Programa de vacunación en prisiones: impacto del virus SARS-CoV-2 y retos de futuro / Prison vaccination programmes: the impact of the SARS-CoV-2 virus and future challenges

La vacunación ha sido tradicionalmente una de las actividades de prevención primaria a la que mayor esfuerzo se ha dedicado en las instituciones penitenciarias españolas. Una vez más, la pandemia de coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2) ha puesto de manifiesto la importancia de la vacunación en el control de las enfermedades inmunoprevenibles. Tras superar la emergencia sanitaria provocada por la enfermedad del coronavirus de 2019 (COVID-19), tenemos por delante el reto de recuperar las coberturas vacunales que teníamos antes de la pandemia, además de aumentar las de otras vacunas con menor implantación en nuestro medio. Entre las estrategias de mejora que se deben implementar, estaría la optimización de la transmisión de la información sanitaria entre centros penitenciarios dependientes de diferentes administraciones. También sería deseable poder acceder a los sistemas de información sobre vacunas de las diferentes comunidades autónomas, tanto para conocer el estado vacunal de los pacientes como para notificar las dosis administradas durante el periodo de internamiento, así como mejorar las estadísticas vacunales disponibles en prisión.(AU)

Vaccination has traditionally been one of the primary prevention activities to which most effort has been devoted in Spanish penitentiary institutions. Once again, the type 2 coronavirus pandemic causing severe acute respiratory syndrome (SARS-CoV-2) pandemic has highlighted the importance of vaccination in the control of immunopreventable diseases.After overcoming the health emergency caused by the coronavirus disease 2019 (COVID-19), we face the challenge of recovering the vaccination coverage we had before the pandemic, in addition to increasing the coverage of other vaccines with lesser implantation in our environment. Among the improvement strategies to be implemented would be the optimization of the transmission of health information between penitentiary centers dependent on different administrations. It would also be desirable to be able to access the vaccine information systems of the different autonomous communities, both to know the vaccination status of patients and to report the doses administered during the period of internment, as well as to improve the vaccine statistics available in prison.(AU)

The Experience of Spanish Prison Nurses with the HIV Pandemic.

INTRODUCTION: This study discusses the experiences of nurses in Spanish prisons during the HIV/AIDS pandemic, emphasizing administrative changes and adaptive measures, such as the creation of the Subdirectorate General of Penitentiary Health. OBJECTIVE: We describe the experiences of nurses in Spanish penitentiary centers in the face of the HIV/AIDS. MATERIALS AND METHODS: The interpretative and phenomenological approach explored experiences between 1981 and 2023 through focus groups and convenience sampling. Participants were recruited through telephone calls and telematic meetings using Microsoft Teams. Four key themes were identified: the stigmatization of inmates, changes in nursing, the importance of training and resources, and equal treatment between genders. RESULTS: The nursing vision focused on gathering information, providing comprehensive patient support, and sharing personal experiences. DISCUSSION: This research provides a historical perspective on the adaptation of prison nursing to the pandemic, highlighting coping processes and suggesting future lines of research on the experiences of inmates, prison guards, and surveillance officers. CONCLUSIONS: We highlight the low media visibility of the pandemic in prisons, underlining the importance of understanding and valuing the nursing experience in prison settings during health crises.

Validity and reliability of an android device for the assessment of fall risk in older adult inmates.

AIM: To validate the Android device, FallSkip, as a tool to assess the fallers in older adult inmates. DESIGN: A cross-sectional descriptive and analytical study. METHODS: For the validation of the FallSkip, the diagnostic criterion used was the risk of having suffered a fall during the last year. RESULTS: The results for the FallSkip tool were as follows: sensitivity 60.7%; specificity 83.0%; positive predictive value 65.4%; negative predictive value 80.0%; accuracy 75.3%. In total, 32.1% of participants were found to be at high risk of falls, 23.5% were at mild risk and 7.4% were found to have no risk. CONCLUSION: The FallSkip device is shown to be a very suitable tool for fall risk assessment. The sample studied presented a statistically significant percentage of fall risk, which made it necessary to carry out interventions through physical activities to improve balance and stability.

