Public health response to an outbreak of SARS-CoV2 infection in a Barcelona prison.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.

[Control of SARS-CoV-2 in prisons]. / El control de la infección por SARS-CoV-2 en prisiones.

OBJECTIVE: Review of control and management of SARS-CoV-2 infection in penitentiary institutions in Spain and other countries. MATERIAL AND METHODS: A systematic review a comprehensive literature search in Global Health, SCOPUS, Medline and EMBASE was performed using relevant keywords and medical descriptors (MeSH) related to the coronavirus disease (COVID-19) and prisons. National and international recommendations and guides were examined as well as documents published by some countries. RESULTS: The key points of the guides are discussed. The vast majority of recommendations coincide with respect to the measures and procedures that should be used, except for some discrepancy regarding the population screening. Until now, most industrialized countries (except the US and some specific scenarios) have controlled successfully the epidemic in prisons. Less data is found as regards to socioeconomically more disadvantaged countries. CONCLUSIONS: Prisons are prone to a high risk of SARS-CoV-2 transmission due to their space limitations and sometimes poor environmental and hygienic conditions. The recommendations of the control and management of SARS-CoV-2 infection must be the same as those outside the prison, but must be adapted to the peculiarities of the prison. The recommendations must be issued by the health administration in coordination with the prison administration. Finally, must be abide by the Mandela Rules or by the Standard Minimum Rules for the treatment of United Nations prisoners.

El control de la infección por SARS-CoV-2 en prisiones / Control of SARS-CoV-2 in prisons

OBJETIVO: Revisar el control y el manejo de la infección por SARS-CoV-2 en instituciones penitenciarias de España y de otros países. MATERIAL Y MÉTODOS: Realizamos una revisión exhaustiva de la literatura en Global Health, SCOPUS, Medline y EMBASE utilizando palabras clave pertinentes y descriptores médicos (DeCS) relacionados con la enfermedad por coronavirus 2019 (COVID-19) y prisiones. También se revisaron las recomendaciones o guías de agencias, nacionales e internacionales, y los documentos publicados on-line por algunos países. RESULTADOS: Se presentan los puntos clave de las guías y recomendaciones. La mayoría de estas guías coinciden básicamente en las medidas y procedimientos a utilizar, salvo alguna discrepancia sobre la extensión poblacional de los cribados. Hasta ahora la mayoría de países industrializados, excepto Estados Unidos y algunas situaciones puntuales, han controlado la epidemia en las prisiones moderadamente bien. Hay menos datos sobre lo ocurrido en países socioeconómicamente más desfavorecidos. CONCLUSIONES: Las prisiones suponen un riesgo elevado para la transmisión del SARS-CoV-2 en cuanto son medios cerrados, a veces con malas condiciones ambientales e higiénicas. La guías y recomendaciones para controlar la infección deben ser elaboradas por la administración sanitaria coordinadamente con la administración penitenciaria; deben ser similares a las extrapenitenciarias, aunque adaptadas a las peculiaridades del entorno penitenciario, y deben atenerse a las Reglas Mandela o Reglas Mínimas para el Tratamiento de los Reclusos de las Naciones Unidas

OBJECTIVE: Review of control and management of SARS-CoV-2 infection in penitentiary institutions in Spain and other countries. MATERIAL AND METHODS: A systematic review a comprehensive literature search in Global Health, SCOPUS, Medline and EMBASE was performed using relevant keywords and medical descriptors (MeSH) related to the coronavirus disease (COVID-19) and prisons. National and international recommendations and guides were examined as well as documents published by some countries. RESULTS: The key points of the guides are discussed. The vast majority of recommendations coincide with respect to the measures and procedures that should be used, except for some discrepancy regarding the population screening. Until now, most industrialized countries (except the US and some specific scenarios) have controlled successfully the epidemic in prisons. Less data is found as regards to socioeconomically more disadvantaged countries. CONCLUSIONS: Prisons are prone to a high risk of SARS-CoV-2 transmission due to their space limitations and sometimes poor environmental and hygienic conditions. The recommendations of the control and management of SARS-CoV-2 infection must be the same as those outside the prison, but must be adapted to the peculiarities of the prison. The recommendations must be issued by the health administration in coordination with the prison administration. Finally, must be abide by the Mandela Rules or by the Standard Minimum Rules for the treatment of United Nations prisoners

Is it possible to eliminate hepatitis C from the prisons of Catalonia, Spain, in 2021?

AIM: Predict the elimination of chronic hepatitis C in Catalan prisons. MATERIAL AND METHOD: We analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA<1%). RESULTS: A total of 1264 treatments were administered by 12/31/2016. The prevalence of hepatitis C virus RNA was 31.2% in 2002, decreasing to 8.81% in 2016. We estimate that prevalence will reach 0-0.5% in 5 years (second half 2021; 95% CI: 2019-2025). DISCUSSION: Appropriate actions can eliminate hepatitis C infection in prisoners. We estimate that by 2021 hepatitis C infection will no longer be a public health problem in Catalonia prisons.

Prevalence and predictive factors of Chlamydia trachomatis genital infection in inmates 25 to 65 years old in four Catalan prisons.

