.

Effect of a monitored home-based exercise program combined with a behavior change intervention and a smartphone app on walking distances and quality of life in adults with peripheral arterial disease: the WalkingPad randomized clinical trial.

Aims: Investigate whether a Home-based Exercise Therapy (HBET) program for patients with Peripheral Arterial Disease (PAD) and Intermittent Claudication (IC) with a behavior change intervention, supported by a smartphone application, is effective in improving walking distances and performance, and quality of life (QoL) over 6 months. Methods and results: This was a single-center, prospective, two-arm, single-blinded randomized controlled trial including 73 patients with PAD and IC, and three assessment moments: baseline, 3, and 6 months. Participants were randomized to receive a walking exercise prescription, with the support (n = 38) or without the support (n = 35) of the WalkingPad app, between January 2021 and July 2022. Both groups received two face-to-face behavior change sessions and 12 structured and targeted reinforcement phone calls over 6 months. Primary outcomes were between-group differences in pain-free walking distance (PFWD), functional walking distance (FWD), maximal walking distance (MWD), and 6-min walk distance (6 MWD) at 3 and 6 months. Secondary outcomes were QoL and walking impairment. Seventy-three patients (mean age 64 ± 7.2 years, 88% men) participated in this study, 60 of whom completed the three assessment moments. The whole sample significantly improved all primary outcomes in the first 3 months; that is, the average PFWD (151.1 m), FWD (175.2 m), MWD (171.1 m), and 6 MWD (30.8 m) increased from T1 to T2. Only MWD exhibited a significant average increase (35.0 m). Secondary outcomes also increased from baseline to 3 and 6 months. There were no between-group differences, except for MWD, which showed a greater increase at 6 months in the group that used the app, excluding patients with weak walking ability and extreme anxiety symptoms at baseline. Conclusion: The intervention improved distances and walking skills as well as the physical, mental, and disease-related quality of life among adults with PAD and IC. The group that used the WalkingPad app improved their MWD in 6 months compared to the control group, except for patients with poor walking ability and extreme anxiety symptoms, which suggests the effectiveness of the WalkingPad app for patients with high walking ability and no severe anxiety symptoms. More research is needed to determine the durability of these findings and to explore what app functionality might promote the other outcomes. Clinical Trial Registration: https://clinicaltrials.gov (NCT04749732).

Subjective well-being and school engagement before versus during the COVID-19 pandemic: What good are positive emotions?

The present study overcomes the limited empirical evidence on the association between well-being and school engagement in times of adversity by exploiting available data from two large and comparable samples of eighth graders; one obtained prior to the COVID-19 pandemic and the second obtained during the pandemic. Results suggest that adolescents were less engaged with their learning context during the pandemic, as well as lower in positive and negative affect, but slightly more satisfied with life. Through SEM we found a stronger positive association between positive affect and school engagement in the COVID-19 group compared with the pre-COVID-19 group. This finding highlights the important role of positive affect in supporting better academic functioning in the aftermath of a global crisis.

Wound healing and healing process in patients with diabetic foot ulcers: A survival analysis study.

AIMS: This study aimed to identify demographic, clinical, and psychological contributors to DFU healing and favorable healing process. METHODS: Patients with a chronic DFU were evaluated at baseline (T0; n = 153), two months later (T1; n = 108), and six months later (T2; n = 71). Patients were evaluated on health literacy, perceived stress, anxiety, depression, and illness perceptions. Cox proportional hazard models were built to analyze the predictors of DFU healing and favorable healing process (wound area reduction), including the assessment of time to achieve those outcomes. RESULTS: More than half of patients had their DFU healed (56.1%) or showed a favorable healing process (83.6%). Median time for healing was 112 days, while for favorable process was 30 days. Illness perceptions were the only predictor of wound healing. Being female , with adequate health literacy, and a first DFU predicted a favorable healing process. CONCLUSIONS: This is the first study showing that beliefs about DFU are significant predictors of DFU healing, and that health literacy is a significant predictor of a favorable healing process. Brief, comprehensive interventions should be implemented, at the treatment initial stage, in order to change misperceptions and to promote DFU literacy and better health outcomes.