[Regulations against the Covid-19 pandemic in spanish prisons]. / Normativa frente a la pandemia covid-19 en las prisiones españolas.

The pandemic caused by SARS-COVID-2 has supposed an extraordinary challenge for prisons. There is an unavoidable need to take action to stop the entry and spread of the virus, however, the measures must respect prisoners' rights and must not constitute any kind of inhuman or degrading treatment. Spanish prison authorities have published and extensive normative that has transformed life in prisons during the pandemic. We have reviewed the content of these norms, which's main treads are: no discrimination and the guarantee of an equivalent treatment than that to the regular population; coordination of medical authorities; interruption or diminution of the spread of the virus from or towards prisons; the strengthening of alternatives to closed regime sentences; mobility restriction methods inside prisons, and measures to minimise the risks employees are exposed to. In general, the measures have respected prisoners' rights. However, indefinite quarantine practices have likely violated them, being that there were other alternative measures. Ultimately, the extensive vaccination of prisoners has public health implications, constitutes an ethical imperative towards this group of vulnerable people and should be implemented promptly.

Normativa frente a la pandemia covid-19 en las prisiones españolas / Regulations against the covid-19 pandemic in spanish prisons

La pandemia por el SARS-COVID-2 ha supuesto un extraordinario desafío para las prisiones. A la indudable necesidad de tomar medidas firmes para evitar la entrada y propagación del virus en ellas, se unía la necesidad de que esas medidas respetaran los derechos de los reclusos y no constituyeran forma alguna de tratoinhumano o degradante. Las autoridades penitenciarias españolas han publicado una extensa normativa queha cambiado la vida en las prisiones durante el tiempo de pandemia. Hemos revisado el contenido de esanormativa, cuyas líneas maestras han sido: no discriminación y garantías de trato equivalente a la poblacióngeneral; coordinación con las autoridades sanitarias; interrupción o disminución de la circulación del virusdesde y hacia las prisiones; potenciación de alternativas al cumplimiento de condenas en régimen cerrado;medidas de restricción de la movilidad dentro de las prisiones y medidas de minimización de riesgos paralos trabajadores. En su gran mayoría, las medidas adoptadas han respetado los derechos de los reclusos. Lasmedidas de cuarentenas indiscriminadas han podido vulnerar esos derechos y además eran factibles medidasalternativas. La vacunación masiva de los reclusos tiene indicaciones de Salud Pública, constituye un imperativo ético en este grupo de personas vulnerables y debería ser implementada con prontitud.

The pandemic caused by SARS-COVID-2 has supposed an extraordinary challenge for prisons. There isan unavoidable need to take action to stop the entry and spread of the virus, however, the measures mustrespect prisoners’ rights and must not constitute any kind of inhuman or degrading treatment. Spanishprison authorities have published and extensive normative that has transformed life in prisons during thepandemic. We have reviewed the content of these norms, which’s main treads are: no discrimination andthe guarantee of an equivalent treatment than that to the regular population; coordination of medicalauthorities; interruption or diminution of the spread of the virus from or towards prisons; the strengthening of alternatives to closed regime sentences; mobility restriction methods inside prisons, and measuresto minimise the risks employees are exposed to. In general, the measures have respected prisoners’ rights.However, indefinite quarantine practices have likely violated them, being that there were other alternative measures. Ultimately, the extensive vaccination of prisoners has public health implications, constitutesan ethical imperative towards this group of vulnerable people and should be implemented promptly.

