The PSP has been implemented in Catalonia in 2006 in an attempt to improve the Primary Care treatment of the most common mental disorders and addictions. It’s based on a collaborative model, made up between Primary Care and Mental Health professionals.

To identify the strengths and limitations of the PSP from the perspective of Primary Care and Mental Health professionals.

Qualitative, exploratory and interpretive study based on Grounded Theory, made between 2018 and 2019 with Primary Care and Mental Health professionals. Group interviews were conducted with triangulated analysis. The study got the approval from the Research Ethics Committee of the Sant Joan de Deu’s foundation.

11 group interviews were conducted in 6 primary care centers and 5 mental health centers in Barcelona. Intrinsic and extrinsic factors impacting the programme functioning were detected. Within the extrinsic factors, elements related to professionals, patients and public health system have been observed. All the professionals agree that the PCSP has a favorable impact on inter-professional relationships and patients, facilitating the management of cases. In contrast the heterogeneity implementation, the lack of training, and the health care burden in is considered to negatively influence an optimal development of the programme. Professionals suggest communication and inter-professional collaboration would be improved by creating more a horizontal structure that eliminates vertical lines of command and disagreements in clinical judgement, thus facilitating shared decisions.

PrimaryCare and MentalHealth professionals value the PSP positively, but conclude there are communication and organizative barriers that should be addressed in order to improve the overall programme’s efficiency.

Telemedicine uses information and communication technologies to provide services in the field where the distance is a critical factor. The aim of the present study is to describe the experience of a synchronous telemedicine between two hospitals in Spain and Angola.

This is a retrospective observational study of all synchronous telemedicine sessions conducted between the Hospital Nossa Senhora da Paz in Angola and the Vall d'Hebron University Hospital in Spain from January 2011 to December 2014.

Seventy-two cases were discussed in the telemedicine sessions. The average age of patients was 18.02 (SD 13.75) years and mostly women (54.38 percent). Reasons to discuss the cases were 46.47 percent doubts in the diagnosis and therapeutic management, 15.47 percent were purely formative cases, and only 8.45 percent treatment doubt. At the time of presentation, 29 percent of the patients were already diagnosed, 95 percent of whom with infectious disease diagnostic, and from the undiagnosed patients 36 percent presented a febrile syndrome.

This study shows the viability of synchronous telemedicine between European and African countries without an excessively sophisticated technology.

This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD).

A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk.

TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01–1.65) were associated with TRD risk.

Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD.

Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients.

In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping.

Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%).

The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.

Childhood obesity is associated with multiple cardio-metabolic abnormalities. A sensitive hypothesis underlying these alterations is oxidative stress, shown to be present in obesity, often accompanied by a diminished antioxidant defense. Specifically, plasma vitamin concentrations have been observed to be associated with obesity in adults and children. However, their association with cardio-metabolic alterations in children is less clear.

985 children (49.2% males, 71.7% prepubertal, 71.9% excess weight) were recruited in a case-control study of obesity in three Spanish hospitals. Pubertal status was assessed and anthropometry (weight, height), systolic and diastolic blood pressure (SBP, DBP) and serum glucose, insulin, triacylglycerols (TAG) and high-density lipoprotein cholesterol (HDL-C) were measured. Plasma concentrations of tocopherols and carotenes were determined with HPLC-MS and referred to TAG. Children were classified as MU if showing one or more of these criteria: SBP or DBP ≥ 90th percentile (age, sex, height), serum TAG > 90th percentile (age, sex), HDL-C < 10th percentile (age, sex), glucose ≥ 100 mg/dL or elevated HOMA-IR (≥ 2.5 prepubertal, ≥ 3.38 pubertal males, ≥ 3.905 pubertal females). Non-fulfillment was indicative of MH status. General linear models adjusted for sex, age, recruitment center and BMI were used to evaluate differences in vitamins between MH and MU children.

