[Comprehensive care program for the mentally ill in Spanish prisons (PAIEM): assessment after four years operation]. / Programa de Atención Integral al Enfermo Mental en las prisiones españolas (PAIEM): valoración tras cuatro años de funcionamiento.

OBJECTIVE: To assess the comprehensive care program for the mentally ill in prison (PAIEM), which has been implemented for 3 years in Spanish prisons with the aim of improving processes and results. METHODS: Descriptive study of the data gathered from an anonymous questionnaire completed by members of the PAIEM team in prisons. Frequency distributions were obtained of all the variables relating to facts, attitudes, opinions, experiences, situations and processes of the PAIEM. RESULTS: 91.2% of the PAIEM teams responded. Psychologists, educators, doctors and social workers were the professionals that collaborated most actively in the PAIEM (73%-84%) and were the ones to act most frequently as tutors. The mentally ill are usually located in ordinary modules (80%). The most commonly used activities for their psycho-social rehabilitation are self care (73%), education for health, preparation for daily life and social skills (more than 60%). Interventions with families are basically by telephone (79%). Bivariate analysis showed that the PAIEMs that operate most effectively are those that coordinate well with other technical teams, that prepare referral more than six months prior to release and ones where the NGOs process the referrals. Over 71% of the professionals observed improvements of disabilities and needs in over half the patients more than half of the professionals involved are satisfied (3.4/5) with their participation, although they acknowledge that there is a greater work load. CONCLUSIONS: The activities of the PAIEM are adequate, especially in the phases of early detection, stabilisation and rehabilitation and less so in the social incorporation phase, which improves when the third sector intervenes in referrals of patients to the social health care network outside prison.

Programa de Atención Integral al Enfermo Mental en las prisiones españolas (paiem ). Valoración tras cuatro años de funcionamiento / Comprehensive Care Program for the Mentally ill in spanish prisons (paiem ). Assessment after four years operation

Objetivo: Evaluar el programa de atención integral a los enfermos mentales (PAIEM) implantado desde hace 3 años en las prisiones españolas, con el fin de mejorar su funcionamiento y resultados. Metodología: Estudio descriptivo de los datos recogidos en un cuestionario anónimo cumplimentado por los miembros del equipo PAIEM de los centros penitenciarios. Se obtuvieron distribuciones de frecuencia de todas las variables acerca de hechos, actitudes, opiniones, experiencias, situaciones y procesos del PAIEM. Resultados: Han respondido el 91,2% de los equipos del PAIEM. Psicólogos, educadores, médicos y trabajadores sociales son los profesionales que colaboran más activamente en el PAIEM (73%-84%) y los que con más frecuencia ejercen como tutores. Los enfermos mentales se ubican habitualmente en módulos ordinarios (80%). Las actividades más utilizadas para su rehabilitación psicosocial son autocuidados (73%) y educación para la salud, preparación para la vida diaria y habilidades sociales con más del 60%. Las intervenciones con las familias son básicamente por contacto telefónico (79%). En el análisis bivariante se demuestra que los PAIEM que mejor funcionan son los que tienen una buena coordinación con el resto de los equipos técnicos, los que preparan la derivación con más de seis meses previos a la libertad y en los que las ONG’s tramitan las derivaciones. Más del 71% de los profesionales observan mejoras en carencias y discapacidades en más de la mitad de los enfermos y están mayoritariamente satisfechos (3,4/5) de su participación, aunque reconocen mayor carga de trabajo. Conclusiones: Las actividades del PAIEM son adecuadas, en especial en las fases de detección precoz, estabilización y rehabilitación y menos en la fase de reincorporación social que mejora cuando interviene el tercer sector en las derivaciones del enfermo a la red sociosanitaria extrapenitenciaria (AU)

