Exploring healthcare barriers and satisfaction levels among deaf individuals in Ecuador: A video-based survey approach.

BACKGROUND: Approximately 80% of Deaf individuals live in low- and middle-income countries, where health systems often overlook their specific needs. This communication gap can result in misdiagnosis and inappropriate treatment, impacting their overall satisfaction with healthcare services. OBJECTIVES: This study aims to uncover barriers to healthcare access and preferences among the Deaf population in Ecuador, and the role of communication barriers in shaping satisfaction levels with healthcare services. METHODS: The study gathered data from 386 participants through online surveys, focusing on demographic characteristics, healthcare experiences, communication methods, and levels of satisfaction. Descriptive statistics and association analyses were employed to analyze the data. RESULTS: The study reveals that nearly all participants possessed an officially recognized disability (95.9%) and 53.9% reported hereditary deafness. Ecuadorian sign language was predominant (60.9%). Communication barriers were evident, with 65.0% having trouble understanding medical instructions, and 66.6% identifying a deficiency of tools for Deaf individuals in healthcare settings. Satisfaction levels were associated with the presence of interpreters during medical care, with 46.6% expressing a preference for interpreters over other communication methods. Additionally, private healthcare facilities were perceived as providing better services, despite being less frequently accessed (38.9%). Dissatisfaction was evident, particularly in aspects of communication and physician courtesy. CONCLUSIONS: This study underscores the importance of tailoring healthcare services to address the unique needs of the Deaf population. Communication barriers emerged as a central obstacle, necessitating the inclusion of sign language interpreters and improvement of resources. The study's implications extend to healthcare equity in developing nations, emphasizing the significance of patient-centered care and inclusive healthcare practices.

Pharmacological preclinical comparison of tenecteplase and alteplase for the treatment of acute stroke.

Alteplase (rtPA) remains the standard thrombolytic drug for acute ischemic stroke. However, new rtPA-derived molecules, such as tenecteplase (TNK), with prolonged half-lives following a single bolus administration, have been developed. Although TNK is currently under clinical evaluation, the limited preclinical data highlight the need for additional studies to elucidate its benefits. The toxicities of rtPA and TNK were evaluated in endothelial cells, astrocytes, and neuronal cells. In addition, their in vivo efficacy was independently assessed at two research centers using an ischemic thromboembolic mouse model. Both therapies were tested via early (20 and 30 min) and late administration (4 and 4.5 h) after stroke. rtPA, but not TNK, caused cell death only in neuronal cultures. Mice were less sensitive to thrombolytic therapies than humans, requiring doses 10-fold higher than the established clinical dose. A single bolus dose of 2.5 mg/kg TNK led to an infarct reduction similar to perfusion with 10 mg/kg of rtPA. Early administration of TNK decreased the hemorrhagic transformations compared to that by the early administration of rtPA; however, this result was not obtained following late administration. These two independent preclinical studies support the use of TNK as a promising reperfusion alternative to rtPA.

Modulation of Abundance and Location of High-Mobility Group Box 1 in Human Microglia and Macrophages under Oxygen-Glucose Deprivation.

While stroke represents one of the main causes of death worldwide, available effective drug treatment options remain limited to classic thrombolysis with recombinant tissue plasminogen activator (rtPA) for arterial-clot occlusion. Following stroke, multiple pathways become engaged in producing a vicious proinflammatory cycle through the release of damage-associated molecular patterns (DAMPs) such as high-mobility group box 1 (HMGB1) and heat shock protein 70 kDa (HSP72). HMGB1, in particular, can activate proinflammatory cytokine production when acetylated (AcHMGB1), a form that prefers cytosolic localization and extracellular release. This study aimed at determining how HMGB1 and HSP72 are modulated and affected following treatment with the anti-inflammatory compound resveratrol and novel platelet membrane-derived nanocarriers loaded with rtPA (CSM@rtPA) recently developed by our group for ischemic artery recanalization. Under ischemic conditions of oxygen-glucose deprivation (OGD), nuclear abundance of HMGB1 and AcHMGB1 in microglia and macrophages decreased, whereas treatment with CSM@rtPA did not alter nuclear or cytosolic abundance. Resveratrol treatment markedly increased the cytosolic abundance of HSP72 in microglia. Using proximity ligation assays, we determined that HSP72 interacted with HMGB1 and with acetylated HMGB1. The interaction was differentially affected under the OGD conditions. Resveratrol treatment under the OGD further decreased HSP72-HMGB1 interactions, whereas, in contrast, treatment increased HSP72-AcHMGB1 interactions in microglia. This study points out a salient molecular interaction suited for a two-pronged nanotherapeutic intervention in stroke: enhancement of rtPA's thrombolytic activity and modulation of cytosolic interactions between HMGB1 and HSP72 by resveratrol.

