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Guided digital mental health interventions are more effective than unguided interventions. While research often emphasizes the frequency and intensity of guidance, less attention has been paid to the behaviors enacted by the therapists supporting clients using these interventions. A scoping review of the literature was conducted to systematically examine the evidence on therapist behaviors (i.e., the actions and feedback provided by supporters to patients). Applying broad eligibility criteria, a systematic search was conducted in PubMed, PsycInfo, the Cochrane Library, and Embase from their inception to January 1st 2024. Sixteen studies met inclusion criteria and were included in the review. Following data extraction, a descriptive analysis and synthesis of the results was performed. Most studies (n = 12; 75 %) focused on therapist behaviors in the context of internet-delivered Cognitive Behavioral Therapy for anxiety and depression. While earlier studies primarily focused on identifying therapist behaviors, later studies shifted towards examining the associations between therapist behaviors and different outcomes, as well as deriving research and clinical applications for improving guided internet-delivered treatments. Identified gaps and recommendations for clinical practice, research, training, and treatment development are discussed.

Abstract Background Research has shown that internet-based cognitive behavioural therapy (iCBT) can be a very promising solution to increase access to and the dissemination of evidence-based treatments to all of the population in need. However, iCBT is still underutilized in clinical contexts, such as primary care. In order to achieve the effective implementation of these protocols, more studies in ecological settings are needed. The Unified Protocol (UP) is a transdiagnostic CBT protocol for the treatment of emotional disorders, which includes depression, anxiety and related disorders, that has shown its efficacy across different contexts and populations. An internet-based UP (iUP) programme has recently been developed as an emerging internet-based treatment for emotional disorders. However, the internet-delivered version of the UP (iUP) has not yet been examined empirically. The current project seeks to analyse the effectiveness of the iUP as a treatment for depression, anxiety and related emotional disorders in a primary care public health setting. Methods The current study will employ a parallel-group, randomized controlled trial design. Participants will be randomly assigned to (a) the internet-based Unified Protocol (iUP), or (b) enhanced waiting list control (eWLC). Randomization will follow a 2:1 allocation ratio, with sample size calculations suggesting a required sample of 120 (iUP=80; eWLC=40). The Mini-International Neuropsychiatric Interview (M.I.N.I.) will be used for assessing potential participants. The Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) as well as other standardized questionnaires will be used for assessments at baseline, 4 weeks, 8 weeks and 12 weeks from baseline and for the iUP condition during the follow-up. Discussion Combining the advantages of a transdiagnostic treatment with an online delivery format may have the potential to significantly lower the burden of emotional disorders in public health primary care setting. Anxiety and depression, often comorbid, are the most prevalent psychological disorders in primary care. Because the iUP allows for the treatment of different disorders and comorbidity, this treatment could represent an adequate choice for patients that demand mental health care in a primary care setting. Trial registration ISRCTN18056450 https://doi.org/10.1186/ISRCTN18056450 .

Objectives: This study aimed to evaluate the therapeutic effcacy of custom-made mandibular advancement devices (MAD) in the control of primary snoring and sleep apnea and to correlate with anatomical changes identified through imaging tests. Methods: Patients (n = 17) diagnosed with sleep apnea or primary snoring were included in this study and subsequently treated with MADs. Changes were assessed using a polysomnographic study (PSG), the Epworth Sleepiness Scale (ESS), and an imaging study with computed tomography scanning (CT). Studies were performed before and after the use of MAD. Anteroposterior measurements were taken in the sagittal plane at the hard palate, glottis, and supraglottic levels along the hard palate axis. Afterward, measurements were taken in the axial plane at the same levels along the hard palate axis. Results: From the six recorded measurements, the airway caliber increased by five. However, these changes were significant only in two measurements (sagittal hard palate and axial supraglottic). Snoring was controlled in 16 of the 17 subjects. From these sixteen, 12 subjects had a correct opening of the airway at the hard palate level. Moreover, daytime sleepiness decreased in all subjects. Discussion: Present results suggest that sagittal hard palate and axial supraglottic opening after use of MAD are mainly responsible for eliminating snoring and improve sleep apnea.

