Open Access
Gender differences in transdiagnostic predictors of problematic alcohol consumption in a large sample of college students in Ecuador
(Health Psychology, 2022) Sánchez Puertas, Rafael; Ruisoto Palomera, Pablo; López Núñez, Carla; Vaca Gallegos, Silvia; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: alcohol use is one of the main risk factors that leads to detrimental health effects and support for a transdiagnostic approach to alcohol use disorders is growing. However, the role of transdiagnostic predictors of problematic alcohol consumption in Ecuador are understudied. Objective: the aim of this study was to examine gender differences in psychological stress and inflexibility as transdiagnostic predictors of problematic alcohol consumption in a large sample of college students in Ecuador. Methods: a total of 7,905 college students (21.49years, SD=3.68; 53.75% females) were surveyed using the following standardized scales: alcohol Use Disorders Identification Test, Perceived Stress Scale-14, and Acceptance and Action Questionnaire (AAQ-7). Macro Process for SPSS (models 4 and 7) was used to analyze mediation and moderation effects. Results: reported alcohol consumption was significantly higher in men than women students. On the other hand, women reported significantly higher levels of perceived stress and psychological inflexibility than men students. Gender, age, psychological stress, and inflexibility were significant predictors of alcohol consumption. Moreover, psychological inflexibility mediated the impact of stress on alcohol consumption, particularly in women (for men b=0.065, 95% CI [0.048 to 0.083], for women b=0.070, 95% CI [0.051 to 0.089]). Discussion: results of this study support psychological stress and psychological inflexibility as critical transdiagnostic variables related to increased rates of alcohol consumption among Ecuadorian college students. These conclusions contribute to the development of transdiagnostic comprehensive programs, which encompasses promotive, preventive, and treatment services that allow to alleviate the burden of alcohol, as well as to enrich the growing research on alcohol consumption in this population from a gender perspective.
Open Access
Beyond clinical risk: tackling loneliness through a population health lens
(Frontiers Media, 2025-08-18) Zeas Sigüenza, Ananda; Ruisoto Palomera, Pablo; Koldewyn, Kami; Muntané, Ferràn; Benach, Joan; Ciencias de la Salud; Osasun Zientziak; Institute for Advanced Social Research - ICOMMUNITAS; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Loneliness is a distressing emotional state that arises from unmet social needs, particularly the quality¿rather than merely the quantity¿of social connections. While it serves an adaptive function by signaling social disconnection and motivating reconnection, chronic loneliness is a well-established risk factor for adverse mental and physical health outcomes. Recognizing its growing prevalence and health burden, the World Health Organization (WHO) has identified loneliness as a public health priority. To date, most research and interventions have focused on high-risk individuals, mainly within clinical populations, often addressing loneliness only after it becomes severe and entrenched. This paper argues for a paradigm shift toward population-level interventions that targets the broader social and environmental determinants of loneliness. Specifically, we propose a loneliness spectrum model and a systemic intervention framework that targets structural determinants, positioning loneliness prevention as a fundamental public health strategy through nature-based and community-driven interventions.
Open Access
Alone and under pressure: the transdiagnostic role of loneliness, stress, and psychological inflexibility in university students
(Frontiers Media, 2025-08-14) Vaca Gallegos, Silvia; Peñaherrera-Aguirre, Mateo; Batallas, Daniela; Paladines Costa, María Belén; López Núñez, Carla; Ruisoto Palomera, Pablo; Ciencias de la Salud; Osasun Zientziak; Institute for Advanced Social Research - ICOMMUNITAS
Introduction: University students face growingmental health challenges that demand both clinical and population-level strategies. Psychological inflexibility, perceived stress, and loneliness have been proposed as key transdiagnostic factors influencing mental health, yet their interrelationships remain unclear. Methods: We conducted a cross-sectional survey among 7,905 students from 11 Ecuadorian universities. Validated instruments were used to assess psychological inflexibility (AAQ-II), perceived stress (PSS), loneliness (UCLA-3), anxiety and depression (PHQ-4), and life satisfaction (LSQ). Data were analysed using Sequential Canonical Analysis to examine direct and indirect associations among predictors and outcomes. Results: Analysis revealed a structured cascade: psychological inflexibility predicted perceived stress, which in turn predicted loneliness. All three variables contributed independently to mental health outcomes. Loneliness was the strongest predictor of anxiety, depression, and reduced life satisfaction, supporting its role as a chronic social stressor. Together, these factors explained 45% of the variance in a higherorder mental health factor and 35% of the variance in life satisfaction. Discussion: Findings underscore the need for integrated strategies in higher education that address both individual vulnerability and social isolation. Framed within Rose’s distinction between the causes of individual cases and the causes of population incidence, results highlight loneliness as a central target for preventive and clinical interventions.
Open Access
Psychological inflexibility and loneliness mediate the impact of stress on anxiety and depression symptoms in healthcare students and early-career professionals during COVID-19
(Frontiers Media, 2021) Bonilla-Sierra, Patricia; Manrique-G., Alexis; Hidalgo-Andrade, Paula; Ruisoto Palomera, Pablo; Ciencias de la Salud; Osasun Zientziak
Background: the current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge. Objective: this study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms. Methods: a total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects. Results: alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19. Discussion: implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.