New Perspectives in Neuroprotection for Ischemic Stroke.

The constant failure of new neuroprotective therapies for ischemic stroke has partially halted the search for new therapies in recent years, mainly because of the high investment risk required to develop a new treatment for a complex pathology, such as stroke, with a narrow intervention window and associated comorbidities. However, owing to recent progress in understanding the stroke pathophysiology, improvement in patient care in stroke units, development of new imaging techniques, search for new biomarkers for early diagnosis, and increasingly widespread use of mechanical recanalization therapies, new opportunities have opened for the study of neuroprotection. This review summarizes the main protective agents currently in use, some of which are already in the clinical evaluation phase. It also includes an analysis of how recanalization therapies, new imaging techniques, and biomarkers have improved their efficacy.

Routine Outcome Monitoring from Psychotherapists' Perspectives: A Framework Analysis Study of Expected Benefits and Difficulties.

Psychotherapists' attitudes and expectations towards routine outcome monitoring can impact the likelihood of its fruitful implementation. While existing studies have predominantly focused on Europe and North America, research in Latin America remains limited. The aim of this study is to explore therapists' expected benefits and difficulties prior to implementing a routine outcome monitoring system in a university psychotherapy service in Ecuador. An exploratory and descriptive cross-sectional qualitative study was carried out with 20 participants aged 21 to 47. Semi-structured interviews were conducted to explore participants' knowledge about routine outcome monitoring, their expectations of the difficulties, benefits, usability and risks of using a monitoring system, as well as their expectations about their role in the process. The data analysis adhered to the framework analysis methodology, leading to the identification of six overarching themes, 36 specific themes and 82 subthemes. The interviews highlighted a spectrum of positive and negative expectations at several levels: institutional/general, therapeutic process, therapists, and clients. Perceived benefits encompassed various aspects, including the availability of supplementary information, continuous adaptation of the therapeutic process, facilitation of organization and treatment planning, opportunities for professional development, and fostering patient trust and empowerment. On the other hand, anticipated difficulties comprised concerns such as discomfort among therapists and clients, increased workload, system usage and technical difficulties, and the risk of excessive quantification. Overall, participants expressed more anticipated benefits than difficulties. We present recommendations that can support and optimize the current local implementation efforts of routine outcome monitoring, both within this service and in other settings. These recommendations consider ways to meet positive expectations and address or mitigate negative ones.

Thrombolytic therapy based on lyophilized platelet-derived nanocarriers for ischemic stroke.

BACKGROUND: Intravenous administration of fibrinolytic drugs, such as recombinant tissue plasminogen activator (rtPA) is the standard treatment of acute thrombotic diseases. However, current fibrinolytics exhibit limited clinical efficacy because of their short plasma half-lives and risk of hemorrhagic transformations. Platelet membrane-based nanocarriers have received increasing attention for ischemic stroke therapies, as they have natural thrombus-targeting activity, can prolong half-life of the fibrinolytic therapy, and reduce side effects. In this study we have gone further in developing platelet-derived nanocarriers (defined as cellsomes) to encapsulate and protect rtPA from degradation. Following lyophilization and characterization, their formulation properties, biocompatibility, therapeutic effect, and risk of hemorrhages were later investigated in a thromboembolic model of stroke in mice. RESULTS: Cellsomes of 200 nm size and loaded with rtPA were generated from membrane fragments of human platelets. The lyophilization process did not influence the nanocarrier size distribution, morphology, and colloidal stability conferring particle preservation and long-term storage. Encapsulated rtPA in cellsomes and administered as a single bolus showed to be as effective as a continuous clinical perfusion of free rtPA at equal concentration, without increasing the risk of hemorrhagic transformations or provoking an inflammatory response. CONCLUSIONS: This study provides evidence for the safe and effective use of lyophilized biomimetic platelet-derived nanomedicine for precise thrombolytic treatment of acute ischemic stroke. In addition, this new nanoformulation could simplify the clinical use of rtPA as a single bolus, being easier and less time-consuming in an emergency setting than a treatment perfusion, particularly in stroke patients. We have successfully addressed one of the main barriers to drug application and commercialization, the long-term storage of nanomedicines, overcoming the potential chemical and physical instabilities of nanomedicines when stored in an aqueous buffer.