BackgroundTransdiagnostic internet-delivered cognitive behavioral therapy (iCBT) for emotional disorders has been shown to be effective in specialized care in the short term. However, less is known about its long-term effects in this specific setting. In addition, predictors of long-term effectiveness may help to identify what treatments are more suitable for certain individuals. ObjectiveThis study aimed to analyze the long-term effectiveness of transdiagnostic iCBT compared with that of treatment as usual (TAU) in specialized care and explore predictors of long-term effectiveness. MethodsMixed models were performed to analyze the long-term effectiveness and predictors of transdiagnostic iCBT (n=99) versus TAU (n=101) in public specialized mental health care. Outcomes included symptoms of depression and anxiety, health-related quality of life (QoL), behavioral inhibition and behavioral activation, comorbidity, and diagnostic status (ie, loss of principal diagnosis) from baseline to 1-year follow-up. Sociodemographic characteristics (sex, age, and education) and clinical variables (principal diagnosis, comorbidity, and symptom severity at baseline) were selected as predictors of long-term changes. ResultsCompared with baseline, transdiagnostic iCBT was more effective than TAU in improving symptoms of depression (b=–4.16, SE 1.80, 95% CI –7.68 to –0.67), health-related QoL (b=7.63, SE 3.41, 95% CI 1.00-14.28), diagnostic status (b=–0.24, SE 0.09, 95% CI –1.00 to –0.15), and comorbidity at 1-year follow-up (b=–0.58, SE 0.22, 95% CI –1.00 to –0.15). From pretreatment assessment to follow-up, anxiety symptoms improved in both transdiagnostic iCBT and TAU groups, but no significant differences were found between the groups. Regarding the predictors of the long-term effectiveness of transdiagnostic iCBT compared with that of TAU, higher health-related QoL at follow-up was predicted by a baseline diagnosis of anxiety, male sex, and the use of psychiatric medication; fewer comorbid disorders at follow-up were predicted by older age and higher baseline scores on health-related QoL; and fewer depressive symptoms at follow-up were predicted by baseline diagnosis of depression. However, this pattern was not observed for baseline anxiety diagnoses and anxiety symptoms. ConclusionsThe results suggest that transdiagnostic iCBT is more effective than TAU to target depressive symptoms among patients with emotional disorders. Anxiety symptoms remained stable at 1-year follow-up, with no differences between the groups. Results on predictors suggest that some groups of patients may obtain specific gains after transdiagnostic iCBT. Specifically, and consistent with the literature, patients with baseline depression improved their depression scores at follow-up. However, this pattern was not found for baseline anxiety disorders. More studies on the predictor role of sociodemographic and clinical variables in long-term outcomes of transdiagnostic iCBT are warranted. Future studies should focus on studying the implementation of transdiagnostic iCBT in Spanish public specialized mental health care. Trial RegistrationClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668

Antecedentes: La trombosis venosa profunda forma parte de los desórdenes venosos tromboembólicos, que incluyen además la tromboflebitis superficial y tromboembolismo pulmonar. Objetivo: Correlacionar los factores de riesgo, manifestaciones clínicas y valor del dímero D en sangre con el diagnóstico de trombosis venosa profunda por ecografía Doppler. Material y métodos: Se realizó un estudio transversal retrospectivo, descriptivo y correlacional que incluyó 73 pacientes con sospecha de trombosis venosa profunda. Resultado: El diagnóstico de trombosis venosa se corroboró en 69 pacientes, con mayor incidencia en mujeres entre 21 y 40 años. Se encontró correlación entre la clínica y valores elevados de dímero D con la confirmación diagnóstica de trombosis venosa por ecografía con (p ≈ 0.000). El embarazo mostró correlación con la confirmación diagnóstica (p = 0.043). Conclusiones: Se encontró correlación significativa entre embarazadas, manifestaciones clínicas y valor del dímero D con el diagnóstico de trombosis venosa por ecografía Doppler.

In this study we have used data from Spanish public universities to assess their efficiency in a longitudinal framework between 2008/9-2014/15. To carry out the analysis, two windows data envelopment analysis and intertemporal, non-radial and radial analysis methodologies were compared. The main results show a significant deterioration in university efficiency from the 2012/13 academic year for the three proposed frontiers, with both methodologies. Some factors may explain these results, such as the ageing of teaching force and its low replacement rate of 10%, and the lack of incentives for young researchers who wish to pursue a research career, influenced by the presence of endogamy, in hiring or promotion. Finally, the resources necessary for the good governance of the Spanish public university with the consequent accountability of these, in terms of teaching, research and its transfer to society, could become a strategic issue that should be taken into account by all the actors involved.