Objective: To assess the comprehensive care program for the mentally ill in prison (PAIEM), which has been implemented for 3 years in Spanish prisons with the aim of improving processes and results. Methods: Descriptive study of the data gathered from an anonymous questionnaire completed by members of the PAIEM team in prisons. Frequency distributions were obtained of all the variables relating to facts, attitudes, opinions, experiences, situations and processes of the PAIEM. Results: 91.2% of the PAIEM teams responded. Psychologists, educators, doctors and social workers were the professionals that collaborated most actively in the PAIEM (73%-84%) and were the ones to act most frequently as tutors. The mentally ill are usually located in ordinary modules (80%). The most commonly used activities for their psycho-social rehabilitation are self care (73%), education for health, preparation for daily life and social skills (more than 60%). Interventions with families are basically by telephone (79%). Bivariate analysis showed that the PAIEMs that operate most effectively are those that coordinate well with other technical teams, that prepare referral more than six months prior to release and ones where the NGOs process the referrals. Over 71% of the professionals observed improvements of disabilities and needs in over half the patients more than half of the professionals involved are satisfied (3.4/5) with their participation, although they acknowledge that there is a greater work load. Conclusions: The activities of the PAIEM are adequate, especially in the phases of early detection, stabilisation and rehabilitation and less so in the social incorporation phase, which improves when the third sector intervenes in referrals of patients to the social health care network outside prison (AU)

[Characteristics of cases of infectious syphilis diagnosed in prisons, 2007-2008]. / Características de los casos de sífilis infecciosa diagnosticados en Instituciones Penitenciarias, 2007-2008.

OBJECTIVE: To describe the characteristics of cases of syphilis amongst prison inmates. MATERIALS AND METHODS: Descriptive study. Confirmed cases of primary, secondary and early latent syphilis were identified in prisons in Spain during 2007-2008. Socio-demographic and clinical information, as well as variables related to transmission, was collected by the attending physicians in a standard form. Frequency distributions of each variable were performed. Annual incidence rates were calculated. To evaluate the association between qualitative variables, the χ² and Fisher's exact tests were used; the Mann-Whitney test was utilized to compare quantitative variables. RESULTS: During the study period, 94 syphilis cases were identified (35.1% primary, 20.2% secondary and 44.7% early latent). The incidence rates were 0.9 cases/1000 prisoners in 2007 and 0.7 cases/1000 prisoners in 2008. Most cases were male (90.4%), between 31-40 years old (30.9%) and foreigners (52.1%). The majority of patients were diagnosed through screening (80.9%). Heterosexual contact was the most frequent transmission route (83.0%). Overall HIV prevalence was 5.3%, and 16.0% of the patients had a history of previous sexually transmitted infections (STI). Almost 40% of the cases reported being a client of a sex worker. CONCLUSIONS: Incidence of syphilis in prison is high. Many syphilis patients were detected through screening, highlighting the role of the Spanish prison health service in STI control.

Características de los casos de sífilis infecciosa diagnosticados en Instituciones Penitenciarias, 2007-2008 / Characteristics of cases of infectious syphilis diagnosed in Prisons, 2007-2008

Objetivo: Describir las características de los casos de sífilis en internos de prisiones. Material y Método: Estudio descriptivo de los casos confirmados de sífilis primaria, secundaria y latente precoz diagnosticados en prisiones españolas (2007-2008). Se recogieron variables sociodemográficas, clínicas y relacionadas con la transmisión en un cuestionario estandarizado cumplimentado por los médicos de los centros. Se obtuvieron distribuciones de frecuencia de las variables cualitativas y la media y desviación estándar para la edad. Se calculó la tasa de incidencia anual por mil internos. Para evaluar la asociación entre variables cualitativas se utilizaron las pruebas de ji-cuadrado y exacta de Fisher y la de U de Mann-Whitney para las cuantitativas. Resultados: Se identificaron 94 casos de sífilis (35,1% primaria, 20,2% secundaria y 44,7% latente precoz). La tasa de incidencia fue 0,9 y 0,7 casos/1.000 internos en 2007 y 2008, respectivamente. La mayoría de enfermos fueron hombres (90,4%), entre 31 y 40 años (30,9%) y extranjeros (52,1%). El 80,9% de los diagnósticos se realizaron por cribaje. Un 5,3% presentó coinfección con el VIH y el 16% refería haber tenido infecciones de transmisión sexual (ITS) previamente. El mecanismo de transmisión más probable fueron las relaciones heterosexuales (83,0%); la situación de riesgo más común para la adquisición de sífilis fue ser cliente de prostitución (39,4%). Conclusiones: La incidencia de sífilis en prisión es elevada. La oferta de screening de sífilis ha permitido detectar pacientes que no estaban siendo tratados y pone de manifiesto la importancia del sistema penitenciario en el control de las ITS(AU)