Stress reduction interventions for patients with chronic diabetic foot ulcers: a qualitative study into patients and caregivers' perceptions.

BACKGROUND: The present study aimed to assess the perceptions of patients with chronic diabetic foot ulcers (DFUs) and their family caregivers regarding the impact of two stress reduction interventions on DFU and psychological wellbeing. The intervention included progressive muscle relaxation and hypnosis sessions. METHODS: This study used a qualitative exploratory design and included individual interviews with eight patients with chronic DFUs and six family caregivers, using a semi-structured interview guide. Transcript analysis employed thematic content analysis. RESULTS: Four key themes common to patients and their caregivers were found: 1) perspectives regarding the intervention; 2) intervention effectiveness; 3) perceived importance of psychology in the DFU treatment; and 4) emotional consequences associated with DFUs. Although themes were common to both intervention groups, sub-themes from the last two themes differed for patients that received muscle relaxation versus those who received hypnosis. CONCLUSION: Patients and caregivers reported perceived benefits from both interventions, regarding DFU healing and emotional wellbeing. Patients who received hypnosis and their caregivers also reported lasting effects. Participants suggested that psychological interventions such as stress reduction interventions could be included in the DFU standard treatment as an adjuvant to the clinical protocol for DFU treatment, preferably offered early on, when patients begin treatment at the diabetic foot consultation.

What Do Patients Know About Peripheral Arterial Disease? A Knowledge Questionnaire.

INTRODUCTION: The lack of knowledge about Peripheral Arterial Disease (PAD) is worryingly high as it triggers and main- tains behaviors of denial, indifference, and non-adherence to therapeutics. Therefore, the aim of this study was to build and assess the reliability and validity of a knowledge questionnaire about PAD (Peripheral Arterial Disease Knowledge Questionnaire - PADKQ). MATERIALS AND METHODS: A longitudinal study was carried out with two evaluations that included a sample of patients with PAD and Intermittent Claudication, with no history of surgical interventions, in follow-up at the vascular surgery consulta- tion. The PADKQ was applied to 114 patients (85% men, with a mean age of 65 years, SD=7.2). Sociodemographic and clinical data were collected from clinical records, and physical activity level (International Physical Activity Questionnaire - IPAQ) and walking impairment (Walking Impairment Questionnaire - WIQ) were evaluated through questionnaires. A 2nd evaluation session took place two weeks after the 1st evaluation session where an educational intervention was performed. Internal consistency, temporal stability, content validity, and convergent validity were performed Results: The sample related results have reflected the good reliability (kr-20=0.775) and validity properties of the PADKQ. This sample showed a high level of knowledge about PAD (10.96 points, SD=3.28, from 0 to 16 possible points), which increased significantly from moment 1 to moment 2 (t= -7.457, p<.001). Only half of the sample considered the disease to be serious and identified smoking habits as one of the risk factors. Patients with higher education were the most physically active. CONCLUSION: The PADKQ proved to be a useful, brief, and easy-to-use instrument in health contexts to identify patients' level of knowledge about PAD. Education about PAD increases patients' knowledge about the disease and the greater the knowl- edge about PAD, the greater the practice of physical activity.

A systematic review on smartphone use for activity monitoring during exercise therapy in intermittent claudication.

OBJECTIVE: Supervised exercise therapy is recommended as first line in the management of intermittent claudication. Its use is often limited by accessibility, compliance and cost. Home-based exercise therapy (HBET) programs emerged as an alternative solution, but have shown inferior results. The use of structured monitoring with the use of external wearable activity monitors (WAM) has been shown to improve outcomes. Mobile applications (apps) can make use of built-in accelerometers of modern smartphones and become an alternative solution for monitoring patients during HBET, potentially providing wider accessibility. This review aims to assess current use of smartphone technology (ie, mobile apps) for monitoring or tracking patients' activity in exercise therapy for peripheral arterial disease (PAD). METHODS: The PubMed database was searched from January 2011 to September 2021. Eligible articles had to include a population of patients with PAD, conduct a mobile-health exercise intervention and use smartphone technology for monitoring or tracking patients' activity. Randomized controlled trials, prospective studies, and study protocols were included. RESULTS: A total of seven articles met the selection criteria. These articles described six different studies and five different mobile apps. Three were fitness apps (FitBit, Nike+ FuelBand, and Garmin Connect) that synchronized with commercially available WAMs to provide users with feedback. Two were PAD-specific apps (TrackPAD and Movn) developed specifically to assess patients' activity during exercise therapy. PAD-specific apps also incorporated coaching and educational elements such as weekly goal setting, claudication reminders, messaging, gamification, training advice, and PAD education. CONCLUSIONS: Current HBET programs use smartphone apps mainly via commercially available fitness apps that synchronize with WAM devices to register and access data. PAD-specific apps are scarce, but show promising features that can be used to monitor, train, coach, and educate patients during HBET programs. Larger studies combining these elements into HBET programs should provide future direction.