Open Access
Loneliness as a public health challenge: a systematic review and meta-analysis to inform policy and practice
(MDPI, 2025-07-11) Zeas Sigüenza, Ananda; Voldstad, Andreas; Ruisoto Palomera, Pablo; Ganho-Ávila, Ana; Guiomar, Raquel; Cacho Fernández, Raúl; Muntané, Ferràn; Benach, Joan; Ciencias de la Salud; Osasun Zientziak; Institute for Advanced Social Research - ICOMMUNITAS; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Loneliness is a recognized public health risk factor associated with increased morbidity and mortality. However, the effectiveness of interventions targeting loneliness remains unclear—particularly in relation to baseline severity. This systematic review and metaanalysis assessed intervention effectiveness and the influence of baseline severity and intervention characteristics. A total of 25 studies were included, of which 16 randomized controlled trials (RCTs; k = 21) were meta-analyzed. Interventions produced a moderate pooled effect at post-intervention (Hedge’s g = 0.65, 95% CI [0.05, 1.26], p = 0.037), though with high heterogeneity. Sensitivity analyses confirmed a moderate effect (g = 0.55, 95% CI [0.22, 0.88], p = 0.003). Higher baseline loneliness predicted greater intervention effects (b = 0.04, 95% CI [0.02, 0.07], Z = 3.36, p < 0.001), with cognitive-behavioral therapy (CBT) showing the largest effect size (g = 0.73). No significant effects were observed at follow-up. These findings underscore the need for dual strategies: targeted psychological interventions (e.g., CBT) for individuals with severe loneliness, and universal, contextbased approaches for the broader population. This aligns with Geoffrey Rose’s distinction between individual-level treatment and population-level prevention and highlights the urgency of embedding loneliness interventions into public health frameworks and policy agendas focused on promoting social connectedness and equity.
Open Access
Metabolic health, mitochondrial fitness, physical activity, and cancer
(MDPI, 2023) Clemente Suárez, Vicente Javier; Martín Rodríguez, Alexandra; Redondo Flórez, Laura; Ruisoto Palomera, Pablo; Navarro Jiménez, Eduardo; Ramos Campo, Domingo Jesús; Tornero Aguilera, José Francisco; Ciencias de la Salud; Osasun Zientziak
Cancer continues to be a significant global health issue. Traditional genetic-based approaches to understanding and treating cancer have had limited success. Researchers are increasingly exploring the impact of the environment, specifically inflammation and metabolism, on cancer development. Examining the role of mitochondria in this context is crucial for understanding the connections between metabolic health, physical activity, and cancer. This study aimed to review the literature on this topic through a comprehensive narrative review of various databases including MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. The review highlighted the importance of mitochondrial function in overall health and in regulating key events in cancer development, such as apoptosis. The concept of “mitochondrial fitness” emphasizes the crucial role of mitochondria in cell metabolism, particularly their oxidative functions, and how proper function can prevent replication errors and regulate apoptosis. Engaging in high-energy-demanding movement, such as exercise, is a powerful intervention for improving mitochondrial function and increasing resistance to environmental stressors. These findings support the significance of considering the role of the environment, specifically inflammation and metabolism, in cancer development and treatment. Further research is required to fully understand the mechanisms by which physical activity improves mitochondrial function and potentially reduces the risk of cancer.
Open Access
Predictors of athlete's performance in ultra-endurance mountain races
(MDPI, 2021) Belinchón de Miguel, Pedro; Ruisoto Palomera, Pablo; Knechtle, Beat; Nikolaidis, Pantelis T.; Herrera-Tapias, Beliña; Clemente Suárez, Vicente Javier; Ciencias de la Salud; Osasun Zientziak
Background: In previous studies, ultra-endurance performance has been associated with training and psychological variables. However, performance under extreme conditions is understudied, mainly due to difficulties in making field measures. Aim: The aim of this study was to analyze the role of training, hydration, nutrition, oral health status, and stress-related psychological factors in athletes' performance in ultra-endurance mountain events. Methods: We analyzed the variables of race time and training, hydration state, nutrition, oral health status, and stress-related psychological factors in 448 ultra-endurance mountain race finishers divided into three groups according to race length (less than 45 km, 45–90 km, and greater than 90 km), using a questionnaire. Results: Higher performance in ultra-endurance mountain races was associated with better oral health status and higher accumulative altitude covered per week as well as higher positive accumulative change of altitude per week during training. In longer distance races, experience, a larger volume of training, and better hydration/nutrition prior to the competition were associated with better performance. Conclusions: Ultra-endurance mountain athletes competing in longer races (>90 km) have more experience and follow harder training schedules compared with athletes competing in shorter dis-tances. In longer races, a larger fluid intake before the competition was the single best predictor of performance. For races between 45 and 90 km, training intensity and volume were key predictors of performance, and for races below 45 km, oral health status was a key predictor of performance. Psychological factors previously reported as ultra-endurance mountain race performance predictors were inconsistent or failed to predict the performance of athletes in the present research.