The Importance of Conducting Practice-oriented Research with Underserved Populations.

There has been a growing emphasis on dissemination of empirically supported treatments. Dissemination, however, should not be restricted to treatment. It can and, in the spirit of the scientific-practitioner model, should also involve research. Because it focuses on the investigation of clinical routine as it takes place in local settings and because it can involve the collaboration of several stakeholders, practice-oriented research (POR) can be viewed as an optimal research method to be disseminated. POR has the potential of addressing particularly relevant gaps of knowledge and action when implemented in regions of the world that have limited resources for or experiences with empirical research, and/or in clinical settings that are serving clinical populations who are not typically receiving optimal mental care services - specifically, individuals in rural and inner cities that have limited economic and social resources. The establishment and maintenance of POR in such regions and/or settings, however, come with specific obstacles and challenges. Integrating the experiences acquired from research conducted in various continents (Africa, Europe, Latin America, and North America), the goal of this paper is to describe some of these challenges, strategies that have been implemented to address them, as well as new possible directions to facilitate the creation and growth of POR. It also describes how these challenges and ways to deal with them can provide helpful lessons for already existing POR infrastructures.

Integrated multi-omics analysis reveals the molecular interplay between circadian clocks and cancer pathogenesis.

Circadian rhythms (CRs) are fundamental biological processes that significantly impact human well-being. Disruption of these rhythms can trigger insufficient neurocognitive development, insomnia, mental disorders, cardiovascular diseases, metabolic dysfunctions, and cancer. The field of chronobiology has increased our understanding of how rhythm disturbances contribute to cancer pathogenesis, and how circadian timing influences the efficacy of cancer treatments. As the circadian clock steadily gains recognition as an emerging factor in tumorigenesis, a thorough and comprehensive multi-omics analysis of CR genes/proteins has never been performed. To shed light on this, we performed, for the first time, an integrated data analysis encompassing genomic/transcriptomic alterations across 32 cancer types (n = 10,918 tumors) taken from the PanCancer Atlas, unfavorable prognostic protein analysis, protein-protein interactomics, and shortest distance score pathways to cancer hallmark phenotypes. This data mining strategy allowed us to unravel 31 essential CR-related proteins involved in the signaling crossroad between circadian rhythms and cancer. In the context of drugging the clock, we identified pharmacogenomic clinical annotations and drugs currently in late phase clinical trials that could be considered as potential cancer therapeutic strategies. These findings highlight the diverse roles of CR-related genes/proteins in the realm of cancer research and therapy.

Variations of work engagement and psychological distress based on three working modalities during the COVID-19 pandemic.

With the onset of the COVID-19 pandemic, the rapid spread of the SARS-CoV-2 virus became a global health threat affecting people's mental and physical health, as well as working conditions and modalities. The reorganization of the work environment also affected work engagement and psychological distress levels. This manuscript assesses how work engagement and distress vary according to gender and age across three working modalities. We used a voluntary response sampling strategy to collect data on psychological distress and work engagement between August 2021 and January 2022. Results are from 542 people working in Ecuador during the COVID-19 pandemic. Overall, participants experienced psychological distress; women and younger participants presented higher psychological distress. Regarding engagement, the sample showed average levels of total engagement, average levels of vigor, and high levels of dedication and absorption. Men presented higher levels of total work engagement and vigor. Psychological distress was significantly and negatively correlated with total work engagement scores and its three factors. There were no differences in work engagement according to the different modalities. However, teleworkers reported significantly higher levels of psychological distress than hybrid workers. Findings are discussed considering ideas for decision-makers to explore the benefits of flexible working practices.