WalkingPad protocol: a randomized clinical trial of behavioral and motivational intervention added to smartphone-enabled supervised home-based exercise in patients with peripheral arterial disease and intermittent claudication.

BACKGROUND: Physical exercise is a first-line treatment for peripheral arterial disease (PAD) and intermittent claudication (IC) reducing pain and increasing the distances walked. Home-based exercise therapy (HBET) has the advantage of reaching a higher number of patients and increasing adherence to physical exercise as it is performed in the patient's residential area and does not have the time, cost, and access restrictions of supervised exercise therapy (SET) implemented in a clinical setting. Even so, rates of adherence to physical exercise are relatively low, and therefore, m-health tools are promising in increasing motivation to behavior change and adherence to physical exercise. A built-in virtual assistant is a patient-focused tool available in a mobile interface, providing a variety of functions including health education, motivation, and implementation of behavior change techniques. METHODS: This is a single-center, prospective, three-arm, single-blind, randomized, controlled, superior clinical trial with stratified and blocked random allocation. Three hundred participants with PAD and IC will be recruited from an Angiology and Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUPorto), Porto, Portugal. All patients will receive the same medical care recommended by  current guidelines. Participants in all three groups will receive a personalized prescription for an HBET program and a behavioral change and motivational intervention. Participants in experimental groups 1 and 2 will receive a smartphone with the WalkingPad app to monitor exercise sessions. Experimental group 2 WalkingPad app will have a built-in virtual assistant that will promote behavioral change and provide motivational support. Participants allocated to the active control group will not receive the m-health tool, but a practice diary to encourage monitoring. The  program will last for 6 months with three evaluation moments (baseline, 3, and 6 months). The primary outcome will be the change in distances walked (maximal and pain-free) from baseline to 3 and 6 months. Secondary outcomes will be changes in quality of life, patients' perception of resistance, and walking speed. DISCUSSION: This study will allow measuring the effectiveness of an m-health tool in increasing motivation for behavior change and adherence to an HBET program in patients with PAD. The superiority of experimental group 2 in the primary and secondary outcomes will indicate that the virtual assistant is effective for motivating behavioral change and encouraging the practice and adherence to physical exercise. The use of m-health tools and virtual health assistants can potentially fill a gap in the access and quality of health services and information, reducing the burden on the health system and promoting self-management and self-care in chronic illness. TRIAL REGISTRATION: ClinicalTrials.gov NCT04749732 . Registered on 10 February 2021.

Anxiety and/or depression: which symptoms contribute to adverse clinical outcomes after amputation?

BACKGROUND: One of the most serious complications of diabetes mellitus (DM) is a diabetic foot ulcer (DFU), with lower extremity amputation (LEA). AIMS: This study aims to explore the role of anxiety and depression on mortality, reamputation and healing, after a LEA due to DFU. METHODS: A sample of 149 patients with DFU who underwent LEA answered the Hospital Anxiety and Depression Scale and a sociodemographic and clinical questionnaire. This is a longitudinal and multicenter study with four assessment moments that used Cox proportional hazards models adjusted for demographic and clinical variables. RESULTS: Rate of mortality, reamputation and healing, 10 months after LEA were 9.4%, 27.5% and 61.7%, respectively. Anxiety, at baseline, was negatively associated with healing. However, depression was not an independent predictor of mortality. None of the psychological factors was associated with reamputation. CONCLUSION: Results highlight the significant contribution of anxiety symptoms at pre-surgery, to healing after a LEA. Suggestions for psychological interventions are made.

