Carlota Las Hayas

Aim: The aim of this study was to co‐create a nurse‐led women's empowerment group intervention to facilitate the deprescription of benzodiazepines and Z‐hypnotics in primary care. Design: User‐centred design based on co‐creation. Methods: A literature review was conducted to identify female empowerment programmes that served as an initial prototype. The subsequent user‐centred design applied a co‐creation methodology in two structured phases: (1) Exploratory, to identify contextual needs and barriers, and (2) Development, to collaboratively define the intervention's final structure and content. Participants included chronic users of benzodiazepines and Z‐hypnotics and primary care professionals (doctors, nurses, and pharmacists) who actively engaged in the collaborative design process. Results: The Exploratory phase identified structural and clinical deprescribing barriers, and female clients' knowledge gaps. Empowerment was confirmed as a key facilitator. The Development phase prioritised content (self‐esteem, self‐image, and healthcare) and adjusted the group intervention's format (duration, frequency, and structure) based on participant input. Conclusion: The co‐creation process resulted in an eight‐session intervention, with support cards and a training video for nurse‐facilitators. This collaboration ensured the final design was precisely tailored to women's needs and clinical practice, maximising its feasibility and relevance. The intervention facilitates the tapering of benzodiazepines and Z‐hypnotics by combining women's empowerment with individualised and supervised dose reduction by primary care clinicians. What Does This Paper Contribute to the Wider Global Clinical Community?: Demonstrates how co‐creation with clients and healthcare professionals can lead to contextually adapted nurse‐led interventions centred on women's empowerment. Highlights the role of women's empowerment as a catalyst for deprescribing long‐term benzodiacepines and Z‐hypnotics in primary healthcare. Introduces a structured and co‐created eight‐session intervention supported by a nurse‐training video and support cards, offering practical toolkits. Public Contribution: Clients (as users) and primary care healthcare professionals actively participated in the design of the intervention aimed at empowering women. Their involvement included participation in co‐creation workshops, in which needs and everyday realities relevant to the process of deprescribing benzodiazepines and Z‐hypnotics were identified. The structure and content of the group intervention, as well as its relevance and feasibility, were defined collaboratively. This direct participation made it possible to develop an intervention that was more client‐centred, equitable, and aligned with clinical practice. Reporting Method: This manuscript follows the short‐form Guidance for Reporting Patient and Public Involvement (GRIPP2) checklist (Staniszewska et al., 2017) to ensure transparent reporting of the co‐creation process, in which clients and healthcare professionals actively participated in the design, development, and evaluation of the intervention (Additional file . GRIPP 2).

Background: A resilience scale tailored for individuals with eating disorders (EDs) could significantly enhance our understanding and treatment of EDs. Therefore, we developed and psychometrically evaluated a new Resilience in Eating Disorders scale (RED) following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Method: Informed by prior qualitative interviews, the new RED scale underwent an initial pilot test among patients with EDs (n = 52) and field tests among patients with EDs (n = 169), ED-recovered individuals (n = 61), and a normative sample of the general population (n = 349), all aged between 27.9 and 29.8 years and residing in Spain. In this study, the participants completed the RED scale, Resilience Scale-25 (RS-25), Eating Attitudes Test-26 (EAT-26), World Health Organisation Quality of Life Scale – Brief Version (WHOQOL-BREF), and Hospital Anxiety and Depression Scale (HADS). Data were collected at baseline and after 1 year. Alongside machine learning techniques, exploratory and confirmatory analyses were employed to evaluate the reliability, construct validity, convergent validity, known-groups validity, predictive validity and responsiveness of the RED scale. Results: The original 52-item version of the RED scale was refined to 44 items following the pilot phase, and ultimately reduced to a 5-item version (RED-5) after field testing and psychometric evaluation. The RED-5 demonstrated strong psychometric properties, with excellent model fit indices (Root Mean Square Error of Approximation (RMSEA) = 0.03, and Comparative Fit Index (CFI) = 0.99) and acceptable internal consistency (Cronbach's alpha = 0.71). Additionally, the RED-5 scale effectively predicted quality of life, anxiety, depression, and ED symptomatology over a 1-year period. Conclusions: The RED-5 is a concise, psychometrically robust scale specifically developed to assess resilience in patients with EDs. It significantly predicts ED symptoms and quality-of-life outcomes, making it a valuable tool for both clinical practice and research. The RED-5 allows for quick administration and easy scoring. It provides mental health professionals with a tool to guide resilience-informed assessment and more personalized treatment planning.

