Carme Ferré-Grau

Background/Objectives: To evaluate the long-term impact of a structured diabetic foot education program on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in individuals with type 1 diabetes. Methods: Retrospective cohort study including 327 adults with type 1 diabetes who participated in a structured diabetic foot education program between 1990 and 2014. The program included 10 h of education focused on diabetes self-management and foot care. Participants were encouraged to attend annual refresher sessions. The primary outcomes were the first occurrence of MALE (major amputation or lower-limb revascularization) and MACE (non-fatal stroke, non-fatal myocardial infarction, or all-cause death). Cox proportional hazards models were used to assess associations between the number of educational programs (EPs) attended (1, 2–3, >3) and outcomes. Results: Participants attended a median of two EPs during a median follow-up of 26.3 years. Of the total number of events, 21 were MALEs (crude incidence of 1.9 per 1000 person-years) and 108 were MACEs (incidence of 12.9 per 1000 person-years). Risk of MALE was not associated with the number of EPs attended (p = 0.384). In contrast, participants who attended >3 EPs had a significantly lower risk of MACE compared with those attending only one program (HR 0.48, 95% CI 0.24–0.99, p = 0.044), although this association was attenuated after adjusting for smoking status. Conclusions: Frequent participation in a structured diabetic foot education program was associated with fewer cardiovascular events, but this benefit was diminished by smoking. Integrating tobacco cessation into education programs may enhance their long-term impact.

Background: The construct of positive mental health (PMH) is defined as the basis of individuals’ psychological well-being and their ability to function effectively and cope with life’s challenges. The Positive Mental Health Questionnaire (PMHQ) is a reliable tool for assessing the PMH factors, but its length (39 items) can pose challenges in certain contexts and populations. This highlights the need for an abridged version of the questionnaire that requires less time to administer. Therefore, the main aim was to validate the Spanish 18 item-shortened version of the PMHQ (PMHQ-SF18). Methods: The sample consisted of 574 nursing students. Psychometric analyses were carried out based on construct validity, criterion validity, and internal consistency. A confirmatory factor analysis was conducted to ascertain whether the internal structure was consistent with the model of the previously validated Portuguese brief version. Results: The results supported the good psychometric properties of the instrument, with adequate validity and reliability. Confirmatory factor analysis revealed optimal goodness-of-fit values, supporting the six-factor structure. The overall Cronbach’s alpha was 0.83. Conclusions: The findings suggest that the PMHQ-SF18 is a valid and reliable instrument, comparable to the original version, but with the added benefits of being shorter, quicker, and easier to administer. Consequently, it may be particularly useful for population-based screening studies and for monitoring change following positive mental health promotion interventions. Its abridged format makes it particularly suitable for assessing individuals with specific characteristics or in contexts where time is limited, and more concise instruments are required, for example, in primary care or critical care.

Introduction: Caring for a dependent individual, particularly over an extended period, places significant strain on family caregivers, often leading to adverse physical, mental, emotional, social, and economic outcomes for both caregivers and those they care for. Common challenges include anxiety, depression, loneliness, and diminished overall well-being. E-health applications have emerged as effective tools to support family caregivers by promoting positive mental health through online interventions, enhancing problem-solving skills, autonomy, interpersonal relationships, self-control, and a prosocial attitude. Methods: This study aimed to translate and culturally adapt the Spanish “Program to Promote Positive Mental Health through the Cuidadoras Crónicos Manual” into the Portuguese context, supporting its implementation as a smartphone application. The process involved translation, back-translation by two native experts, and refinement through a focus group with eight participants. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: The translation and back-translation processes identified several adjustments, which informed discussions in the focus group. Three key themes emerged: (i) conceptual and semantic equivalence, (ii) optimisation of content, and (iii) relevance and timeliness of the manual. Conclusions: The Spanish manual for promoting positive mental health among family caregivers was successfully translated and culturally adapted into European Portuguese. Validated through expert input, this marks the first version of the manual tailored to Portuguese caregivers, using Positive Mental Health models to support caregivers of individuals with chronic conditions.