Behavioral profile, lifestyle and social skills in Portuguese adolescents.

BACKGROUND: Seventy percent of premature deaths in adults are due to behaviors initiated during adolescence. Therefore, it is essential to promote individual and social behaviors that educate adolescents in the ability to make healthy choices. Accordingly, the main goals of this study were to characterize Lifestyles and Social Skills, as well as identify homogeneous subgroups, in a sample of Portuguese adolescents. METHODS: A cross-sectional study was conducted, including 1008 adolescents attending the 7th to the 9th grades of five middle schools from the Tâmega and Sousa regions of Portugal, and using the My Lifestyle Questionnaire and the Social Skills Inventory. To establish a profile of the participants, a Cluster Analysis (K-means) was performed, and the Jaccard coefficient was used to assess the stability of the solution found. RESULTS: From the total sample, 556 adolescents with a mean age of 13.43 years (SD = 1.1) were included in the analysis. The majority of the sample presented a healthy lifestyle (72.26%) and 50.7% of the adolescents had a highly elaborated repertoire of Social Skills. Moreover, three clusters were found. Cluster 1 (n = 92) showed a less elaborate repertoire of Social Skills and was designated as the "Adjusted". Cluster 2 (n = 115) comprised adolescents with a good repertoire of Social Skills and was named the "Sociable". Cluster 3 (n = 258) was composed of adolescents with a highly elaborate repertoire of Social Skills and the best Lifestyle indicators and was named the "Healthy". CONCLUSIONS: The group of adolescents in the cluster called the "Sociable" needs to be included in health education and Social Skills programs. Nutrition and Monitored Safety behaviors reveal low values and, therefore, present a greater need for awareness, sensitization, and intervention in the school context. For this reason, the promotion of a healthy lifestyle should be part of the academic curriculum and transversal to all academic disciplines.

Attachment style and body image as mediators between marital adjustment and sexual satisfaction in women with cervical cancer.

PURPOSE: The majority of cervical cancer survivors face persisting sexual debilitating problems over time. The impairment in sexual function and satisfaction are not limited to physical dimensions. The goals of this study were to assess if marital adjustment and body image mediated the relationship between attachment style, sexual functioning, and sexual satisfaction. METHODS: This study used a cross-sectional design. The sample included 113 sexually active women that completed the EORTC QLQ C30 and EORTC QLQ CX24, the Index of Sexual Satisfaction, the Experiences in Close Relationships Scale, and the Revised Dyadic Adjustment Scale. RESULTS: Using structural equation modeling to describe the relationship between variables, an excellent fitted model was found: X2(5) = 6.309 (p = 0.277); X2/df = 1262; GFI = 0.982; CFI = 0.986; SRMR = 0.0475; RMSEA = 0.048; P (RMSEA< 0.05) = 0.429. Sexual/vaginal functioning and avoidance had a direct effect on sexual satisfaction. Marital adjustment was a partial mediator in the relation between avoidance and sexual satisfaction. Avoidance and anxious attachment had an indirect effect on sexual satisfaction mediated by marital adjustment. Body image was a partial mediator in the relationship between marital adjustment and sexual satisfaction. CONCLUSIONS: The results showed that vaginal/sexual functioning, attachment style, marital adjustment, and body image were important predictors of sexual satisfaction. Psychoeducational programs to help patients deal with the impairment of sexual/vaginal functioning, as well as emotional support programs for couples to strengthen their marital relationship, need to be implemented, i.e., the couple's intimacy and women's body image, that have a clear impact on sexual satisfaction.

Burden and quality of life in caregivers of patients with amputated diabetic foot.