Associations and community health workers: analysis and time trends over ten years of training-action / Asociaciones y agentes de salud de base comunitaria: análisis y tendencias temporales durante diez años de formación-acción

Objective: To analyse the profile of the persons and associations that participated in the course, quantify peer education activities and analyse their evolution. Method: A quantitative study using an analysis of the course records from 2009 to 2018 was designed for this purpose inside mihsalud program designed to promote health amongst persons in vulnerable situations in the city of Valencia (Spain). It offers a yearly training-action course of community health workers (CHW) that is attended by persons who have been proposed by associations. The associations were defined according to their population (immigrant, local or intercultural) and the CHWs according to gender, country of birth, year of course, association and continuity after training. Means and confidence intervals were calculated at 95% and a bivariate analysis was conducted in order to compare the activities that took place in 2009 to 2013 with those of 2014 to 2018. The time trends were analysed by applying linear regression models that included the different years studied as the dependent variable. Results: 201 CHW of 31 nationalities were trained, 81.6% (95% confidence interval [95% CI]: 75.5-86.7] were women. Eighty-two associations participated, 51.2% (95% CI: 39.9-62.4] worked with culturally diverse populations. Participation by associations (p=.017) and CHWs (p=.377) increased in a statistically significant manner over the years. After the course, 35.3% (95% CI: 28.7-42.4] of the CHWs continued to collaborate voluntarily in the associations. (AU)

Objetivo: Analizar el perfil de las personas y asociaciones que participaron en los cursos, cuantificar las actividades de educación entre iguales y analizar su evolución. Método: Se diseñó un estudio cuantitativo utilizando un análisis de los registros del curso de 2009 a 2018, dentro del programa mihsalud diseñado para promover la salud entre las personas en situación de vulnerabilidad en la ciudad de Valencia (España). Anualmente se ofrece un curso de formación-acción para agentes de salud de base comunitaria (ASBC), al que asisten personas propuestas por asociaciones. Las asociaciones se definieron según su población (inmigrantes, locales o interculturales) y los ASBC según el género, el país de nacimiento, el año de curso, la asociación y la continuidad después de la capacitación. Las medias y los intervalos de confianza se calcularon al 95% y se realizó un análisis bivariado para comparar las actividades que tuvieron lugar en 2009 a 2013 con las de 2014 a 2018. Las tendencias temporales se analizaron aplicando modelos de regresión lineal que incluyeron el estudio de diferentes años como la variable dependiente. Resultados: 201 ASBC de 31 nacionalidades fueron entrenados, 81.6% (intervalo de confianza del 95% [IC 95%]: 75,5 a 86,7) eran mujeres. Participaron 82 asociaciones, el 51,2% (IC 95%: 39,9 a 62,4) trabajaron con poblaciones culturalmente diversas. La participación de asociaciones (p = 0,017) y ASBC (p = 0,377) aumentó de manera estadísticamente significativa a lo largo de los años. Después del curso, el 35,3% (IC 95%: 28,7 a 42,4] de los ASBC continuaron colaborando voluntariamente en las asociaciones.(AU)

Associations and community health workers: analysis and time trends over ten years of training-action.

OBJECTIVE: To analyse the profile of the persons and associations that participated in the course, quantify peer education activities and analyse their evolution. METHOD: A quantitative study using an analysis of the course records from 2009 to 2018 was designed for this purpose inside mihsalud program designed to promote health amongst persons in vulnerable situations in the city of Valencia (Spain). It offers a yearly training-action course of community health workers (CHW) that is attended by persons who have been proposed by associations. The associations were defined according to their population (immigrant, local or intercultural) and the CHWs according to gender, country of birth, year of course, association and continuity after training. Means and confidence intervals were calculated at 95% and a bivariate analysis was conducted in order to compare the activities that took place in 2009 to 2013 with those of 2014 to 2018. The time trends were analysed by applying linear regression models that included the different years studied as the dependent variable. RESULTS: 201 CHW of 31 nationalities were trained, 81.6% (95% confidence interval [95% CI]: 75.5-86.7] were women. Eighty-two associations participated, 51.2% (95% CI: 39.9-62.4] worked with culturally diverse populations. Participation by associations (p=.017) and CHWs (p=.377) increased in a statistically significant manner over the years. After the course, 35.3% (95% CI: 28.7-42.4] of the CHWs continued to collaborate voluntarily in the associations. CONCLUSIONS: The results of the CHW training-action course improve over time given that a significant increase in participation by associations and women can be seen, along with a greater number of activities completed during the training. One effect of this is that CHWs are contracted or carry out voluntary activities in the associations.