Fostering practice-based evidence through routine outcome monitoring in a university psychotherapy service for common mental health problems: a protocol for a naturalistic, observational study.

INTRODUCTION: Data-informed psychotherapy and routine outcome monitoring are growing as referents in psychotherapy research and practice. In Ecuador, standardised web-based routine outcome monitoring systems have not been used yet, precluding data-driven clinical decisions and service management. Hence, this project aims at fostering and disseminating practice-based evidence in psychotherapy in Ecuador by implementing a web-based routine outcome monitoring system in a university psychotherapy service. METHODS AND ANALYSES: This is a protocol for an observational naturalistic longitudinal study. Progress and outcomes of treatment in the Centro de Psicología Aplicada of the Universidad de Las Américas in Quito, Ecuador will be examined. Participants will be adolescents and adults (≥11 years) seeking treatment, as well as therapists and trainees working at the centre between October 2022 and September 2025. Clients' progress will be monitored by a range of key variables: psychological distress, ambivalence to change, family functioning, therapeutic alliance and life satisfaction. Sociodemographic information and satisfaction with treatment data will be collected before and at the end of treatment, respectively. Also, semi-structured interviews to explore therapists' and trainees' perceptions, expectations and experiences will be conducted. We will analyse first contact data, psychometrics of the measures, reliable and clinically significant change, outcome predictors as well as trajectories of changes. Moreover, we will conduct a framework analysis for the interviews. ETHICS AND DISSEMINATION: The protocol for this study was approved by the Human Research Ethics Committee of the Pontificia Universidad Católica del Ecuador (#PV-10-2022). The results will be disseminated in peer-reviewed scientific articles, at conferences and in workshops. TRIAL REGISTRATION NUMBER: NCT05343741.

Comparative analysis of long-term self-reported COVID-19 symptoms among pregnant women.

BACKGROUND: The negative effects of COVID-19 infections during pregnancy have been amply described, however, the persistent sequels of this infection have not been explored so far. OBJECTIVE: The aim of this study was to describe persisting symptoms after COVID-19 infection in pregnant and non-pregnant women in Ecuador. METHODS: A cross-sectional analysis based on an online, self-reporting questionnaire was conducted in Ecuador from April to July 2022. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 457 surveys were included in this study. We compared risk factor variables and long-term persisting symptoms of pregnant and non-pregnant women in Ecuador. RESULTS: Overall, 247 (54.1 %) responders claimed to have long-term symptoms after SARS-CoV-2 infection. Most of these symptoms were reported by non-pregnant women (94.0 %). The most common Long-COVID symptoms in pregnant women were fatigue (10.6 %), hair loss (9.6 %), and difficulty concentrating (6.2 %). We found that pregnant women who smoked had a higher risk of suffering fatigue. CONCLUSIONS: The most frequent Long-COVID symptoms in pregnant women were fatigue, hair loss, and difficulty concentrating. Apparently, the patterns of presentation of long-term sequelae of SARS-CoV-2 infection in pregnant women do not differ significantly from reports available from studies in the general population.

A comparison of mental health of student and not student emerging adults living in Ecuador.

Most of the studies about mental health and quality of life of emerging adults have been conducted in developed countries and non-students' population has been neglected, limiting the generalisation of the results to other socioeconomic realities. This paper reports the results of an observational study on differences between the two cohorts (students vs non-students) both on mental health and quality of life measures but also on demographic, lifestyle and mental health variables in emerging adults living in a middle-income country. Associations between variables and interactions in the prediction of both outcomes scores were explored to understand how much other variables may contribute to differences between the two groups. We found poorer mental health and worse health-related quality of life in the students than the non-students, although effect sizes were small. Differences between the groups on some sociodemographic predictor variables were statistically significant, showing fairly strong effects, for social status, sleeping hours and parenting, however, none of the predictor variables showed confounding with group effects on both outcomes. Developing countries are growing and work forces are changing, creating a huge global need to understand these changes and the effects on the mental health and quality of life of this evolving population.Registration: ClinicalTrials.gov (NCT04596345).