Informal caregivers of chronically ill patients often report burden and poor quality of life. This study aimed to evaluate the impact of caring on caregivers of amputated patients with type 2 diabetes and diabetic foot. A cross-sectional study included a convenience sample of 110 caregivers who answered: the Burden Assessment Scale, the Depression Anxiety Stress Scales, the Social Support Satisfaction Scale, the Family Assessment Device, and the Short Form Health Survey. Multiple linear hierarchical regressions were performed to identify the variables that contributed to the burden and the physical and mental quality of life. Differences in burden as well as physical and mental quality of life were found, according to several caregivers' sociodemographic characteristics. Lower social support, more distress, and caregiver's perception of the impact of caring on the family dynamics contributed to burden. Lower distress and not having a chronic illness besides diabetes explained the physical quality of life whereas exercise and lower distress explained mental quality of life. To promote quality of life in caregivers and reduce the burden associated with caregiving, interventions should focus on social support, distress, and the practice of exercise.

Students' Personality Contributes More to Academic Performance than Well-Being and Learning Approach-Implications for Sustainable Development and Education.

The present study aimed to describe the predictive role of personality dimensions, learning approaches, and well-being in the academic performance of students. In total, 602 students participated in this cross-sectional study and completed a set of questionnaires assessing personality, learning approach, and well-being. Two indexes were calculated to assess affective and non-affective well-being. The results partially support the hypotheses formulated. Results revealed that personality temperament and character dimensions, deep learning approach, and affective well-being were significant predictors of academic performance. A deep approach to learning was a full and partial mediator of the relationship between personality and academic performance. The results improve the understanding of the differential contribution of personality, type of learning approach, and type of well-being to academic performance. Comprehending that personality is the strongest predictor of academic performance, after controlling the type of learning approach and the type of well-being, informs school policies and decision-makers that it is essential to encourage personality development in adolescents to improve academic performance. These results also have implications for educational policies and practices at various levels, including an emphasis on the role of well-being as an educational asset. Understanding the links between personality, well-being, and education is essential to conceptualize education as a vital societal resource for facing current and future challenges, such as sustainable development.

PTSD, psychological morbidity and marital dissatisfaction in colonial war veterans.

Background: Forty years after Colonial War, veterans still show psychological disturbances affecting their marital and sexual satisfaction.Aims: This study analyzed the relationships between Post-Traumatic Stress Disorder (PTSD), number of PTSD symptoms and symptom clusters, psychological morbidity, marital dissatisfaction and sexual dissatisfaction; the variables that contributed to marital dissatisfaction and the mediator role of marital dissatisfaction and sexual dissatisfaction, in a sample of colonial War Veterans.Method: The sample included 138 Portuguese war veterans who answered Index of Marital Satisfaction; Index of Sexual Satisfaction; Beck Depression Inventory; State Trait Anxiety Inventory; Post-Traumatic Stress Disorder Scale.Results: PTSD, number of PTSD symptoms and symptom clusters were associated with psychological morbidity, marital and sexual dissatisfaction. Age, depression symptoms and sexual dissatisfaction contributed to marital dissatisfaction and the model explained 55% of the variance. Marital dissatisfaction mediated the relationship between depression symptoms and sexual dissatisfaction, as well as between number of PTSD symptoms and sexual dissatisfaction.Conclusions: Health professionals need to take into consideration the veteran's marital and sexual relationship in clinical routine consultations. As such, treating the veteran in the couple' context seems warranted.

Differences, predictors, and moderators of therapeutic adherence in patients recently diagnosed with type 2 diabetes.

This study analyzed the differences over time in newly diagnosed type 2 diabetes patients on reported adherence. A longitudinal design with two assessment moments was used with 268 patients who were assessed on adherence to self-care behaviors and medication, beliefs about medicines, psychological distress, trust in the physician, and satisfaction with care. HbA1c and general beliefs about medicines decreased from T1 to T2 while adherence to foot care, the needs of medicines, and psychological distress increased. Beliefs about medicines, satisfaction with communication/information, and trust in physician predicted adherence. Intervention should consider these variables when promoting adherence.

Quality of Life Following a Lower Limb Amputation in Diabetic Patients: A Longitudinal and Multicenter Study.