Objective The purpose of this study was to explore experiences of family and professional caregivers of persons with dementia in order to design a tailored community-based support programme. Design A two-stage study was deployed. First, qualitative research draws on three focus groups. Two of these comprised family caregivers and the third was made up of care provision professionals. Thematic content analysis was conducted by interpretative description for applied practice. Second, an experience-based codesign methodology was applied to design a tailored support programme in accordance with carers’ demands and contextual realities. Setting and study period Rural region in Catalonia, at northeast of Spain. March–June 2019. Participants We interviewed 12 family caregivers and 8 primary care providers. Results 10 main themes were identified: caregivers’ feelings, repercussions of caregiving in caregivers’ lives, education about dementia and caring skills, education about time management and self-care, caregivers’ needs to receive more information and training, improved patients’ follow-up and social assistance and more psychologic support. Finally, three themes related to caregivers’ demands: social services resources, multidisciplinary approach programmes and support from other caregivers. From these results, a multicomponent, professionally led community-based intervention was designed. The main components were the following: education and caring skills, professional psychological support, and social and community resources. Conclusion This study allowed the design of a multicomponent support intervention for family caregivers of persons with dementia aimed at reducing their burden and improving their quality of life in ways consistent with their actual needs and the available local resources.

Introduction: The available knowledge regarding the issue of Family Caregivers is consensual in recognizing that providing care to a dependent person, especially for an extended period, involves significant strain, with consequences for the caregivers’ health. The exhaustion of dealing with various tasks and responsibilities can lead to states of anxiety, depression, panic, and loneliness which will ultimately impact the physical, mental, emotional, social, and economic aspects not only of Family Caregivers but also of the person being cared for. E-health applications are an effective intervention in helping family carers that emerged to promote positive mental health among those who took care of chronic patients by empowering them and, consequently, by achieving an enhancement in their biopsychosocial health status through online interventions for positive mental health. This increase in Positive Mental Health (MH+) will have effect impact on problem-solving skills, autonomy, personal satisfaction, interpersonal relationships, self-control, and prosocial attitude. Methods: This study aimed to translate and culturally adapt the Spanish version of the “Program to Promote Positive Mental Health through ´Cuidadoras Crónicos manual” into the Portuguese context, this manual will support an telephone app. The translation and back-translation process was carried out by two native experts and, secondly, through a Focus Group with 8 participants. In addition, this study respected the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: From the translation and back translation process emerged several changes that were taken into account for the Focus group (FG) session. Additionally, the following thematic emerged concerning FG 3: (i) theme 1- conceptual and semantic equivalence; (ii) theme 2 – optimization of content; (iii) theme 3 - relevance and timeliness of the manual. Conclusions: The Spanish version of the manual to promote positive mental health in family caregivers was translated and culturally adapted into European Portuguese and subsequently validated by experts in a Focus Group approach. This is the first version of the manual for the Portuguese context that uses SM+ models aimed at caregivers of people with chronic diseases

Aim: To evaluate the effectiveness of a positive mental health program for adults (PMHP) in the community.Background: Positive mental health (PMH) can be seen as a construct represented by six factors (personal satisfaction, prosocial attitude, self‐control, autonomy, problem resolution, and self‐actualization, and interpersonal relationship skills) according to the Multifactorial Model for PMH. Although there are several interventions in promoting mental health, research on effective promotion of PMH for adults in the community with structured and validated programs of PMH is scarce.Methods: This study protocol describes a randomized controlled trial (RCT) following a wait‐list control design, aimed at evaluating the effectiveness of a PMHP in the community. This study was approved in June 2019 by the Ethics Committee. Participants will be recruited from the school community of teachers. Participants aged ≥ 18 years. The participants will be randomized 1:1 to either (a) an intervention group, which will integrate the PMHP, or (b) the standby control group. Three assessment moments for both groups will take place initial, after the intervention, and a follow‐up of 3–6 months. The evaluation instruments will include a sociodemographic questionnaire, a PMH questionnaire, and a psychological vulnerability scale.Conclusion: The current study provides an innovative approach to PMH. Further, the study may demonstrate new interventions in PMH in the community, based on a program with systematized guidelines and sessions structured according to individual needs. It is expected that at the end of the program, the experimental group will increase the level of PMH.Relevance to clinical practice: To allow future official implementation of the PMH program and the replication of the study in other professional groups as a promotion tool.No patient or public contribution: There was no funding to remunerate a participant for this study.Trial Registration: ClinicalTrials.gov identifier: NCT04600401. Registered on May 15, 2020