The effect of two cognitive therapies on subjective wellbeing of individuals with depression: results from a randomised controlled trial.

BACKGROUND: Despite the burden associated to depression, current standards of care are still limited in scope and effectiveness. In addition, therapy outcomes have frequently focused solely on symptoms, leaving patients' wellbeing relatively unaddressed. AIMS: The objective of this study was to test whether two cognitive therapies increased subjective wellbeing in a sample of adults diagnosed with a depressive disorder, additionally assessing the relationship between this growth and decreases in both depression severity and psychological distress. METHODS: Data from 116 participants from a randomised controlled trial comparing the efficacy of cognitive behavioural therapy and dilemma-focused therapy were analysed. Multilevel linear models were employed, together with correlational analyses. RESULTS: Results showed that both interventions significantly improved wellbeing with moderate to large effect sizes, while no significant differences were found between treatments. In turn, the increase in wellbeing was significantly associated to improvements in depression severity and psychological distress. CONCLUSIONS: This study sheds light on the complex relationship between happiness and depression, supporting their conceptualisation as related yet independent human experiences, and strengthening subjective wellbeing as a useful outcome for psychological research. Psychotherapy is presented as an effective intervention to enhance wellbeing, even among individuals with severe depressive symptoms.

Long COVID at Different Altitudes: A Countrywide Epidemiological Analysis.

BACKGROUND: Several reports from around the world have reported that some patients who have recovered from COVID-19 have experienced a range of persistent or new clinical symptoms after a SARS-CoV-2 infection. These symptoms can last from weeks to months, impacting everyday functioning to a significant number of patients. METHODS: A cross-sectional analysis based on an online, self-reporting questionnaire was conducted in Ecuador from April to July 2022. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 2103 surveys were included in this study. We compared socio-demographic variables and long-term persisting symptoms at low (<2500 m) and high altitude (>2500 m). RESULTS: Overall, 1100 (52.3%) responders claimed to have Long-COVID symptoms after SARS-CoV-2 infection. Most of these were reported by women (64.0%); the most affected group was young adults between 21 to 40 years (68.5%), and most long-haulers were mestizos (91.6%). We found that high altitude residents were more likely to report persisting symptoms (71.7%) versus those living at lower altitudes (29.3%). The most common symptoms were fatigue or tiredness (8.4%), hair loss (5.1%) and difficulty concentrating (5.0%). The highest proportion of symptoms was observed in the group that received less than 2 doses. CONCLUSIONS: This is the first study describing post-COVID symptoms' persistence in low and high-altitude residents. Our findings demonstrate that women, especially those aging between 21-40, are more likely to describe Long-COVID. We also found that living at a high altitude was associated with higher reports of mood changes, tachycardia, decreased libido, insomnia, and palpitations compared to lowlanders. Finally, we found a greater risk to report Long-COVID symptoms among women, those with previous comorbidities and those who had a severer acute SARS-CoV-2 infection.

Self-concept 6 months after traumatic brain injury and its relationship with emotional functioning.

This is an observational exploratory study assessing self-concept and its association with depression, anxiety, satisfaction with life, and quality of life 6 months after experiencing a traumatic brain injury. Participants were 33 patients who suffered a traumatic brain injury 6 months before the assessment. The measures used in this study were the Repertory Grid Technique, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Satisfaction With Life Scale, and the Quality of Life after Brain Injury. We calculated Euclidean distances to assess differences in pre-and post-injury self-perception, as well as the proportion of opposed pole construct rating and polarization to understand how they are associated with the scores of the other offered measures. We found that the distance between the present and ideal self, as well as the distance between the present self and the self before the lesion showed moderate positive correlations with depression, and negative correlations with satisfaction with life and quality of life. Also, for the present and self before the lesion, the proportion of opposed pole ratings was correlated with depression symptoms, quality, and satisfaction with life, while for the present self and the ideal self this proportion was correlated with all the measures. The proportion of polarization of the present self and the total polarization was negatively correlated with symptom measures. The repertory grid might facilitate a greater understanding of self-concept after traumatic brain injury. This information could be used to guide treatments that address the emotions related to distances observed in the perception of the self.