Sociodemographic, Clinical, and Therapeutic Aspects of Penitentiary Psychiatric Consultation: Toward Integration Into the General Mental Health Services.

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.

[Cardiovascular risk factors in young adults of a penitentiary center]. / Factores de riesgo cardiovascular en adultos jóvenes de un centro penitenciario.

OBJECTIVE: The quantification of the cardiovascular risk factors (CVRF) in a population of young adults, allows to identify their vulnerabilities and contributes to focus on prevention strategies in a group more susceptible of changing their behavior and establishing healthier daily habits. The objectives of this work were to describe the main CVRF and estimate the risk through different models. METHODS: Observational, descriptive, analytical and crosssectional study. All of the population of the centre of both genders, who were admitted and their age span from 18 to 35 as of the 15 September 2017, are included. Sociodemographic, anthropometric and clinical variables were gathered. A descriptive and a gender comparative analysis took place using classical statistical techniques and binary logistic regression analysis. It was determined that cardiovascular risk using Framingham's equation, REGICOR, SCORE, DORICA, and Q-RISK 2017 version. All of the patients who participated gave their authorizations and consent. The project was approved by a Committee of Ethics in Clinical Research. RESULTS: The targeted population were 211 young adults, 6 members could not be contacted so the study held had a population of 205: 170 men (82.9%) and 35 women (17.1%). The average age is 29.9 (IC 95%: 29.3-30.5). The mean stay is 13.3 months. CVRF underlines: genetics 46.3%, sedentariness 38.0%; familiar backgrounds 17.6%; Triglyceridemic 16.6%; obesity 13.2%. Others: psychological 79.5%, eating disorders 72.2%, cocaine consumption 58.0%. Cardiovascular risk by Framingham: low 85.9%, light 12.9%, moderate 1.2%. DORICA: low 87.6%, light 11.8%, moderate 0.6%. REGICOR: low 98.8%, light 1.2%. CONCLUSIONS: The identified risk factors were high toxic consumption, influence of sedentary lifestyle and psychological and alimentary factors.

OBJETIVO: La cuantificación de factores de riesgo cardiovascular (FRCV) en una población de adultos jóvenes permite identificar su vulnerabilidad y contribuye a focalizar estrategias de prevención en un grupo más susceptible de cambiar conductas y establecer hábitos de vida más saludables. Los objetivos de este estudio fueron describir los principales FRCV y estimar el riesgo mediante distintos modelos. METODOS: Estudio observacional, descriptivo, analítico y transversal. Se incluyó toda la población de ambos sexos ingresada en el centro, cuyas edades estuviesen comprendidas entre los 18 y 35 años a 15 de septiembre de 2017. Se recogieron variables sociodemográficas, antropométricas, y clínicas. Se realizó un análisis descriptivo y comparativo por sexo mediante técnicas estadísticas clásicas y modelos de regresión logística binaria. Se determinó riesgo cardiovascular mediante ecuaciones de Framingham, REGICOR, SCORE, DORICA y Q-RISK versión 2017. Todos los pacientes participantes dieron consentimiento autorizado. El proyecto fue aprobado por un Comité de Ética en Investigación Clínica. RESULTADOS: La población diana fue de 211 adultos jóvenes, no se pudo contactar con 6. La cohorte final fue de 205 suje- tos: hombres 170 (82,9%), mujeres 35 (17,1%). Media de edad 29,9 (IC 95%: 29,3-30,5). Estancia mediana 13,3 meses. FRCV mayores: Tabaquismo 82,0%; Dislipidemia 21,5%; Hipertensión 15,1%; Diabetes 2,0%. FRCV predisponentes: genéticos 46,3%; sedentarismo 38,0%; antecedentes familiares 17,6%; Trigliceridemia 16,6%; obesidad 13,2%. Otros: psicológicos 79,5%,alimentarios 72,2%; consumo cocaína 58,0%. Riesgo cardiovascular según Framingham: bajo 85,9%, ligero 12,9% moderado 1,2%. DORICA: bajo 87,6%, ligero 11,8%, moderado 0,6%. REGICOR: bajo 98,8% ligero 1,2%. CONCLUSIONES: Los factores de riesgo identificados fueron un alto consumo de tóxicos, la influencia de sedentarismo y los factores psicológicos y alimentarios.