Purpose: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe.Methods: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles.Results: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification.Conclusion: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed.Trial registration number (TRN) and date of registration: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

Background: Adolescence is crucial period for laying the foundations for healthy development and mental well-being. The increasing prevalence of mental disorders amongst adolescents makes promotion of mental well-being and prevention interventions at schools important. UPRIGHT (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers) is designed as a whole school approach (school community, students and families) to promote a culture of mental well-being and prevent mental disorders by enhancing resilience capacities. The present article aims at describing the rationale, conceptual framework, as well as methodology of implementation and evaluation of the UPRIGHT intervention. Methods: UPRIGHT project is a research and innovation project funded by the European Union’s Horizon 2020 Research and Innovation programme under grant agreement No. 754919 (Duration: 48 months). The theoretical framework has been developed by an innovative and multidisciplinary approach using a co-creation process inside the UPRIGHT Consortium (involving seven institutions from Spain, Italy, Poland, Norway, Denmark, and Iceland). Resulted is the UPRIGHT programme with 18 skills related to 4 components: Mindfulness, Coping, Efficacy and Social and Emotional Learning. Among the five Pan-European regions, 34 schools have been currently involved (17 control; 17 intervention) and around 6000 adolescents and their families are foreseen to participate along a 3-year period of evaluation. Effectiveness of the intervention will be evaluated as a randomized controlled trial including quantitative and qualitative analysis in the five Pan-European regions representative of the cultural and socioeconomic diversity. The cost-effectiveness assessment will be performed by simulation modelling methods. Discussion: We expect a short- to medium-term improvement of mental well-being in adolescents by enhancing resilience capacities. The study may provide robust evidence on intrapersonal, familiar and social environmental resilience factors promoting positive mental well-being. Trial registration: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

Wrist fractures are the most common arm fractures in older adults. The impact of wrist fractures on daily functionality has been less studied than that of other types and so, less is known about the complexity of factors related to the functional impact of these fractures. This study is aimed to assess the role of individual and health care factors and its association with daily living functional changes after a wrist fracture. A prospective cohort of patients aged 65 or more, affected by a fracture due to a fall, was conducted. These patients were identified at the emergency rooms of the six participating hospitals. As independent factors, the following were studied: socio-demographic data, characteristics of the fracture, health-related quality of life, wrist function and provided treatment. The main outcome was functional status measured by the Barthel Index for daily living basic activities and the Lawton Instrumental Activities of Daily Living (IADL) Scale for daily living instrumental activities. Data were collected at baseline just after the fall and after six months of follow-up. Patients were considered to have deteriorated if their functional status as measured by Barthel Index or Lawton IADL scores decreased in a significant way during the six months of follow up. Barthel Index and/or Lawton IADL scores fell at six months after the fracture in 33 % of participants. This functional decline was more frequent in patients with comorbidity (p < 0.0001), polypharmacy (p < 0.0001), low health-related quality of life prior to the fall (p < 0.0001) and lower educational level (p = 0.009). The derived multivariate models show that patients that become dependent six months after the fall, have advanced age, severe chronic diseases, low functional performance prior to the fracture, and repeated episodes of accidental falls. This profile is consistent with a frailty phenotype. Wrist fractures are associated to the occurrence of dependence, especially in frail patients. These patients could benefit from being identified at the time the fracture is treated, in order to tackle their complex needs and so, prevent some of the burden of dependence generated by these fractures.

The objectives of the authors in this study were two-fold: (1) to explore the role of resilience in recovery from eating disorders (EDs), and (2) to develop a model of resilience in women with EDs. Semi-structured interviews with ten women were conducted in April 2011, along with two focus groups with women who had recovered from EDs (n = 5 women each; conducted in April 2012 at the University of Deusto, Spain), one focus group with clinical experts (n = 8; conducted in April 2012 at the Foundation Against EDs of Biskay, Spain), and six narratives from primary caregivers of ED patients living in Biskay, Spain (conducted in November 2012). All data were analyzed using a grounded theory approach. All female participants acknowledged experiencing resilience in their recovery. The analysis resulted in a conceptual model of resilience composed of the following categories: deep dissatisfaction with life, turning point, acceptance, hope, determination to change, accountability for the ED, active coping, getting social support, gaining self-knowledge, getting information about EDs, increase well-being, trait resilience, initiating new projects and living in the here and now. According to the model presented, resilience preceded the experience of recovery in women with EDs in this sample and could be a useful asset for future interventions.