A Comparison of Working Conditions and Workers' Perceptions among On-Site, Telework, and Hybrid Workers in Ecuador during the COVID-19 Pandemic.

The COVID-19 pandemic has forced many companies to adopt different work modalities to ensure their operation during this period. In this study, we described and compared working conditions and perceptions among face-to-face workers, teleworkers, and hybrid workers in Ecuador. A cross-sectional study was conducted with a sample of 542 participants, using a self-report survey to assess sociodemographic data, working conditions, and workers' perceptions. Variables were described and then compared by the Chi-square test, ANOVA, and the Kruskal-Wallis test. The results indicated a higher proportion of on-site workers without higher education and in the public sector compared to the other modalities. At the same time, there was evidence of increased perceived productivity. People in the hybrid modality tended to have more than one job, earning a higher monthly salary, perceiving a decrease in productivity, an increase in daily working hours, and a lower capacity for time management. In addition, most teleworkers reported fair working conditions, a dedicated workspace, and easy adaptation to this work mode. This study builds a more in-depth understanding of how workers perceived their working conditions among work modalities for organizational decision-making because the evolution of the COVID-19 pandemic is modifying the ways of working permanently.

Fibrin-Targeted Nanoparticles for Finding, Visualizing and Characterizing Blood Clots in Acute Ischemic Stroke.

Recanalization of the occluded artery is the gold standard treatment for acute ischemic stroke, which includes enzymatic fibrinolytic treatment with the use of recombinant tissue plasminogen activators (rtPAs) to disrupt the occluding clot, the use of mechanical thrombectomy to physically remove the clot, or a combination of both. Fibrin is one of the main components of blood clots causing ischemic stroke and is the target of rtPA upon activation of plasminogen in the clot. In addition, fibrin content also influences the efficacy of mechanical thrombectomy. Current imaging methods can successfully identify occlusions in large vessels; however, there is still a need for contrast agents capable of visualizing small thrombi in ischemic stroke patients. In this work, we describe the synthesis and the in vitro characterization of a new diagnostic nanoparticle, as well as the in vivo evaluation in an animal model of thromboembolic stroke. Gd-labeled KCREKA peptides were synthesized and attached onto the surface of PEGylated superparamagnetic nanoparticles. Magnetic resonance imaging (MRI) of blood clots was performed in vitro and in vivo in animal models of thromboembolic stroke. KCREKA-NPs were synthesized by attaching the peptide to the amino (N) termini of the PEG-NPs. The sizes of the nanoparticles, measured via DLS, were similar for both KCREKA-NPs and PEG-NPs (23 ± 4 nm, PDI = 0.11 and 25 ± 8 nm, PDI = 0.24, respectively). In the same line, r2 relaxivities were also similar for the nanoparticles (149 ± 2 mM Fe s−1 and 151 ± 5 mM Fe s−1), whereas the r1 relaxivity was higher for KCREKA-NPs (1.68 ± 0.29 mM Fe s−1 vs. 0.69 ± 0.3 mM Fe s−1). In vitro studies showed that blood clots with low coagulation times were disrupted by rtPA, whereas aged clots were almost insensitive to the presence of rtPA. MRI in vitro studies showed a sharp decrease in the T1 × T2 signals measured for aged clots incubated with KCREKA-NPs compared with fresh clots (47% [22, 80] to 26% [15, 51]). Furthermore, the control blood showed a higher value of the T1 × T2 signal (39% [20, 61]), being the blood clots with low coagulation times the samples with the lowest values measured by MRI. In vivo studies showed a significant T1 × T2 signal loss in the clot region of 24% after i.v. injection of KCREKA-NPs. The thrombus age (2.5% ± 6.1% vs. 81.3% ± 19.8%, p < 0.01) confirmed our ability to identify in vivo fresh blood clots. In this study, we developed and tested a dual MRI nanoparticle, acting as T1 and T2 contrast agents in MRI analyses. The developed KCREKA-NPs showed affinity for the fibrin content of blood clots, and the MRI signals provided by the nanoparticles showed significant differences depending on the clot age. The developed KCREKA-NPs could be used as a tool to predict the efficacy of a recanalization treatment and improve the triage of ischemic stroke patients.