Factores de riesgo cardiovascular en adultos jóvenes de un centro penitenciario / Cardiovascular risk factors in young adults of a penitentiary center

Fundamentos: La cuantificación de factores de riesgo cardiovascular (FRCV) en una población de adultos jóvenes permite identificar su vulnerabilidad y contribuye a focalizar estrategias de prevención en un grupo más susceptible de cambiar conductas y establecer hábitos de vida más saludables. Los objetivos de este estudio fueron describir los principales FRCV y estimar el riesgo mediante distintos modelos. Métodos: Estudio observacional, descriptivo, analítico y transversal. Se incluyó toda la población de ambos sexos ingresada en el centro, cuyas edades estuviesen comprendidas entre los 18 y 35 años a 15 de septiembre de 2017. Se recogieron variables sociodemográficas, antropométricas, y clínicas. Se realizó un análisis descriptivo y comparativo por sexo mediante técnicas estadísticas clásicas y modelos de regresión logística binaria. Se determinó riesgo cardiovascular mediante ecuaciones de Framingham, REGICOR, SCORE, DORICA y Q-RISK versión 2017. Todos los pacientes participantes dieron consentimiento autorizado. El proyecto fue aprobado por un Comité de Ética en Investigación Clínica. Resultados: La población diana fue de 211 adultos jóvenes, no se pudo contactar con 6. La cohorte final fue de 205 sujetos: hombres 170 (82,9%), mujeres 35 (17,1%). Media de edad 29,9 (IC 95%: 29,3-30,5). Estancia mediana 13,3 meses. FRCV mayores: Tabaquismo 82,0%; Dislipidemia 21,5%; Hipertensión 15,1%; Diabetes 2,0%. FRCV predisponentes: genéticos 46,3%; sedentarismo 38,0%; antecedentes familiares 17,6%; Trigliceridemia 16,6%; obesidad 13,2%. Otros: psicológicos 79,5%, alimentarios 72,2%; consumo cocaína 58,0%. Riesgo cardiovascular según Framingham: bajo 85,9%, ligero 12,9% moderado 1,2%. DORICA: bajo 87,6%, ligero 11,8%, moderado 0,6%. REGICOR: bajo 98,8% ligero 1,2%. Conclusiones: Los factores de riesgo identificados fueron un alto consumo de tóxicos, la influencia de sedentarismo y los factores psicológicos y alimentarios