Objective: To describe the characteristics of cases of syphilis amongst prison inmates. Materials and Methods: Descriptive study. Confirmed cases of primary, secondary and early latent syphilis were identified in prisons in Spain during 2007-2008. Socio-demographic and clinical information, as well as variables related to transmission, was collected by the attending physicians in a standard form. Frequency distributions of each variable were performed. Annual incidence rates were calculated. To evaluate the association between qualitative variables, the ÷2 and Fisher’s exact tests were used; the Mann-Whitney test was utilized to compare quantitative variables. Results: During the study period, 94 syphilis cases were identified (35.1% primary, 20.2% secondary and 44.7% early latent). The incidence rates were 0.9 cases/1000 prisoners in 2007 and 0.7 cases/1000 prisoners in 2008. Most cases were male (90.4%), between 31-40 years old (30.9%) and foreigners (52.1%). The majority of patients were diagnosed through screening (80.9%). Heterosexual contact was the most frequent transmission route (83.0%). Overall HIV prevalence was 5.3%, and 16.0% of the patients had a history of previous sexually transmitted infections (STI). Almost 40% of the cases reported being a client of a sex worker. Conclusions: Incidence of syphilis in prison is high. Many syphilis patients were detected through screening, highlighting the role of the Spanish prison health service in STI control(AU)

[Description of the first three notified outbreaks of influenza A (H1N1) 2009 in Spanish prisons]. / Descripción de los tres primeros brotes de gripe A (H1N1) 2009 notificados en prisiones de España.

AIM: This study describes three reported outbreaks of influenza H1N1 2009 in Spanish prisons between july and september 2009. METHODS: An outbreak was defined as the appearance of three or more cases with influenza symptoms and with an epidemiological link in the same module of a prison. The outbreaks were reported using a specific questionnaire. The analysis, which used variables of gender, age, date of notification, duration of outbreak, risk factors and clinical features are presented as absolute numbers, percentages and attack rates, while study of the diffusion of the illness is expressed as epidemic curves. RESULTS: Three outbreaks were reported at the prisons of Alcala-Meco (85 affected males), Pamplona (18 affected males) and Jaen (12 affected females) with an overall attack rate that ranged from 7.1% to 17.9%. Duration of the outbreaks was between 8 and 35 days, and the average duration of the illness itself was 3 days. Only 4 inmates were admitted who were later given discharges for recovery. The men were younger (p<0.001). The epidemiological curves of the outbreaks did not show any clear propagation patterns. DISCUSSION: The attack rates are highly variable although they are lower than other community outbreaks. Symptoms were slight and lethality was zero. The women's age was significantly greater that that of the men, although it is practically the same amongst the prison population. Low morbidity was very probably the cause of the reduction in consultations of the persons affected and the consequent underestimation of the rates.