Involvement of Ceramide Metabolism in Cerebral Ischemia.

Ischemic stroke, caused by the interruption of blood flow to the brain and subsequent neuronal death, represents one of the main causes of disability in worldwide. Although reperfusion therapies have shown efficacy in a limited number of patients with acute ischemic stroke, neuroprotective drugs and recovery strategies have been widely assessed, but none of them have been successful in clinical practice. Therefore, the search for new therapeutic approaches is still necessary. Sphingolipids consist of a family of lipidic molecules with both structural and cell signaling functions. Regulation of sphingolipid metabolism is crucial for cell fate and homeostasis in the body. Different works have emphasized the implication of its metabolism in different pathologies, such as diabetes, cancer, neurodegeneration, or atherosclerosis. Other studies have shown its implication in the risk of suffering a stroke and its progression. This review will highlight the implications of sphingolipid metabolism enzymes in acute ischemic stroke.

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial / Terapias Cognitivo-Conductual y de Constructos Personales para la depresión en mujeres con fibromialgia: un estudio controlado aleatorizado

ResumenAntecedentes/Objetivo: La fibromialgia es un trastorno de dolor crónico que los síntomas depresivos agravan. El objetivo de este estudio es probar la eficacia de la Terapia de Cons-tructos Personales (TCP), aproximación que enfatiza las características identitarias y los significados personales como foco de la intervención, para el tratamiento de síntomas de-presivos en mujeres con fibromialgia. Método: Comparamos la TCP con la Terapia Cognitivo-Conductual (TCC) en un ensayo multicéntrico paralelo aleatorizado. Mujeres con fibromial-gia y síntomas depresivos (n = 106) fueron aleatorizadas a TCC (n = 55) o TCP (n = 51), en formato individual y modular para ajustarse a las necesidades de las pacientes. Los datos se analizaron usando modelos lineales de efectos mixtos. Resultados: Ambas condiciones redu-jeron significativamente los síntomas depresivos sin encontrarse diferencias significativas después del tratamiento (β= -0,47, t = -0,49, p = 0,63) ni en el seguimiento (β= -1,12, t = -1,09, p = 0,28). Resultados similares se encontraron para la ansiedad, el impacto de la fi-bromialgia, la distribución del cambio clínicamente significativo para los síntomas depresi-vos y el dolor. Conclusiones: la TCP y TCC parecerían ser igualmente efectivas para el trata-miento de los síntomas depresivos, postulando la TCP como una alternativa de tratamiento.

AbstractBackground/Objective:Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia. Method: We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models. Results: Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β= -0.47, t = -0.49, p = .63) and at follow-up (β= -1.12, t = -1.09, p = .28). Results were similar between groups for anxiety, fibromyalgia’s impact, and the distribution of clinically significant changes in depressive symptoms and pain. Conclusions: PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.

Self-Esteem, Happiness, and Flourishing in Times of COVID-19: A Study During the Lockdown Period in Ecuador.

Objective: Several studies have investigated the negative toll the pandemic has had on people's mental health. However, there is limited research on the pandemic's effect on positive mental health variables. This article reports on the levels of self-esteem and well-being (flourishing and happiness) in a sample of adults living in Ecuador and their relationships with the characteristics of their personal situation and the effects of the COVID-19 pandemic had on their personal lives. Methods: A total of 766 adults completed an anonymous online survey between March and August 2020. Results: Participants reported average scores in the flourishing scale, the majority considered themselves to be happy or very happy people, and more than half presented high levels of self-esteem. Age, education, socioeconomic status, time spent using mobile phones and on hobbies, among others, explained self-esteem, happiness, and flourishing. Conclusion: The relationships between sociodemographic and situational variables of confinement during the pandemic are discussed, as well as the possible predictors of happiness, flourishing, and self-esteem.