Background: The quantification of the cardiovascular risk factors (CVRF) in a population of young adults, allows to identify their vulnerabilities and contributes to focus on prevention strategies in a group more susceptible of changing their behavior and establishing healthier daily habits. The objectives of this work were to describe the main CVRF and estimate the risk through different models. Methods: Observational, descriptive, analytical and cross-sectional study. All of the population of the centre of both genders, who were admitted and their age span from 18 to 35 as of the 15 September 2017, are included. Sociodemographic, anthropometric and clinical variables were gathered. A descriptive and a gender comparative analysis took place using classical statistical techniques and binary logistic regression analysis. It was determined that cardiovascular risk using Framingham's equation, REGICOR, SCORE, DORICA, and Q-RISK 2017 version. All of the patients who participated gave their authorizations and consent. The project was approved by a Committee of Ethics in Clinical Research. Results: The targeted population were 211 young adults, 6 members could not be contacted so the study held had a population of 205: 170 men (82.9%) and 35 women (17.1%). The average age is 29.9 (IC 95%: 29.3-30.5). The mean stay is 13.3 months. CVRF underlines: genetics 46.3%, sedentariness 38.0%; familiar backgrounds 17.6%; Triglyceridemic 16.6%; obesity 13.2%. Others: psychological 79.5%, eating disorders 72.2%, cocaine consumption 58.0%. Cardiovascular risk by Framingham: low 85.9%, light 12.9%, moderate 1.2%. DORICA: low 87.6%, light 11.8%, moderate 0.6%. REGICOR: low 98.8%, light 1.2%. Conclusions: The identified risk factors were high toxic consumption, influence of sedentary lifestyle and psychological and alimentary factors

Sentido de coherencia y mapa de activos para la salud en jóvenes presos de la Comunidad Valenciana en España.

Estudio realizado desde el enfoque de la salutogénesis que pretende determinar el sentido de coherencia (SOC) en jóvenes presos de la Comunidad Valenciana en España y elaborar un mapa de activos para la salud dirigido a promover la salud en esta población. Se utilizó el test "SOC-13" y un cuestionario de preguntas abiertas elaborado ad hoc, el cual autocompletaron los internos de 18 a 22 años de edad, de los tres centros penitenciarios de la región. Participaron 124 jóvenes varones (ya que no había ninguna mujer) y se recogieron variables sociodemográficas y penitenciarias. En el análisis cuantitativo, las variables categóricas se expresaron como frecuencias absolutas y relativas; y las cuantitativas, mediante medias con intervalos de confianza (IC) al 95%. Se realizó un estudio comparativo bivariante, utilizando las siguientes pruebas: Student t-test, análisis de variación (ANOVA), Wilcoxon y Ji-cuadrado. Del cuestionario de preguntas abiertas, se realizó un análisis cualitativo descriptivo temático de los activos identificados, clasificándolos en: internos (recursos personales, en relación con los demás y capacidad para realizar comportamientos saludables) y externos (personas, grupos, instituciones y espacios físicos, situados tanto dentro como fuera de prisión). La edad media fue de 21,1 años (IC 95%: 20,8-21,3); y el SOC de 52,4 (IC 95%: 50,5-54,3), de entre un valor mínimo de 13 y máximo de 91 para la prueba. Los internos del centro penitenciario que ofrecía más actividades escolares y deportivas obtuvieron una puntuación mayor en la dimensión de significatividad del SOC ( p = 0,024), y los internos inmigrantes presentaron un SOC superior ( p = 0,037) a los españoles, en los tres centros. Los jóvenes identificaron los activos internos que cualitativamente se vinculan con las dimensiones de comprensibilidad, manejabilidad y significatividad del SOC; y los activos externos, sobre todo los amigos, familiares y espacios relacionados con la actividad físico-deportiva, tanto dentro como fuera de prisión. Estos activos y sus interrelaciones podrían incorporarse al diseño de futuras intervenciones de promoción de la salud.

Cambios en las características clínico-epidemiológicas de los nuevos casos de infección por el VIH-1 en Castellón (España) y su repercusión en la presentación tardía (1987-2011) / Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)

