Episodes of voluntary total fasting (hunger strike) in Spanish prisons: A descriptive analysis.

OBJECTIVE: To provide a description of the frequency and main features of the episodes of voluntary total fasting (VTF) taking place in Spanish prisons. MATERIAL AND METHODS: Information on the episodes of VTF reported between 04/01/2013 and 03/31/2014 was gathered. Once the appropriate informed consent was given, other data on social, demographic, penitentiary and clinical aspects were collected. A descriptive study of such variables together with a bivariate analysis was then carried out by means of standard statistical techniques and binary logistic regression models. IBM SPSS Statistics v.20 software was used for this purpose. This study was approved by an accredited Clinical Research Ethics Committee. RESULTS: 354 episodes of VTF took place among an average population of 29,762 prisoners. Therefore, the incidence rate was 11.9 VTF episodes per ‰ inmates-year. Informed consent (IC) was given in 180 cases (50.8%). 114 were of Spanish nationality and the average age was 38.7 years old (95% CI 37.2-40.1). The median duration of the episodes was 3 days (IQR 1-10), ranged between 1 and 71 days. The main reason was a disagreement on the decisions of treatment groups (57 cases, 31.7%). The average weight loss was 1.3 kg (70.8 vs. 69.5; p < 0.0001) and 0.7 of the BMI (24.5 vs. 23.8; p < 0.0001). 60 prisoners (33.3%) lost no weight at all and only 8 (4.4%) lost over 12% of the basal weight (8.5 kg). Ketone smell was identified in 61 cases (33.9%) and ketonuria in 63 (35%). CONCLUSIONS: Only one third of those who go on hunger strike in prison actually fast. Revindicative episodes of voluntary total fasting are somewhat common in Spanish prisons, but rarely are they carried out rigorously and entail a risk for those who fast.

Professional deontology and medical practice in prisons.

OBJECTIVE: To study the knowledge on professional deontology amongst doctors in prisons. MATERIALS AND METHOD: Descriptive, transversal and multi-centre study. Labour, collegiate, social, demographic and deontological variables were collected. A descriptive analysis of the variables was performed. A bivariate analysis was made by binary logistic regression models, attending to the odds ratio, and assuming a 95% confidence interval. Data was processed by SPSS v.20 software. RESULTS: 118 doctors replied. 68 men (57.6%), with an average age of 51 years (50-53). 100 know about the Deontology Committee (84.7%), but just 77 (65.3%) know its functions properly. 42 (35.6%) know about the existence of the Deontological Code, and 37 (31.3%) have read and apply it. Those who made a correct definition of deontology do find more deontological issues in their daily work [23(46.9%) vs. 18(26.1%); OR: 2.506; IC95%: 1.153-5.451; p=0.020] and would denounce a colleague more often to the Medical Association [40(81.6%) vs. 42 (60.9%); OR: 2.857; IC95%: 1.197-6.819; p=0.018]. Older ones know more about the deontology commissions' functions [54(73%) vs. 23(52.3%); OR: 2.465; IC95%: 1.127-5.394; p=0.024] and have already denounced situations to the Medical Association [27(36.5% vs. 5(11.4%); OR: 4.481; IC95%: 1.577-12.733; p=0.005], but think that a different Care Ethics Committee is unnecessary [57(77%) vs. 42(95.5%); OR: 0.160; IC95%: 0.035- 0.729; p=0.018]. CONCLUSIONS: Prison doctors know little about what professional deontology really is. This knowledge increases with age in the profession and is associated with an increased perception of deontological issues in daily practice.

[Prevalence of chronic diseases and risk factors among the Spanish prison population]. / Prevalencia de patologías crónicas y factores de riesgo en población penitenciaria española.

BACKGROUND: chronic diseases are responsible for 60% of deaths and 75% of spending on public health. There are few works on the prevalence of this type of pathology in prison. OBJECTIVE: Describe the prevalence of chronic major diseases in the population and the major risk factors observed. METHODS: Multicenter transversal descriptive study. The sample size was 1,170 people, who were selected through sampling stratified with simple allocation by strata among 9 prisons in the country. There were interviews and physical examinations between May and June 2013. Variables were collected: socio-demographic, diagnostic, anthropometric, clinical-analytical and risk factors. A descriptive and subsequent comparative analysis was carried out using non-parametric tests for quantitative variables using the Mann-Whitney test and a Ji-square test for categorical variables. Subsequently, binary logistic regression models to evaluate the influence of factors of risk in major pathologies. The manuscript was approved by the Ethics Committee for clinical research of the University General Hospital of Castellon. RESULTS: 1 of every 2 inmates has some type of chronic disease out of the 1,077 participated (92.1). Median age of 37.4 years IQR (30.0 to 44.8). 95 males, 40.6 foreigners. Prevalence: dyslipidemias (34.8); arterial hypertension (17.8); Diabetes (5.3); asthma (4.6); COPD (2.2); ischaemic heart disease (1.8) and (1.5) cardio-circulatory pathologies. Main risk factors: smoking, obesity, abdominal fat distribution, consumption of cocaine and age. CONCLUSIONS: It would be interesting to establish early diagnosis, encourage giving up smoking, and physical activity and dietary advice to combat the major modifiable risk factors.