OBJECTIVES: Determine the prevalence of Chlamydia trachomatis (CT) infection, the risk factors for infection in inmates aged 25 to 65 years old in four Catalan prisons. MATERIALS AND METHODS: This is a cross sectional study conducted in four Catalan prisons chosen at convenience with a random stratified sample of the penitentiary population 25 to 65 years old taken within these centres. A urine specimen was analysed using the Anyplex CT/NG Seegene technique. An ad hoc questionnaire was used to determine sociodemographic and behavioural risk factors for infection within the previous year. The prevalence estimates of CT were calculated. Crude and adjusted odds ratios (ORs) and 95% Confidence Intervals (CIs) were used to estimate associations between infection and risk factor. RESULTS: Out of 1,469 participants, 15 men tested positive for CT (prevalence: 1.02%). We explored age, country of birth, education, occupation, sexual orientation, age initiation sexual activity, number and type of sexual partners (sporadic vs. stable) in a year, concurrency of sexual partners, preservative use in previous sexual relationship, etc. The only factor independently associated with infection was being heterosexual man having sexual relationships with different sporadic partners. Among those who had had an STI (Sexually Transmitted Infection) in life 27% did not notify to all their partners and the main reason was not being able to retrieve them. CONCLUSIONS: CT prevalence in inmates 25 to 65 years old is very low in four prisons of Catalonia. No systematic screening of infection is justified although prisoners having different sporadic sexual partners may need more sexual infection prevention advice.

Asistencial and therapeutic continuity after release from prison: an urgent problem that requires solutions. The model applied in Catalonian prisons.

Deficits in health after being released are common, even with a higher risk of death. In these cases, the main cause of death is the use of heroin and other opioids, but there are more causes of death and most are potentially preventable. The most vulnerable groups to the increase of post-release morbidity and mortality are the drug users, the mentally ill and the foreign inmates from countries with few economic resources. It is urgent to implement interventions that optimize access to health devices after the prison release, avoid interruptions in the continuity of care and treatment prescribed in prison and reduce morbidity and mortality. To achieve this, it is necessary to coordinate the effective form of care inside and outside the prison and apply support measures. We present the project implemented in the prisons of Catalonia, which the "nurse of liaison" has used as a key figure in the process. We also present the internal and external procedure used to facilitate the transfer of sanitary and therapeutic information, to link released patients to health devices and to ensure that they are received in a timely and appropriate manner.

¿Es posible eliminar la hepatitis C en las prisiones de Cataluña en el 2021? / Is it possible to eliminate hepatitis C from the prisons of Catalonia, Spain, in 2021?

Objetivo: predecir la eliminación de la hepatitis C crónica en las prisiones de Cataluña. Material y método: se analiza la tendencia de la prevalencia de ácido ribonucleico (ARN)-virus de la hepatitis C (VHC) y los tratamientos antihepatitis C prescritos en Cataluña en el periodo 2002-2016. Mediante un alisado exponencial de los valores históricos de la serie, se calcula el tiempo en que podrá eliminarse la hepatitis C en Cataluña como problema de salud pública (prevalencia ARN-VHC<1%). Resultados: hasta el 31 de diciembre de 2016, se habían prescrito 1.264 tratamientos. La prevalencia de ARN-VHC fue del 31,2% en 2002, y drecreció hasta el 8,8% en 2016. Se estima que la prevalencia alcanzará una tasa del 0-0,5% en cinco años (segundo semestre de 2021; intervalo de confianza, IC, del 95%: 2019-2025). Discusión: con las acciones adecuadas, puede y debe eliminarse la hepatitis C en los presos. En Cataluña, esta enfermedad dejaría de ser un problema de salud pública en 2021

Aim: predict the elimination of chronic hepatitis C in Catalan prisons. Material and method: we analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA<1%). Results: a total of 1264 treatments were administered by 12/31/2016. The prevalence of hepatitis C virus RNA was 31.2% in 2002, decreasing to 8.81% in 2016. We estimate that prevalence will reach 0-0.5% in 5 years (second half 2021; 95% CI: 2019-2025). Discussion: appropriate actions can eliminate hepatitis C infection in prisoners. We estimate that by 2021 hepatitis C infection will no longer be a public health problem in Catalonia prisons

Prevalencia y factores predictivos de infección por Chlamydia trachomatis genital en presos de 25 a 65 años en cuatro prisiones de Cataluña / Prevalence and predictive factors of Chlamydia trachomatis genital infection in inmates 25 to 65 years old in four Catalan prisons