Descripción de los tres primeros brotes de gripe A (H1N1) 2009 notificados en prisiones de España / Description of the first three notified outbreaks of influenza A (H1N1) 2009 in Spanish prisons

Objetivo: describir los tres primeros brotes de gripe A (H1N1) 2009 notificados entre julio y septiembre de 2009 en lasprisiones españolas.Metodología: Se definió brote como la aparición de tres o más casos con síntomas gripales y con vínculo epidemiológico enel mismo módulo de una prisión. Los brotes son notificados mediante cuestionario específico. El análisis realizado por las variablessexo, edad, fecha de notificación, duración de los brotes, factores de riesgo y características clínicas se presenta en forma denúmeros absolutos, porcentajes y tasas de ataque y el estudio de la difusión de la enfermedad a través de las curvas epidémicas.Resultados: Se notifican tres brotes desde las prisiones de Alcalá-Meco con 85 varones afectados, Pamplona (18 varonesafectados) y Jaén (12 mujeres afectadas) con una tasa de ataque global que varía entre el 7,1% y el 17,9%. La duración de los brotesvaría entre 8 y 35 días, y la mediana de duración de la enfermedad es de 3 días. Sólo ingresaron 4 internos que fueron dadosde alta por mejoría. Los hombres son mas jóvenes (p<0,001). Las curvas epidémicas de los tres brotes no muestran un patrón depropagación evidente.Discusión: Las tasas de ataque son muy variables aunque bajas en comparación con otros brotes comunitarios. La enfermedadpresentó sintomatología leve y con nula letalidad. La edad de las mujeres es significativamente mayor que la de los hombresaunque entre la población ingresada en prisión es prácticamente igual. La baja morbilidad seguramente ha provocado unadisminución en la consulta de los afectados y por tanto una infravaloración de las tasas(AU)

Aim: This study describes three reported outbreaks of influenza H1N1 2009 in Spanish prisons between july and september2009.Methods: An outbreak was defined as the appearance of three or more cases with influenza symptoms and with an epidemiologicallink in the same module of a prison. The outbreaks were reported using a specific questionnaire. The analysis, which usedvariables of gender, age, date of notification, duration of outbreak, risk factors and clinical features are presented as absolute numbers,percentages and attack rates, while study of the diffusion of the illness is expressed as epidemic curves.Results: Three outbreaks were reported at the prisons of Alcala-Meco (85 affected males), Pamplona (18 affected males) andJaen (12 affected females) with an overall attack rate that ranged from 7.1% to 17.9%. Duration of the outbreaks was between 8and 35 days, and the average duration of the illness itself was 3 days. Only 4 inmates were admitted who were later given discharpegesfor recovery. The men were younger (p<0.001). The epidemiological curves of the outbreaks did not show any clear propagationpatterns.Discussion: The attack rates are highly variable although they are lower than other community outbreaks. Symptoms wereslight and lethality was zero. The women’s age was significantly greater that that of the men, although it is practically the sameamongst the prison population. Low morbidity was very probably the cause of the reduction in consultations of the persons affectedand the consequent underestimation of the rates(AU)

Investigación en Sanidad Penitenciaria: Evolución de las comunicaciones presentadas en los Congresos, 1993-2004 / Prison health care investigation: Development in communications presented to year 1993-2004 conferences

