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Resumen: El maltrato sobre la infancia y la adolescencia (MTIA) es un grave y complejo problema de salud pública global con efectos potencialmente devastadores en la salud y el bienestar físico y mental de las personas a lo largo de toda la vida. Se trata de un tema sanitario que, aunque no se haya reconocido hasta hace pocos decenios, posee gravísimas consecuencias sobre la vida de esos niños futuros adultos y sus familias. Al adoptar diversas formas y modalidades (violencias, abusos, negligencias y otras), resulta altamente prevalente y con graves repercusiones sobre el desarrollo personal y la morbilidad tanto mental como física. Los y las profesionales de APS pueden desempeñar una función clave en la detección del MTIA, en su exploración, en la adopción de las primeras medidas terapéuticas o mitigadoras, en la puesta en marcha de la red de cuidados sobre estos casos, y en el seguimiento a medio y largo plazo de las situaciones de maltrato. Este subprograma del PAPPS, de atención al maltrato sobre la infancia y la adolescencia, intenta proporcionar unas líneas básicas sobre cada uno de esos apartados. Abstract: Childhood and adolescent abuse (MTIA) is a serious and complex global public health problem with potentially devastating effects on the physical and mental health and well-being of people throughout their lives. This is a health issue that, although it was not recognized until a few decades ago, has very serious consequences on the lives of these future adult children and their families. By adopting various forms and modalities (violence, abuse, neglect and others), it is highly prevalent and has serious repercussions on personal development and both mental and physical morbidity. PHC professionals can play a key role in the detection of MTIA, in its exploration, in the adoption of the first therapeutic or mitigating measures, in the implementation of the care network for these cases, and in the follow-up in the medium and long term of abuse situations. This PAPPS subprogram, for attention to abuse of children and adolescents, attempts to provide some basic lines on each of these sections.

Resumen: La crianza y el desarrollo psicosocial de los hijos que viven con padres con trastornos mentales graves (esquizofrenia y trastornos delirantes, depresión mayor, episodio de manía, intentos de suicidio, trastornos graves de la personalidad, alcoholismo o abusos de otras drogas y otros trastornos) pueden ser más difíciles, y su calidad de vida, sus relaciones y su salud mental pueden verse seriamente afectadas. Conseguir un cierto conocimiento en la práctica clínica que facilite la recogida y la investigación de antecedentes psiquiátricos de los padres y la identificación de factores de riesgo y señales de alerta elementales en los niños supone una mejoría en las capacidades de los equipos de Atención Primaria de Salud (APS) para integrar los elementos de salud mental en su práctica cotidiana. Se trata, además, de un paso previo imprescindible para poner en marcha intervenciones preventivas, al menos elementales, necesarias para la protección de la salud mental de esos niños y futuros adultos: ese es el núcleo de este subprograma del PAPPS para el cuidado de la salud mental de los niños y de los adolescentes en el caso de antecedentes de psicopatología en los progenitores o cuidadores. Abstract: The upbringing and psychosocial development of children who live with parents with serious mental disorders (schizophrenia and delusional disorders, major depression, manic episode, suicide attempts, severe personality disorders, alcoholism or abuse of other drugs and other disorders) can be more difficult, and your quality of life, relationships, and mental health may be seriously affected. Achieving a certain knowledge in clinical practice that facilitates the collection and investigation of parents’ psychiatric history and the identification of risk factors and basic warning signs in children, represents an improvement in the capabilities of Primary Health Care (PHC) teams to integrate mental health elements into your daily practice. It is also an essential preliminary step to implement preventive interventions, at least elementary, necessary to protect the mental health of these children and future adults: that is the core of this PAPPS subprogram for the care of the mental health of children and adolescents in the case of a history of psychopathology in parents or caregivers.