[Sense of coherence and health assets in a youth center for minors]. / Sentido de coherencia y activos para la salud en jóvenes internos en centros de menores

OBJECTIVES: To determine the Sense of Coherence (SOC) amongst young people at 2 Youth Detention Centres in Valencia, the views of professionals on SOC and how young people identify health assets. MATERIALS AND METHODS: 45 young people answered the SOC-13 test. Categorical variables were expressed as absolute and relative frequencies, while the quantitative ones were expressed via means with confidence intervals (CI) at 95%. We designed and conducted a group interview with 5 teenage inmates and an open-ended questionnaire for six professionals. We performed an analysis based on content and categories. RESULTS: Mean SOC score is 54.4 (95% CI 53.9 to 59.8). Regarding the size of the test, manageability, 17.6 (95% CI 16.5 to 18.8); comprehensibility, 19.6 (95% CI: 18.1, 21.1) and meaningfulness, 17,1 (95% CI: 16.0 to 18.2). Young people identify internal assets such as "sport" and "being positive" and external assets such as "persons (family and friends)" and "spaces related to physical activity". Professionals believe that SOC places value on aspects that are relevant to the life of the centre and that young people obtain a moderate score. DISCUSSION: The SOC level obtained is moderate and similar to other populations. The results show limitations linked to acquisition of the sample, but also indicate scope for further research on SOC, and on the differences between youth cultures, SOC and identified health assets. Assets could be given further impetus by young people themselves with support from professionals, family and the community environment.

[Changes in the use of hospital resources from prison: a 16 year study]. / Cambios en el uso de recursos hospitalarios desde la prisión: un estudio de 16 años.

OBJECTIVE: To describe hospital morbidity caused by the inmates of our prison over the past 16 years. MATERIAL AND METHODS: retrospective study of hospital admissions between 01-01-1994 and 31-12-2009, divided into four periods. Socio-demographic variables were collected: duration of stay and discharge diagnosis. Quantitative variables were described as means and medians and qualitative variables as absolute and relative frequencies. A mean comparison was performed on quantitative variables and qualitative proportions. For equal variances, an ANOVA test was performed with linear trend study of encoding the variable "period" with orthogonal contrasts. Without equality of variances, comparisons were made using the Kruskal-Wallis test, and tendencies by means of the nonparametric Jonckheere-Terpstra test. For qualitative variables we used the Pearson Chi-Square, evaluating the trend with the chi-square for linear trend. RESULTS: 625 patients generated 996 admissions with no temporal variation. The median age is 33 years, with an upward trend (29 years to 38, p <0.0001). 47.9% were HIV + [(63.3% to 35.9%), p <0.0001]. The average stay was 9.6 days (95% CI 8.8 to 10.4) [11.9 (10.0 to 13.9) 9.6 (8.8 to 10.4), p = 0.002]. The frequency of internal and year 1000 remained unchanged (111.6 to 87.9, p = 0.366). The days of hospitalization decreased (3066 to 2442, p = 0.049)) and the average admitted per day (2.1 to 1.7, p = 0.049). CONCLUSIONS: The use of hospital resources from prison is constant. The way they use it has changed along with the pathology that causes it. HIV is no longer the primary pathology.

[Description of the psychiatric unit in prisons in the autonomous community of Valencia]. / Descripción de la consulta psiquiátrica en centros penitenciarios de la Comunidad Valenciana.

INTRODUCTION: Little work has been done on the contents of psychiatric consultancies in prisons. AIMS: To explore the sociodemographic, clinical and treatment profile of the patients who were assessed in the psychiatric consultancy of three prisons. METHODS: This is a prospective, longitudinal, descriptive and multicenter-based epidemiological study of patients who were assessed in the psychiatric consultacy of three prisons in the Autonomous Community of Valencia from 2009 to 2011. Sociodemographic, clinical and prison data was obtained from each patient. Their frequency was compared with Pearson's Ji² and averages with the ANOVA test or with The Kruskall-Wallis method. The probability of keeping the patients in schedule was calculated with Kaplan-Meier's curves and differences with the Mantel-Haenzsel method (Logrank) were established. A logistic regression model was designed to determine the data linked to frequent users. RESULTS: 786 patients were assessed in 2,006 visits (2.5 visits/patient). 90% were male, 88.2% Spanish and their average age was 36 years. 29.9% suffered from an infectious chronic pathology. 69.5% used some kinds of substance. 59.2% suffered from personality disorder and 11.6% from the spectrum of schizophrenia. The most frequent medical profiles were: 49.1% with anxiety disorder, 20.8% depressive disorder and 11.7% psychotic disorder. These psychotic disorders meant a greater probability of 1.5 times for maintaining in schedule. The most commonly prescribed medications were quetiapine, mirtazapine, pregabalin and diazepam. CONCLUSION: There is a high prevalence of mental disorders in prisons. It is necessary to improve the available resources to deal with these pathologies in the most effective way.