Open Access
The distinctive role of grounded optimism and resilience for predicting burnout and work engagement: a study in professional caregivers of older adults
(Elsevier, 2022) Nieto-Carracedo, Ana; Contador Castillo, Israel; Palenzuela, David L.; Ruisoto Palomera, Pablo; Ramos, Francisco; Fernández-Calvo, Bernardino; Ciencias de la Salud; Osasun Zientziak
Background: Resilience and optimism have been proposed as psychological resources which may help to cope better with work demands, preventing negative consequences of stress, whereas external locus of control (ELC) is considered an intra-psychic vulnerability factor associated with increased burnout. Noteworthy, the specific role of these overlapping constructs on the prevention of burnout and promotion of work engagement, respectively, remains unclear. Objective: The main aim of this study was to compare the differential significance of resilience and optimism, joined with ELC, on the prediction of burnout and work engagement. Method: A sample of 265 professional caregivers of dependent older adults was assessed using an extensive standardized protocol. Optimism and ELC were measured using the Palenzuela's Battery of Generalised Expectancies of Control, and the Connor-Davidson Scale was used to estimate resilience. Moreover, the Maslach Burnout Inventory and the Utrecht Work Engagement Scale were used to measure burnout and work engagement, respectively. Different hierarchical regression models were conducted with burnout and work engagement as dependent factors. Results: The results showed that more than half (51%) variance in resilience was accounted by grounded optimism scores. The ELC was the main explanatory factor of burnout, whereas optimism and resilience were the best predictors of work engagement. Finally, even after controlling the effect of resilience, the effect of optimism remained significant for predicting work engagement. Conclusions: These findings support distinctive role resilience and optimism, two closely related psychological constructs, for promoting work engagement and reducing burnout in professional caregivers of older adults.
Open Access
Anatomy of educational innovations based on learning by discovery in higher education
(Consejo General de la Psicología de España, 2024) Ruisoto Palomera, Pablo; Contador Castillo, Israel; Quintero, Esperanza; López-García, Juan Carlos; Álvarez-Díaz, Beatriz; Cacho Fernández, Raúl; Fernández-Calvo, Bernardino; Ciencias de la Salud; Osasun Zientziak; Institute for Advanced Social Research - ICOMMUNITAS
El objetivo de este trabajo es examinar las innovaciones docentes derivadas del Plan Bolonia, centrando la atención en el aprendizaje basado en problemas y la gamificación, que resaltan la importancia del aprendizaje por descubrimiento o autónomo. Se analizan metaanálisis y artículos prominentes en ¿Education¿ and ¿Educational Research¿ de los últimos 5 años. Utilizando un símil biomédico, se identifican los principios activos de las innovaciones basadas en aprendizaje por descubrimiento, destacando la subordinación de contenidos teóricos a competencias prácticas y la ruptura del binomio docente-estudiante. Se señalan efectos adversos como la devaluación de clases magistrales, desacreditación de la autoridad docente y la infantilización de estudiantes. Diferentes estudios indican que la eficacia del aprendizaje por descubrimiento en la educación superior es débil e inconsistente. Por tanto, se aboga por la prudencia en su implementación y la preservación de la función social universitaria para transmitir conocimiento a niveles superiores.
Open Access
Performance of fuzzy multi-criteria decision analysis of emergency system in COVID-19 pandemic. An extensive narrative review
(MDPI, 2021) Clemente Suárez, Vicente Javier; Navarro Jiménez, Eduardo; Ruisoto Palomera, Pablo; Dalamitros, Athanasios A.; Beltrán Velasco, Ana Isabel; Hormeno-Holgado, Alberto Joaquín; Laborde Cárdenas, Carmen Cecilia; Tornero Aguilera, José Francisco; Ciencias de la Salud; Osasun Zientziak
The actual coronavirus disease 2019 (COVID-19) pandemic has led to the limit of emergency systems worldwide, leading to the collapse of health systems, police, first responders, as well as other areas. Various ways of dealing with this world crisis have been proposed from many aspects, with fuzzy multi-criteria decision analysis being a method that can be applied to a wide range of emergency systems and professional groups, aiming to confront several associated issues and challenges. The purpose of this critical review was to discuss the basic principles, present current applications during the first pandemic wave, and propose future implications of this methodology. For this purpose, both primary sources, such as scientific articles, and secondary ones, such as bibliographic indexes, web pages, and databases, were used. The main search engines were PubMed, SciELO, and Google Scholar. The method was a systematic literature review of the available literature regarding the performance of the fuzzy multi-criteria decision analysis of emergency systems in the COVID-19 pandemic. The results of this study highlight the importance of the fuzzy multi-criteria decision analysis method as a beneficial tool for healthcare workers and first responders' emergency professionals to face this pandemic as well as to manage the created uncertainty and its related risks.