Objetivo: Describir la participación de los profesionales sanitarios que trabajan en el ámbito penitenciario, en los Congresos de la Sociedad Española de Sanidad Penitenciaria (SESP), a través de las comunicaciones presentadas y conocer los aspectosde la salud que más les interesan.Material y método: Análisis de las comunicaciones presentadas a los Congresos de Sanidad Penitenciaria de 1993, 1998, 2002 y 2004. Se ha calculado la distribución de las comunicaciones por años, comunidades autónomas y centros de trabajo de los autores. Se han identificado 12 áreas temáticas de interés y se analiza su evolución en el tiempo.Resultados: Se han presentado un total de 322 comunicaciones a los cuatro congresos analizados. La comunidad autónoma con más trabajos es Cataluña, 126 (39,1%), seguida por Madrid con 67 (20,8%), Comunidad Valenciana con 36 (11,2%) y Andalucía con 26 (8,1%). El 75% de los trabajos (n = 200) lo aportan 18 centros penitenciarios. En 267 comunicaciones (82,9%) el primer autor era un profesional de un centro penitenciario y en 54 (16,8%) de uno extrapenitenciario. Las comunicacioneshan sido realizadas por 1.475 autores, 1.142 de centros penitenciarios (77,4%) y 318 (27,9%) de instituciones extrapenitenciarias. De las áreas temáticas definidas, el primer lugar lo ocupa la infección VIH/SIDA con el 21,4% de las comunicaciones, seguida por drogas/metadona (14,0%), gestión/calidad asistencial (11,8%), salud mental (11,8%) y tuberculosis (11,2%).Discusión: Se mantiene una participación consistente en los Congresos de Sanidad Penitenciaria, tanto en cuanto al número de estudios como al de autores. La mayor parte de los trabajos se llevan a cabo en un número reducido de centros y el tamaño del equipo sanitario no se muestra decisivo en la actividad investigadora. Las materias que se han tratado con más frecuenciacoinciden con las patologías más prevalentes en las prisiones. Conforme ha descendido la epidemia por VIH/SIDA otros temas han emergido, como la gestión, calidad asistencial o la patología en inmigrantes. Es necesario establecer estrategias que estimulen la investigación en las prisiones especialmente en aquellas áreas geográficas donde menos se produce

Objective: To describe the participation of health professionals who work in Spanish prisons, in the Conferences of the Spanish Society of Prisons Health (SESP), through the communications they present, and also to describe the health topics they are interested in.Methods: We analysed the communications presented to years 1993, 1998, 2002 and 2004 Conferences. The distribution of number of communications by year, region and prison were calculated. Twelve areas of interest were identified and their time evolution was analysed.Results: A total of 322 communications were presented in the four Conferences analysed. Cataluña was the first region in number of communications, 126 (39.1%), followed by Madrid with 67 (20.8%), Comunidad Valenciana with 36 (11.2%) and Andalucía with 26 (8.1%). A percentage of 75% communications (n = 200) were done in 18 prisons. The first author of 267 communications (82.9%) was from a prison and of 54 (16.8%) was from another centre (hospital, university, etc.). A totalof 1475 authors were identified, 1142 from prisons (77.4%) and 318 (27.9%) from other centres. The main topic was HIV/AIDS in 21.4% of the communications, followed by drugs/methadone (14.0%) management/health care quality (11.8%), mental health (11.8%) and tuberculosis (11.2%).Discussion: The participation in the Conferences of the SESP is consistent regarding both, the number of communications and the number of authors. Most studies have been done in a small group of prisons and the size of the medical team has not relation with the level of investigation activity. The topics most frequently analysed are related to prevalent diseases in prisons. However, as the HIV/AIDS epidemic declined so increased the interest in other topics such as management, healthcare quality or immigrant’s health. It is necessary to encourage health investigation in prisons especially in some geographical areas with little investigation work

[Cases of neurological symptoms associated with star anise consumption used as a carminative]. / Casos de enfermedad de sintomatología neurológica asociados al consumo de anís estrellado empleado como carminativo.

BACKGROUND: Since March 2000, a series of infants with serious gastrointestinal and neurological symptoms have been observed in Spain. These symptoms were suspected to be associated with the use of star anise infusion. We performed an epidemiological study to determine the characteristics of these patients and to evaluate the association between the symptoms and anise consumption. METHOD: From February to September 2001, a matched case-control study (1:2) was performed among infants aged less than 3 months admitted to the pediatric emergency departments of two hospitals in Madrid. Mantel-Haenszel and conditional logistic regression odds ratios (OR) were calculated to quantify the association and the dose-response relationship. Laboratory analyses of the implicated substances were performed. RESULTS: Twenty-three cases were studied. The mean age was 29.2 days (SD: 25.5). The symptoms observed were irritability, abnormal movements, vomiting and nystagmus. Eighteen cases and 36 controls were included in the case-control study. Nine controls (25 %) consumed anis infusion (consumption was high in five and low in four). The Mantel-Haenszel OR was 18.0 (2.03-631) and the OR for the dose-response relationship was 11.7 (95 % CI: 1.3-188.5) for low levels of consumption and 18.2 (95 % CI: 1.8-183.5) for high levels. Laboratory analyses revealed contamination of Illicium verum by Illicium anisatum. CONCLUSIONS: This study confirms the association between the symptoms described and the use of anise infusion. The dose response analyses provide further evidence for the association. Cross-contamination was found between the product and other anise species. We recommend destruction of the contaminated products, avoidance of anise infusions among infants, and dissemination of the results among pediatricians.