Objective Diabetes Self-Management Education and Support (DSMES) is a critical component of diabetes care. This study aims to examine the effect of online-based educational interventions on diabetes management compared to face-to-face interventions. Methods A systematic review was conducted by searching three databases for studies in English or Spanish between December 2023 and March 2024. The inclusion criteria were studies that compared face-to-face DSMES with online interventions. Results The follow-up duration of the trials ranged from 1 to 12 months. Multidisciplinary teams delivered online DSMES through various means, including Short Message Service (SMS), telephone calls, video calls, websites, and applications. Online DSMES was found to be comparable to face-to-face interventions in terms of glycated hemoglobin (HbA1c) levels in people with type 1 diabetes (T1D). In contrast, online interventions that focus on weight management in people with type 2 diabetes (T2D) have shown a significant reduction in HbA1c compared to face-to-face interventions. Online DSMES was found to be superior in terms of quality of life and cost-effectiveness in both T1D and T2D. None of the analyzed studies explored the differences between individual and group methodologies. Conclusions The current evidence indicates that online DSMES services provide at least comparable biomedical benefits to face-to-face interventions, suggesting that online interventions could be incorporated into clinical practice as a complement or reinforcement. However, further research is needed to explore the potential benefits and effectiveness of online group sessions in DSMES.

What is known on the subject Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role. Many authors highlight the importance of a non-judgmental approach when providing support and care to clients with mental illness who are parents. Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked. There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families.What this paper adds to existing knowledge Trust is the basis that helps clients to be open to receiving care and answering parenting-related questions. Therefore, without adequate professional-client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client. Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care.What are the implications for practice Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care.

Positive mental health is defined as the ability to perceive and interpret the context of a situation and to adapt to it whenever necessary. Considering the pandemic situation, identifying the factors that may have the greatest impact on quality of life and consequently, on positive mental health is paramount. The objective of this study was to assess the impact of health literacy on the adoption of behaviours that promote positive mental health during COVID-19. A descriptive, cross-sectional and correlational study was conducted on a sample of 770 patients using a questionnaire for sociodemographic characterization, the Positive Mental Health Questionnaire and the Mental Health Knowledge Questionnaire. Concerning health-promoting behaviours, those who sleep enough hours, exercise regularly, eat healthy and are more aware of mental health promotion activities, or have greater mental health literacy, have higher positive mental health scores. Thus, having more knowledge of mental health and adopting health-promoting behaviours improve positive mental health.

Patients with chronic disease have become one of the major challenges for health and social protection systems in developed countries. Integrated care models (ICM) have demonstrably improved the quality of care of chronic patients. However, new models of integration need further evaluation of its effectiveness and outcomes. The ICM studied promoted coordination between the health and social sectors during a 6-month period, through an ad hoc developed application (app) that enabled a constant flow of communication between professionals from both sectors. Patients’ quality of life, treatment adherence, chronic patient experience and caregiver overload were assessed by questionnaires at baseline, at the end of the intervention and 6 months post-intervention. The implementation of the new health and social ICM permitted new case detection and medical and social services offered to chronic patients. Furthermore, the quality of life and treatment adherence of patients and caregiver overload were significantly improved. These positive effects lasted at least 6 months after the intervention. Integrated care may facilitate access to care services, increase perceived patient quality of life and treatment adherence. Enhanced access to medical and social services from complex chronic patients may have important implications for caregivers and the care systems who are struggling to adapt to an expanding demand.