Prepubertal and pubertal children with excess weight showed lower tocopherols (Pre: 0.133 ± 0.061 vs 0.165 ± 0.065, P < 0.001; Pub: 0.120 ± 0.057 vs 0.163 ± 0.066, P < 0.001) and carotenes (Pre: 15.63 ± 13.72 vs 30.31 ± 26.04, P < 0.001; Pub: 12.34 ± 9.86 vs 22.98 ± 19.25, P < 0.001) plasma concentrations than normal-weight children. MU prepubertal and pubertal children showed lower tocopherols (Pre: 0.120 ± 0.056 vs 0.165 ± 0.064, P < 0.001; Pub: 0.111 ± 0.051 vs 0.154 ± 0.066, P < 0.001) and carotenes (Pre: 14.07 ± 12.61 vs 25.97 ± 21.94, P < 0.001; Pub: 10.90 ± 8.54 vs 19.03 ± 14.58, P < 0.001) plasma concentrations than MH children, independently of BMI. Individual MU components analyses showed similar associations between tocopherols and carotenes and insulin resistance, low HDL-C values and hypertriglyceridemia in prepubertal children; and between tocopherols and carotenes and elevated SBP, hyperglycemia and hypertriglyceridemia in pubertal children.

Our findings agree with previous studies that showed decreased plasma concentrations of tocopherols and carotenes in children with obesity. However, we observe further implications of low circulating concentrations of non-enzymatic antioxidants in terms of their negative association with cardio-metabolic alterations such as insulin resistance and dyslipidemia in prepubertal and pubertal children, independently of BMI. These results must be considered when designing prevention and treatment strategies of obesity and its complications.

Hypertension is a public health problem and its prevalence in children is on the rise, often continuing into adulthood and increasing the risk related cardiovascular complications. Sleep plays an essential role in children's growth and several studies suggest that insufficient sleep duration is associated with hypertension in adults. However, few studies have evaluated this association in children. Thus, the aim of the study is to ascertain whether the sleep duration is a risk factor for elevated blood pressure (BP) in children.

We studied 776 children (5–18 years old), (46.7% male, 78.8% 5–13 years, 73.6% overweight/obesity). Weight and height were measured and body mass index (BMI) was calculated. BP was measured with an electronic manometer to find a 25.3% of children with an elevated systolic BP (SBP, > P90th) and 14% with an elevated diastolic BP (DBP, > P90th) (Task Force 2017). Sleep duration was assessed by asking the parents “¿How many hours does your child sleep in a typical weekday?”. Weekday sleep hours were considered since they are more representative of children's routines than weekend hours. Hours were converted into a dichotomous variable based on the fulfillment or not of the “Canadian 24-Hour Movement Guidelines for Children and Youth recommendations”: 9–11 hours for 5- to 13-year-olds; 8–10 hours for 14- to 17-year-olds.

A spearman correlation analysis was performed between sleep duration, SBP and DBP. Then, a general linear model analysis adjusted for BMI Z-score was done to evaluate differences in SBP and DBP between children following the sleep recommendations. Analyses were stratified by sex and age range (5–13 and 14–17).

In girls 5–13 years, we found a significant negative correlation between sleep duration and body mass index (BMI) (r = -0.226, p = 0.000) and between sleep and systolic BP (r = -0.188, p = 0.001). Girls 5–13 years not following sleep recommendations showed significantly higher SBP values than those who followed the recommendations (112 ± 11 mmHg vs. 106 ± 12 mmHg, p = 0.007), independently of BMI. No significant differences were observed in girls 14–17 years nor in males.

In the present study, we show that girls 5–13 years with shorter sleep duration show increased SBP values independently of BMI, in contrast to previous studies which showed similar associations that disappeared when adjusting for BMI. Our results support the need for wider strategies in population education so that sleep recommendations are followed by children in the general population.

Typhoon Haiyan partially destroyed the Ormoc District Hospital in the Philippines. A field hospital was established to replace its outpatient department for 5 weeks. We investigated the reasons for medical consultation in the field hospital.