Abstract Background Metabolic syndrome (MetS) has become a growing risk factor of some non-communicable diseases. Increase of greenhouse gas emissions affects the planet. Aims To assess the association between MetS severity and amount of carbon dioxide (CO2) emitted in an adult population. Design Cross-sectional study (n = 6646; 55-76-year-old-men; 60-75-year-old-women with MetS). Methods Dietary habits were assessed using a pre-validated semi quantitative 143-item food frequency questionnaire. The amount of CO2 emitted due to the production of food consumed by person and day was calculated using a European database, and the severity of the MetS was calculated with the MetS Severity Score. Results Higher glycaemia levels were found in people with higher CO2 emissions. The risk of having high severe MetS was related to high CO2 emissions. Conclusions Low CO2 emissions diet would help to reduce MetS severity. Advantages for both health and the environment were found following a more sustainable diet. Trial registration ISRCTN, ISRCTN89898870 . Registered 05 September 2013.

Abstract Background Research related to sustainable diets is is highly relevant to provide better understanding of the impact of dietary intake on the health and the environment. Aim To assess the association between the adherence to an energy-restricted Mediterranean diet and the amount of CO2 emitted in an older adult population. Design and population Using a cross-sectional design, the association between the adherence to an energy-reduced Mediterranean Diet (erMedDiet) score and dietary CO2 emissions in 6646 participants was assessed. Methods Food intake and adherence to the erMedDiet was assessed using validated food frequency questionnaire and 17-item Mediterranean questionnaire. Sociodemographic characteristics were documented. Environmental impact was calculated through greenhouse gas emissions estimations, specifically CO2 emissions of each participant diet per day, using a European database. Participants were distributed in quartiles according to their estimated CO2 emissions expressed in kg/day: Q1 (≤2.01 kg CO2), Q2 (2.02-2.34 kg CO2), Q3 (2.35-2.79 kg CO2) and Q4 (≥2.80 kg CO2). Results More men than women induced higher dietary levels of CO2 emissions. Participants reporting higher consumption of vegetables, fruits, legumes, nuts, whole cereals, preferring white meat, and having less consumption of red meat were mostly emitting less kg of CO2 through diet. Participants with higher adherence to the Mediterranean Diet showed lower odds for dietary CO2 emissions: Q2 (OR 0.87; 95%CI: 0.76-1.00), Q3 (OR 0.69; 95%CI: 0.69-0.79) and Q4 (OR 0.48; 95%CI: 0.42-0.55) vs Q1 (reference). Conclusions The Mediterranean diet can be environmentally protective since the higher the adherence to the Mediterranean diet, the lower total dietary CO2 emissions. Mediterranean Diet index may be used as a pollution level index.

Resumen: El embarazo en la adolescencia es generalmente un embarazo no deseado, una situación que conlleva importantes sobrecargas biológicas, psicológicas y sociales con repercusiones en la salud de la madre y el hijo. Pero el dato psicosocialmente más importante es que un embarazo no deseado en todo su desarrollo da lugar al nacimiento de un niño ambivalentemente deseado, un niño de alto riesgo. Los nacidos en España en 2020 de mujeres menores de 20 años de edad fueron 8.305, lo que corresponde al 1,97% del total de nacimientos. En esta revisión se presentan medidas y recomendaciones para la protección y prevención de la salud mental de la madre y el niño cuando el embarazo tiene lugar en la adolescencia. Abstract: Adolescent pregnancy is generally an unwanted pregnancy, a situation that involves significant biological, psychological and social overloads, with repercussions on the health of the mother and the child. But the psychosocially important fact is that an unwanted pregnancy in its entirety gives rise to the birth of an ambivalently wanted child, a high-risk child. Those born in Spain in 2020 to women under 20 years of age were 8,305, which corresponds to 1.97% of all births. This review presents measures and recommendations for the protection and prevention of the mental health of the mother and child when pregnancy takes place in adolescence.

Resumen: En el trabajo se hace una aproximación a las características psicológicas y psicosociales que está adquiriendo la pandemia de la COVID-19 en los países de nuestro medio socio-cultural. Se discute la escasez de investigaciones al respecto y la necesaria aceptación de la incertidumbre para enfrentar la situación, tanto a nivel social, como sanitario y personal.En consecuencia, se proponen una serie de reflexiones y recomendaciones para los cuidados psicológicos de la población, los trabajadores sanitarios y la organización social basándose en: 1) La existencia de investigaciones psicológicas y psicosociales sobre temas conectados con estos y 2) En las nuevas perspectivas neurocientíficas sobre las emociones y su elaboración en situaciones de crisis. Abstract: An approach is made to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment. The scarcity of research in this regard and the necessary acceptance of uncertainty to face the situation, both socially, as well as health and psychological, are discussed.Consequently, a series of reflections and recommendations are proposed for the psychological care of the population, health workers and social organization based on: 1) The existence of psychological and psychosocial research into connected fields and 2) In the new neuroscientific perspectives on emotions and their elaboration in crisis situations.