Objective: Lower limb amputation (LLA) leads to several emotional and physical sequelaes that have a negative impact on individuals` life. The objectives of this study were: 1) to analyze the relationship between emotional reactions (anxiety, depression and traumatic stress symptoms) and functionality level, before and after a LLA due to diabetic foot ulcer, and mental/physical quality of life; and 2) to analyze the mediator role of social support between emotional reactions and mental/physical quality of life. Method: A multicenter, longitudinal study with four time assessments: before the surgery, one month, six months, and ten months after surgery, including 206 individuals hospitalized with diabetic foot ulcer indicated for a LLA. The instruments used were the following: Revised Impact of Event Scale; Barthel Index; Hospital Anxiety and Depression Scale and SF-36. Results: Anxiety symptoms before surgery and depression symptoms one month after surgery contribute to Mental Component Score (MCS) ten months after surgery. The level of functionality before and one month after surgery, traumatic stress symptoms one month after surgery as well as satisfaction with social support six months after surgery contribute to the Physical Component Score (PCS), ten months after surgery. Social support was a mediator between traumatic stress symptoms one month after surgery and PCS ten months after surgery. Conclusion: Identifying risk variables and the extent to which and when they affect mental/physical quality of life, will help to develop appropriate psychological interventions to promote quality of life in this population.

Beliefs about medicines as mediators in medication adherence in type 2 diabetes.

AIMS: This study analysed whether beliefs about medicines mediated the relationship between illness representations and medication adherence. BACKGROUND: Adherence to medication is required in diabetes treatment, contributing to decreased blood glycaemic levels. The knowledge and perception of patients about diabetes as well as the beliefs about medicines are considered to be key factors for medication adherence. DESIGN: The study used a cross-sectional design that included 387 patients recently diagnosed with type 2 diabetes. METHODS: Participants were assessed, between 2010 and 2013, and answered the Medication Adherence Scale, the Beliefs about Medicines Questionnaire, and the Brief Illness Perception Questionnaire. RESULTS: The results of the path analysis showed that beliefs about medicines had a mediating role on self-report medication adherence with the exception of beliefs about specific concerns with medicines. Therefore, both general beliefs and specific needs about medicines mediated the relationship between diabetes consequences and self-report medication adherence as well as between treatment control and self-report medication adherence. Needs about medicines mediated the relationship between personal control and self-report medication adherence. CONCLUSION: Health professionals should target beliefs about medicines besides illness representations regarding medication adherence. The current study may help optimize adherence to medication in early-diagnosed type 2 diabetes patients.

Quality of life in elderly Portuguese war veterans with post-traumatic stress symptoms.

BACKGROUND: Studies show that post-traumatic stress symptoms among Portuguese veterans who participated in Colonial War (1961-75) are high, even though 43 years have gone by since the end of the war. AIMS: This study analyzed the role of family type, personality traits, and social support as predictors of post-traumatic stress symptoms and quality of life in war veterans, and whether satisfaction with social support was a mediator between neuroticism/post-traumatic stress symptoms and quality of life. METHOD: A cross-sectional study was conducted including 230 war veterans with a mean age of 60 years (SD=3.82). RESULTS: Results indicated a high prevalence of post-traumatic stress symptoms as well as high neuroticism, 16.5 (SD=4.41); 81% of veterans presented high psychological distress, suggesting emotional disturbance and 71% belonged to extreme families (families with cohesion and adaptability problems). Results showed that age (ß=-0.166, p<0.05), social support (ß=-0.184, p<0.01), and neuroticism (ß=0.325, p<0.001) predicted post-traumatic stress symptoms. Age, professional status, social support, post-traumatic stress symptoms, family type, neuroticism, and extroversion predicted different dimensions of quality of life. Finally, a path analysis showed that satisfaction with social support was a mediator in the relationship between neuroticism and quality of life (ß=-0.066; p<0.01) and between post-traumatic stress symptoms and quality of life (ß=-0.108; p<0.01). CONCLUSION: Four decades after the Colonial War have passed, there is still a high prevalence of post-traumatic stress symptoms. Screening elderly veterans who present post-traumatic stress symptoms, for the presence of neuroticism traits, and assessing family type and social support, should be a standard practice in health care services, especially in the oldest and those who are retired. Social support should be promoted in order to enhance quality of life in this population.