We described the consultations by sex, age, week, and diagnosis according to the Surveillance in Post-Extreme Emergencies and Disasters system. We compared the number and proportion of upper respiratory tract infections (URTIs) with a control season in 2014.

We included 6785 consultations, 55.9% from women. The majority of consultations were communicable diseases (88.2%) followed by noncommunicable (7.1%) and injuries (5.6%). Males suffered more often from injuries than women (66.0% vs 34.0%). Consultations due to injuries decreased from 10.0% in the first to 2.9% in the last week. The most frequent diagnosis over the study period was acute respiratory infections (ARIs) (73.1%), of which 83.0% were children. The number of daily URTIs was higher than in a similar 2014 period.

ARI was the most prevalent diagnosis. We recommend ARI treatments being fully accessible after such a disaster. During the first week, injury prevention should focus on adult men. Studies after natural disasters should include control periods to better understand disease distribution, ultimately improving the prioritization in disasters.

Cognitive representations of an illness have an important impact on psychological outcomes. The current systematic review explored 1) the characteristics of illness representations held by parents of children and adults with serious mental illness (SMI), and 2) the associations of these representations with both parents’ and patients’ psychological outcomes.

PSYINFO and PUBMED were screened for eligible studies published between January 2000 and August 2018. Selection was based on PRISMA guidelines. Reference lists of these papers were checked for additional references. Two independent coders extracted all relevant data.

The search resulted in 31 relevant studies, which were divided, by type of methodology, into three sections: quantitative, qualitative, and mixed quantitative-qualitative. In each section, findings were divided in accordance with the two research questions.

Parents struggle to make meaning of their child’s illness, often holding stigmatizing ideas about the illness and blaming themselves for its existence. More longitudinal studies that include both of the child’s parents, as well as interventional studies, are needed to expand our knowledge of ways to help parents construct more beneficial representations of their children’s illnesses.

For more than 60 years, Colombia experienced an armed conflict involving government forces, guerrillas, and other illegal armed groups. Violence, including torture and massacres, has caused displacement of entire rural communities to urban areas. Lack of information on the problems displaced communities face and on their perceptions on potential solutions to these problems may prevent programs from delivering appropriate services to these communities. This study explores the problems of Afro-Colombian survivors from two major cities in Colombia; the activities they do to take care of themselves, their families, and their community; and possible solutions to these problems.

This was a qualitative, interview-based study conducted in Quibdó and Buenaventura (Colombia). Free-list interviews and focus groups explored the problems of survivors and the activities they do to take care of themselves, their families, and their community. Key-informant interviews explored details of the identified mental health problems and possible solutions.

In Buenaventura, 24 free-list interviews, one focus group, and 17 key-informant interviews were completed. In Quibdó, 29 free-list interviews, one focus group, and 15 key-informant interviews were completed. Mental health problems identified included: (1) problems related to exposure to torture/violent events; (2) problems with adaptation to the new social context; and (3) problems related to current poverty, lack of employment, and ongoing violence. These problems were similar to trauma symptoms and features of depression and anxiety, as described in other populations. Solutions included psychological help, talking to friends/family, relying on God’s help, and getting trained in different task or jobs.

Afro-Colombian survivors of torture and violence described mental health problems similar to those of other trauma-affected populations. These results suggest that existing interventions that address trauma-related symptoms and current ongoing stressors may be appropriate for improving the mental health of survivors in this population.

Santaella-TenorioJ, Bonilla-EscobarFJ, Nieto-GilL, Fandiño-LosadaA, Gutiérrez-MartínezMI, BassJ, BoltonP. Mental Health and Psychosocial Problems and Needs of Violence Survivors in the Colombian Pacific Coast: A Qualitative Study in Buenaventura and Quibdó. Prehosp Disaster Med. 2018;33(6):567–574.