Resumen: La pandemia por la enfermedad conocida como COVID-19 (acrónimo del inglés coronavirus disease-2019) o «enfermedad del coronavirus», que se detectó por primera vez en la ciudad china de Wuhan en diciembre de 2019, ha supuesto una emergencia de salud pública internacional por diferentes razones (amenaza para la vida de muchas personas, crisis sanitaria y socioeconómica sin precedentes, cese de actividades escolares y laborales, o la necesidad de adoptar medidas extraordinarias como la puesta en cuarentena de ciudades o países enteros, entre otras). El Grupo de Salud Mental del PAPPS ha considerado importante observar, reflexionar e investigar sobre los fenómenos que se están dando y se darán en la que, posiblemente, ha sido una de las intervenciones de salud pública más amplias y radicales de la historia reciente. En este trabajo se hace una aproximación a las características psicológicas y psicosociales que está adquiriendo la pandemia de la COVID-19 en los países de nuestro medio sociocultural y se proponen una serie de reflexiones y recomendaciones para los cuidados psicológicos de la población, los trabajadores sanitarios y la organización social. Abstract: The pandemic of the disease known as COVID-19 (acronym for coronavirus disease-2019), which was first detected in the Chinese city of Wuhan in December 2019, has led to an international public health emergency. This due to several reasons (threat to the lives of many people, unprecedented health and socioeconomic crisis, cessation of school and work activities, or the need to adopt extraordinary measures, including quarantining entire cities or countries). The PAPPS Mental Health Group has considered it important to observe, reflect and investigate the phenomena that are occurring, and will occur, in what has possibly been one of the most extensive and radical public health interventions in recent history. This work makes an approach to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment, and proposes a series of reflections and recommendations for the psychological care of the population, health workers, and social organisation.

Objective: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. Design: Pre-post controlled study. Setting: Catalonia, autonomous community located in north-eastern Spain. Participants: Individuals aged 35–74 years assigned to general practitioners of the Catalan Health Institute. Intervention: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform. Main outcomes: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. Results: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. Conclusions: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear.

Background The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs). This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension.Methods Eligible study participants are those aged 35–74 years assigned to family practitioners (FPs) of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1) a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2) a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1) suspected and confirmed diagnoses, (2) control of clinical variables, (3) requests for tests and (4) proportions of patients with adequate drug prescriptions.Results This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013.Conclusion This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.

Se realiza una breve justificación de la necesidad, eficacia y posible eficiencia de realizar algún tipo de programas preventivos en el campo de la salud mental desde la Atención Primaria de Salud y sus dispositivos actuales. Se valoran como importantes las posibilidades de colaboración entre Equipos de Salud Mental y los Equipos de Atención Primaria que supone el trabajo conjunto en ese campo. A continuación, se exponen los criterios sobre «subprogramas preventivos iniciales» aprobados por el PAPPS (Programa de Actividades Preventivas y de Promoción de la Salud) de la Sociedad Española de Medicina de Familia y Comunitaria: los subprogramas de diagnóstico precoz de la depresión y prevención del suicidio, comunes al trabajo con niños y adolescentes y al trabajo con adultos y los otros diez subprogramas elementales básicos: atención a la mujer y el niño durante el embarazo y puerperio, embarazo en la adolescencia, hijos de familias monoparentales, antecedentes de patología psiquiátrica en los padres y retraso escolar/trastornos en el desarrollo del lenguaje en la atención a niños y adolescentes. En la atención a adultos y ancianos el PAPPS valora como prioritarios los subprogramas pérdida de un familiar o allegado, pérdida de funciones psicofísicas importantes, cuidado del paciente terminal y de su familia, jubilación y cambios frecuentes de domicilio en los ancianos. Se realiza una breve descripción de los elementos básicos para practicar dicho subprograma y de la justificación de cada uno.