Casos de enfermedad de sintomatología neurológica asociados al consumo de anís estrellado empleado como carminativo / Cases of neurological symptoms associated with star anis consumption used as a carminative

Antecedentes: Desde marzo de 2001 se observaron en España una serie de niños, menores de 3 meses, que presentaban sintomatología digestiva y neurológica grave, presuntamente asociada al consumo de anís estrellado. Se inició un estudio epidemiológico con el objetivo de conocer las características de los afectados y valorar la asociación entre el cuadro y el consumo de anís. Método: Estudio de casos-controles apareados (1:2), en niños menores de 3 meses ingresados en las urgencias pediátricas de dos hospitales de Madrid, entre febrero y septiembre de 2001. Se emplearon odds ratio (OR) de Mantel-Haenzel y regresión logística condicionada para cuantificar la asociación y la dosis-respuesta. Se realizaron análisis de laboratorio de las sustancias implicadas. Resultados: Se estudiaron 23 casos. La sintomatología consistió en irritabilidad (78,3%), movimientos anormales y vómitos (56,5%), nistagmo (52,2%) y episodios de desaturación de oxígeno (21,7%). En el estudio de casos-controles se emplearon 18 casos y 36 controles. Nueve (25%) controles consumieron anís estrellado (exposición leve, 5 casos; alta, 4 casos). La OR de Mantel-Haenzel fue de 18,0 (intervalo de confianza [IC] del 95%, 2,03-631) y para la dosis-respuesta de 11,7 (IC 95%, 1,3-188,5) en la exposición leve y de 18,2 (IC 95%, 1,8-183,5) en la alta. Los análisis de laboratorio mostraron contaminación de Illicium verum con Illicium anisatum. Conclusiones: Se confirma la relación entre la enfermedad y el consumo de anís estrellado. La asociación se refuerza en los análisis de dosis-respuesta. Se encontró contaminación del producto con otras especies de anís. Se recomienda destrucción de las partidas contaminadas, no utilizar en lactantes y divulgación de los resultados entre pediatras (AU)

The influence of HIV infection and imprisonment on dissemination of Mycobacterium tuberculosis in a large Spanish city.

SETTING: Culture-positive cases of tuberculosis (TB) from the urban population of southern Madrid and from all the prisons located throughout the city. OBJECTIVE: To determine the frequency with which common strains of Mycobacterium tuberculosis cause disease among patients from both the urban and prison populations of a large Spanish city. DESIGN: Restriction fragment length polymorphism analysis was performed on culture-positive cases of TB identified between 1 January 1997 and 31 December 1998. Risk factors that might be associated with the dissemination of common strains of TB among the two populations were also investigated. RESULTS: Two hundred and twenty-one cases of culture-positive TB were identified, 99 (47.8%) of which were grouped in 23 clusters. Eleven were general clusters that spanned the prison and urban populations involved 69 patients (31.2%). Univariate analysis of risk factors showed that age <35 years, human immunodeficiency virus (HIV) infection, intravenous drug use and current or previous imprisonment were all associated at a statistically significant level with inclusion in general clusters. The final logistic regression model showed an interaction between HIV infection and incarceration. CONCLUSIONS: Dissemination of common strains of M. tuberculosis between prison inmates and the urban population of Madrid is significant, and involves subjects with a history of imprisonment and HIV infection.