OBJETIVO: Describir la evolución de las características clínico-epidemiológicas en una cohorte de pacientes infectados por el VIH-1 en Castellón (España), y su repercusión en la presentación tardía. MÉTODOS: Estudio descriptivo retrospectivo en el que se revisaron datos de la primera visita de pacientes infectados por el VIH-1 que consultaron desde 1987 a 2011. RESULTADOS: Durante el periodo de estudio se produjeron importantes cambios en las características de los 1.001 pacientes que consultaron por primera vez. La edad media pasó de ser de unos 30 años antes de 1996, a situarse alrededor de los 35 tras el periodo 2000-2002. El porcentaje de extranjeros pasó de ser < 2% antes de 1997 a representar el 50% en el periodo 2009-2011, y el de transmisión por drogas parenterales del 92,3% antes de 1988 a < 20% tras el periodo 2003-2005, con un descenso paralelo en la coinfección por VHC. La presentación tardía no experimentó cambios significativos, con una media del 47,1% en el periodo estudiado. Los factores asociados a este retraso en solicitar asistencia fueron: mayor edad, diagnóstico realizado a nivel hospitalario, mayor demora en el tiempo estimado entre infección y diagnóstico serológico, y en el tiempo entre diagnóstico serológico y primera visita. CONCLUSIÓN: En nuestro entorno, la epidemiología del VIH-1 ha cambiado considerablemente desde el inicio de la epidemia. El progresivo retraso en el diagnóstico serológico es una importante causa de la escasa variación en el porcentaje de presentaciones tardías, y evidencia el escaso impacto de las estrategias de diagnóstico precoz

OBJECTIVE: To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS: Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS: There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (< 2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS: The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies

[Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)]. / Cambios en las características clínico-epidemiológicas de los nuevos casos de infección por el VIH-1 en Castellón (España) y su repercusión en la presentación tardía (1987-2011).

OBJECTIVE: To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS: Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS: There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (<2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS: The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies.

[Clinical research and prisoners: coercion and grounds to participate]. / Investigación clínica y presos: coerción y motivos para participar.

AIM: To assess the coercion perceived, the quality of the information, and the reasons that lead prisoners to participate in clinical research. MATERIAL AND METHOD: Descriptive and multicenter study. Information was gathered on the social, demographic and penitentiary characteristics, perceived coercion, kind of information received and reasons that lead prisoners to take part in research. Both univariate and bivariate analyses were performed. Quantitative variables are expressed as mean or median, and qualitative ones as absolute numbers or percentages. Comparison between means is performed by a Student T-test, and between medians by a Mann-Whitney U-test. The research was approved by an accredited Ethical Research Committee. RESULTS: The sample comprises 110 prisoners from 11 different prisons, mean age 41.8 (40.4-43.2) years. Of these 105 were men and 8 non-Spanish. 83 prisoners (75.5%) opined they received high quality information about the clinical research; although, only 73 (66.4%) understood it completely. 104 (94.5%) felt no coercion and to 92.5% said they were guaranteed an anonymity. The reasons to be included in the research were: benefits for science (67.3%); benefit for future patients (65.5%); altruism (65.5%); possibility of improvement in the own illness (70%). Bivariate analyses showed no differences that depended on the length of the sentence or educational level. CONCLUSIONS: Spanish prisoners take part in clinical researches freely. The information provided on the research should be improved and be made more understandable. Altruism and benefits for the science are the principal reasons for participating in research.

[Causes and trends of mortality in a Spanish prison (1994-2009)]. / Causas y tendencia de la mortalidad en una prisión española (1994-2009).

BACKGROUND: There are a few mortality researches in prisons. To know this measure can to be important for take decisions of Public Health. The aim of the paper is to describe mortality and its trend in our prison. METHODS: This is a descriptive and retrospective study of the deaths between 01/01/1994 and 31/12/2009. Two periods of 8 years have been compared through exact test of Fisher in order to detect changes in causes of mortality. First of all, we made an indirect standardization of rates and compare mortality in our institution with other Spanish prisons. Through linear regression model we have settled in trends of mortality rates. RESULTS: Had 59 deaths, 58 in men with a median age 34.9 years old (28.7- 40.4). 64,4% were HIV+ . From 1994 to 2001 the main cause of mortality was VIH infection (48.6%) the second one was cardiovascular event (10.8%), while that between 2002 and 2009 this trend have change, cardiovascular event caused (31.8%) and VIH infection (22.07%) (p=0.026).The annual crude mortality rate decreased -0.485 deaths ‰ inmates/year (IC 95%: -0.864 to -0.107). Standardizing rates, we get 42 deaths expected for the wholly period, with Standarized Mortality Ratio of 1.407 (I.C. 95%: 1.071 to 1.816). CONCLUSIONS: The main cause of mortality has been no-HIV diseases, among these mainly cardiovascular events. The trend of mortality rate has been decreasing although we observe 40.7% plus of deaths than we would expect.