[Vascular risk factors in HIV-infected patients in a penitentiary center]. / Factores de riesgo vascular en pacientes infectados por el VIH en un centro penitenciario.

OBJECTIVE: There is little data regarding vascular risk factors (VRF) in HIV-infected inmates. In this study, we have studied the prevalence of VRF in HIV-infected patients, analyzing the differences with a non-infected population. PATIENTS AND METHOD: HIV-infected inmates (n=80) and two non-HIV controls selected for each patient and matched for age and sex (n=160) were included in a descriptive cross-sectional study. We analyzed the VRF, and risk was assessed according to the SCORE, Framingham and REGICOR functions. RESULTS: In the studied population (mean age: 38.1 years; 92.5% men), HIV-infected patients had a significantly higher prevalence of cigarette smoking (97.5 vs 78.8%), diabetes (8.8 vs 1.3%), serum triglyceride s>150 mg/dl (43.8 vs 26.3%), low HDL-cholesterol levels (61.3 vs 40.6%), HCV infection (87.5 vs 22.5%), and cocaine consumption (77.5 vs 39.4%). The non-infected group had significantly higher prevalence of total cholesterol>200mg/dl and/or LDL-cholesterol >130 mg/dl (45.6 vs 28.8%), obesity (14.4 vs 2.5%), sedentary lifestyle (67.5 vs 42.5%) and increased waist circumference (14.4 vs 3.8%). All the evaluated inmates were considered to be at a low risk by SCORE and REGICOR, and 1.3% to be at a high risk by Framingham in both groups. CONCLUSION: The prevalence of VRF in HIV-infected patients of the studied prison was much higher to that of the HIV-negative subjects. However, the estimation of the cardiovascular risk was low.

[Multi-centre study of the prevalence of latent tuberculosis infection amongst inmates in Spanish prisons]. / Estudio multicéntrico de prevalencia de infección tuberculosa latente en los internados en prisiones españolas.

AIMS: To study the prevalence of latent tuberculosis infection (LTBI) amongst inmates in Spanish prisons. MATERIALS AND METHODS: Multi-centre, cross-sectional study; two stage sampling. Socio-demographic, prison and clinical variables were gathered. A univariate, bivariate and multivariate analysis was carried out using logistic regression with the variables that showed statistical significance. The odds ratio was calculated with a confidence interval of 95%. RESULTS: 378 patients. The Mantoux test (PPD) assessable in 90.2% was available. 91.2% men, 37.8% foreigners with average age of 35.9±10.3 years. Average stay in prison: 2 years, 28.7% had been > 5 years in prison. 49.6% entered prison in 2006 or before. 24.5% had a history of intravenous drug use (IDU). 50.4% presented LTBI that was associated with: age > 40 years (63.2 vs 43.8%; CI: 1.39-3.49; OR: 2.20; p=0.001); stay of > 5 years in prison (71.2 vs 41.3%; CI: 2.13-5.75; OR: 3.50; p<0.001); in prison since 2006 or before (58.1 vs 42.6%; CI: 1.22-2.88; OR:1.87; p=0.004); infected with HCV+ (66.3 vs 45.3%; CI:1.40-4.0; OR: 2.37; p=0.001). The logistic regression model confirmed the independent association of LTBI with: a) age > 40 years (OR: 1.76; CI: 1.08-2.87; p=0.024); and length of prison stay > 5 years (OR: 2.50; CI: 1.41-4.43; p=0.002). CONCLUSIONS: The prevalence of LTBI in prison is very high, especially amongst inmates over 40 and those who have been in prison for more than five years. To prevent the risk of progression to tuberculosis, treatment is recommended for those who require it along with the maintenance of control programmes for this pathology.

[Job satisfaction of nursing staff in Spanish prisons]. / Satisfacción laboral de la enfermería en las prisiones españolas.

BACKGROUND: There are no available studies assessing job satisfaction amongst nursing staff in Spanish prisons. The aim of this study is to establish overall levels of job satisfaction and determine each of the components. METHOD: Cross-sectional and multi-centre descriptive study conducted in Spanish prisons. A Font Roja satisfaction questionnaire adapted by J. Arranz for the study was used to measure degrees of job satisfaction using a Likert's scale. A parametric test was used and a regression model was constructed for predictive ends. RESULTS: 376 nurses answered the questionnaire (Participation Rate 62.7%; Response Rate 76.7%) 67 centres took part (91.8%). The average satisfaction mark was 2.84 (CL 95%: 2.81-2.87). The lowest ranked components were job variety 1.66 (CL 95%: 1.58-1.74), job-related stress 2.15 (CL 95%: 2.08-2.23) and control over job 2.77 (CL 95%: 2.73-2.82). The highest ranked aspect was job satisfaction, averaging 3.52 (CL 95%: 3.44-3.58). CONCLUSIONS: The average satisfaction mark for prison nursing staff was low when compared to other groups of health care professionals, which implies the need for corrective measures.