Individualised measures of quality of life (QoL) refer to instruments that encourage the respondent to actively elicit which areas of their life are most relevant for his/her QoL. The aim of this study is to compare individualised versus standard measures of QoL in a sample of patients with eating disorder (ED). The Schedule for the Evaluation of the Individual Quality of Life (SEIQoL) and a generic measure of QoL [World Health Organization Brief Quality of Life Assessment Scale (WHOQOL‐BREF)] were applied on two occasions (one‐year follow‐up) to a sample of 165 patients with ED, 57 recovered patients with ED, and 349 women from the general population. The areas of ‘family’, ‘education/career or job’, ‘friends’, ‘leisure’, ‘romantic partner’ and ‘health’ were identified as the most important for their QoL for all groups, both times. The WHOQOL‐BREF was more sensitive than the SEIQoL in detecting changes that occurred over time. Clinical interventions for ED should consider social components as objectives of intervention. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Introduction Resilience enables people to develop and regain mental health in the face of adversity, and is related to recovery. There are no current measures of resilience for Bipolar Disorder (BD). Aims To develop and validate a BD specific resilience measure, and examine relationships between resilience and recovery-related variables. Objectives (1) Describe the development and psychometric evaluation of the Spanish 23-item Resilience to Bipolar Disorder (RBD) questionnaire. (2) Test relationships between RBD scores and recovery-related variables in BD. Method The 41-item RBD questionnaire (developed based on prior qualitative research) was completed by 113 participants with BD, along with measures related to quality of life, functioning and recovery. Exploratory Factor Analysis (EFA) using Principal Axis Factoring with promax rotation was conducted to identify redundant items and underlying factors. Reliability and Confirmatory Factor Analysis (CFA) for the resulting factorial structure were assessed. Results EFA identified 23RBD items suitable for retention, structured within five factors. Cronbach αs were all satisfactory (all αs ≥ .76) at both subscale and total score level. Convergent validity was supported through positive correlations between RBDand the Resilience Scale-25. Additionally, the RBD correlated significantlywith quality of life, well-being, personal recovery, functional impairment and symptoms. CFA fit indexes supported the five factor structure of the RBD scale. Conclusions TheRBD is a reliable and valid measure of resilience in BD, being associated with measures related to quality of life, functioning and recovery, which is consistent with previous research in resilience and mental health in other psychiatric populations

The impact of hip fracture because of a fall on health-related quality of life (HRQoL) and activities of daily living (ADL) have not been well established. To evaluate changes in HRQoL and the ability to conduct ADL among patients with hip fracture because of a fall and to compare these changes with patients who did not fall and break a hip, adjusting by gender and age. Adults aged 65 or more who attended the emergency departments of seven public hospitals were recruited in a prospective double-cohort study (fracture cohort, n = 776; non-fracture cohort, n = 115). ADL and HRQoL were assessed at baseline (during the postfall hospitalisation or by telephone afterwards) and 6 months later using the Barthel Index and the Lawton Brody Index for ADL, and the Short Form Health Survey (SF-12) and Western Ontario and McMaster Universities Osteoarthritis Index short form (WOMAC-SF) for HRQoL. Adjusting by gender, age and baseline status, a hip fracture was a strong predictor of decline in all outcomes measured except for mental quality of life among men (measured by SF-12). Hip fracture patients younger than 74 years reported significantly more pain (measured by WOMAC-SF) than the comparison group (p = 0.02), but this difference was not observed among older patients (p = 0.19 for 75-84 years; p = 0.39 for ≥ 85 years). Hip fractures have profound effects on HRQoL and ADL in both men and women, regardless of age. This indicates the need for special follow-up care of elderly hip fracture patients in the immediate and late postfracture periods.