Abstract Background The Positive and Negative Affect Schedule (PANAS) is the most widely and frequently used scale to assess positive and negative affect. The PANAS has been validated in several languages, and it has shown excellent psychometric properties in the general population and some clinical samples, such as forensic samples, substance users, and adult women with fibromyalgia. Nevertheless, the psychometric properties of the scale have not yet been examined in clinical samples with anxiety, depressive, and adjustment disorders. In addition, the proliferation of Internet-based treatments has led to the development of a wide range of assessments conducted online with digital versions of pen and paper self-report questionnaires. However, no validations have been carried out to analyze the psychometric properties of the online version of the PANAS. The present study investigates the psychometric properties of the online Spanish version of the PANAS in a clinical sample of individuals with emotional disorders. Methods The sample was composed of 595 Spanish adult volunteers with a diagnosis of depressive disorder (n = 237), anxiety disorder (n = 284), or adjustment disorder (n = 74). Factor structure, construct validity, internal consistency, and sensitivity to change were analyzed. Results Confirmatory factor analysis yielded a latent structure of two independent factors, consistent with previous validations of the instrument. The analyses showed adequate convergent and discriminant validity, good internal consistency as well as sensitivity to change. Conclusions Overall, the results obtained in this study show that the online version of the PANAS has adequate psychometric properties for the assessment of positive and negative affect in a Spanish clinical population.

Introducción: El traumatismo vascular constituye una entidad de importancia en los servicios de emergencia por su alta incidencia de complicaciones. Objetivo: Caracterizar el traumatismo vascular en un hospital de segundo nivel de Ecuador durante el periodo julio 2017-julio 2020. Material y métodos: Se realizó un estudio descriptivo, transversal y correlacional que incluyó 45 pacientes. Se calcularon medidas de tendencia central como media y desviación estándar de la variable cuantitativa edad, así como las frecuencias absolutas y relativas para las demás variables. Resultados: Predominaron los jóvenes de sexo masculino. Resultó más frecuente el trauma penetrante por arma blanca y accidentes de tránsito. La mayoría de los diagnósticos se realizó por sospecha clínica. La técnica quirúrgica de mayor empleo fue la revascularización con vena safena invertida en trece pacientes. Conclusiones: Predominaron los traumatismos vasculares de arteria humeral por mecanismos penetrantes en jóvenes de sexo masculino y de procedencia urbana, solucionados por revascularización con vena safena.

En este trabajo se presenta el diseño y evaluación de un recurso educativo del tipo juego de mesa, titulado ‘S.O.S. Civilizaciones’. El diseño de este recurso está basado en el juego comercial “La Isla Prohibida”. Fundamentándose en el aprendizaje basado en juegos, su objetivo es contribuir a la formación y conocimiento del alumnado de Bachillerato en problemáticas medioambientales y sociales del s. XXI, a través de los Objetivos de Desarrollo Sostenible (ONU). La capacidad del juego diseñado para fomentar la motivación y el compromiso pro-ambiental ha sido evaluada mediante un análisis cualitativo utilizando dos marcos teóricos.

Background: Transdiagnostic iCBT has been shown to be effective for the treatment of emotional disorders. Less is known about the optimal level of therapist and patient involvement in these interventions. Specific characteristics of Internet-delivered interventions include treatment adherence (e.g., amount of review of the materials) and guidance (e.g., amount of therapist support). Exploring the importance of these elements in treatment outcome may help to maximize the efficiency of Internet-delivered psychological interventions. Aim: In this study, we aimed to analyze the relationship between patient and therapist involvement (i.e., platform usage and amount of therapist guidance) in a sample of patients with emotional disorders who received transdiagnostic iCBT in Spanish public specialized mental healthcare services. Method: This is a secondary analysis of a randomized controlled trial. The sample included 63 patients who completed transdiagnostic iCBT for emotional disorders. Platform usage metrics included number of logins into the platform and number of times the participants reviewed the modules. Therapist guidance was measured as the number of support phone calls with a therapist and their total duration (minutes). Logistic regressions and ROC analyses were performed to explore the predictive value of platform usage and therapist guidance in symptom reduction. Clinical outcomes included depressive and anxiety symptoms assessed at baseline and post-intervention. The bivariate relationship between the platform usage and therapist guidance variables was also explored. Results: Overall, platform usage and therapist guidance were not associated with symptom improvement. However, the patient and therapist involvement parameters were intercorrelated. Specifically, the number of calls and their duration were associated with a greater number of logins (r = 0.61; p

Los limbos arqueológicos son sitios extraoficiales en México no son administrados por el Instituto Nacional de Antropología e Historia sino que por terceras personas (particulares, comunidades, entidades o municipios), a la sombra de las zonas monumentales consagradas en el imaginario nacionalista que acaparan los escasos recursos y personal disponibles. Este documento busca trasladar a quienes lo lean a algunos de estos proyectos en contextos geográficos y culturales divergentes, a La Proveedora en la frontera norte, un sitio privado de petrograbados en el desierto sonorense; al centro, donde un ejido mestizo custodia las pinturas rupestres de El Boyé, Hidalgo; al sureste, a Xoclán, administrado como un parque municipal y a Yaxuná, una antigua urbe preservada por una comunidad maya.