Causas y tendencia de la mortalidad en una prisión española (1994-2009) / Causes and trends of mortality in a Spanish prison (1994-2009)

Fundamento: El conocimiento de las causas de mortalidad puede ser una herramienta valiosa para procurar mejores cuidados de salud a las personas encarceladas. El objetivo del trabajo es describir la mortalidad y su tendencia en nuestro centro. Método: Estudio descriptivo de los fallecimientos ocurridos entre el 01/01/1994 y 31/12/2009. Se compararon mediante el test exacto de Fisher dos periodos de 8 años para valorar cambios en las causas de mortalidad. Previa estandarización indirecta de tasas, comparamos la mortalidad de nuestro centro con la del resto de las prisiones españolas. Mediante un modelo de regresión lineal establecimos la tendencia de las tasas de mortalidad. Resultados: Hubo 59 defunciones, 58 en hombres, con una mediana de edad de 34,9 años (28,7- 40,4). El 64,4% eran VIH+. Desde 1994 hasta 2001 la principal causa de mortalidad fue la infección VIH (48,6%) y la segunda los eventos cardiovasculares (10,8%), mientras que entre 2002 y 2009 los eventos cardiovasculares causaron un 31,8% y la infección VIH un 22,7% (p=0,026). Las tasas crudas de mortalidad anual tuvieron tendencia descendente a razón de 0,485 muertes internos/año (IC 95%: 0,864 a -0,107). Estandarizando tasas corresponderían 42 muertes esperadas en todo el período, con una Razón de Mortalidad Estandarizada de 1,407 (IC 95%: 1,071 a 1,816). Conclusiones: La principal causa de mortalidad fue la enfermedad no-VIH, fundamentalmente por eventos cardiovasculares. La tendencia de la tasa de mortalidad fue descendente, aunque observamos un 40,7% más de defunciones de las que cabría esperar (AU)

Background: There are a few mortality researches in prisons. To know this measure can to be important for take decisions of Public Health. The aim of the paper is to describe mortality and its trend in our prison. Methods: This is a descriptive and retrospective study of the deaths between 01/01/1994 and 31/12/2009. Two periods of 8 years have been compared through exact test of Fisher in order to detect changes in causes of mortality. First of all, we made an indirect standardization of rates and compare mortality in our institution with other Spanish prisons. Through linear regression model we have settled in trends of mortality rates. Results: Had 59 deaths, 58 in men with a median age 34.9 years old (28.7- 40.4). 64,4% were HIV+ . From 1994 to 2001 the main cause of mortality was VIH infection (48.6%) the second one was cardiovascular event (10.8%), while that between 2002 and 2009 this trend have change, cardiovascular event caused (31.8%) and VIH infection (22.07%) (p=0.026).The annual crude mortality rate decreased -0.485 deaths inmates/year (IC 95%: -0.864 to -0.107). Standardizing rates, we get 42 deaths expected for the wholly period, with Standarized Mortality Ratio of 1.407 (I.C. 95%: 1.071 to 1.816). Conclusions: The main cause of mortality has been no-HIV diseases, among these mainly cardiovascular events. The trend of mortality rate has been decreasing although we observe 40.7% plus of deaths than we would expect (AU)

La sanidad penitenciaria en imágenes: Escabiosis / No disponible

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