Objetivos: Determinar la prevalencia de Chlamydia trachomatis (CT) en la población penitenciaria con edad comprendida entre los 25 y 65 años y los factores de riesgo en cuatro prisiones de Cataluña. Materiales y métodos: Estudio transversal realizado, en cuatro centros escogidos a conveniencia, con una muestra aleatoria estratificada de presos por grupo de edad y sexo dentro de cada uno de los centros. Se recogió una muestra de orina para determinar el ADN de CT mediante la técnica Anyplex CT/NG Seegene: se utilizó una encuesta ad hoc para recoger las variables sociodemográficas, de comportamiento y de factores de riesgo de infección en el año anterior. Para estimar la asociación entre infección y factor de riesgo, se calcularon: las razones de posibilidades u odds ratios (OR) crudas y ajustadas y los intervalos de confianza del 95% (IC). Resultados: La prevalencia de CT fue del 1,02%, afectando a 15 hombres heterosexuales entre 1.469 participantes. Se exploró la edad, el país de nacimiento, la educación, la ocupación, la orientación sexual, la edad de inicio de relaciones sexuales, el número y el tipo de parejas sexuales (esporádicas frente a estables) en el año anterior, la concurrencia de parejas, el uso del preservativo en la última relación sexual, etc. El único factor asociado independientemente a la infección por CT fue tener relaciones sexuales con parejas esporádicas dentro o fuera de la prisión. Entre los que manifestaron haber tenido una infección de transmisión sexual (ITS) en el curso de su vida, el 27% no lo notificaron a todas sus parejas, y la principal razón fue la imposibilidad de recuperar el contacto con ellas

Objective: Determine the prevalence of Chlamydia trachomatis (CT) infection, the risk factors for infection in inmates aged 25 to 65 years old in four Catalan prisons. Material and method: This is a cross sectional study conducted in four Catalan prisons chosen at convenience with a random stratified sample of the penitentiary population 25 to 65 years old taken within these centres. A urine specimen was analysed using the Anyplex CT/NG Seegene technique. An "ad hoc" questionnaire was used to determine sociodemographic and behavioural risk factors for infection within the previous year. The prevalence estimates of CT were calculated. Crude and adjusted Odds Ratios (ORs) and 95% (CIs) were used to estimate associations between infection and risk factors. Results: Out of 1469 participants 15 men tested positive for CT (prevalence: 1.02%). We explored age, country of birth, education, sexual orientation, age initiation sexual activity, number and type of sexual partners (sporadic vs. stable) in a year, concurrency of sexual partners, preservative use in previous sexual relationship, etc. The only factor independently associated with infection was being heterosexual man having sexual relationships with different sporadic partners. Among those who had had a sexually transmitted infection (STI) in life 27% did not notify to all their partners and the main reason was not being able to retrieve them. Conclusions: CT prevalence in inmates 25 to 65 years old is very low in four prisons of Catalonia. No systematic screening of infection is justified although prisoners having different sporadic sexual partners may need more sexual infection prevention advice

Catalan contribution in the European project MEntally Disturbed Inmates Care and Support (MEDICS).

OBJECTIVE: To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. MATERIAL AND METHODS: Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. RESULTS: Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p <0.001). 40.7% were men and 57.7% women. Among the non-health staff 70% of correctional officers held a degree. Most of the total (62.4%) had their work as their main sources of knowledge about mental health. The main answers given are presented. DISCUSSION: Almost 25% of penitentiary professionals participated in the MEDICS project. Most of them (67%) held a degree. There is a professional concern about mental disorders but not discrimination. Some groups (doctors and, specially, non-health professionals) believe as basic a continuing training and working in multidisciplinary teams.

Aportación de Cataluña al proyecto europeo MEntally Disturbed Inmates Care and Support (MEDICS) / Catalan contribution in the European project MEntally Disturbed Inmates Care and Support (MEDICS)

Objetivo: Conocer la opinión de los trabajadores penitenciarios sobre las causas, métodos de manejo y propuestas de mejora en la atención de los reclusos que presentan trastornos mentales no graves. Material y métodos: Actividad realizada de marzo a mayo de 2015. En Cataluña participaron tres prisiones. Se distribuyeron siete modelos diferentes de cuestionarios anónimos, diseñados por Italia, y dirigidos a directores, técnicos de los equipos de tratamiento, funcionarios de vigilancia, profesores, médicos, enfermeros y voluntarios. Para estudiar la asociación entre variables cualitativas se utilizaron la prueba de ji al cuadrado y el test exacto de Fisher. Resultados: Se distribuyeron 744 cuestionarios y hubo 174 cumplimentaciones (23,4%). La participación fue mayor en sanitarios y profesionales del equipo de tratamiento (88% y 36%, respectivamente). Los médicos tenían más edad media que otros grupos, con diferencias estadísticamente significativas (p <0,001). El 40,7% eran hombres y el 57,7% mujeres. El 70% de los funcionarios de vigilancia tenían estudios superiores. La mayoría (62,4%) consideró que el mayor conocimiento en salud mental lo había obtenido por el trabajo penitenciario. Se presentan las principales respuestas obtenidas de cada colectivo. Discusión: Casi un cuarto de los trabajadores participaron en el proyecto MEDICS. El 67% del total de participantes eran licenciados universitarios. Hay preocupación profesional sobre los trastornos mentales, pero no discriminación, y algunos grupos (médicos y, sobre todo, profesionales no sanitarios) consideran básica la formación continuada en este ámbito y el trabajo en equipo interprofesional

Objective: To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. Material and methods: Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. Results: Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p <0.001). 40.7% were men and 57.7% women. Among the non-health staff 70% of correctional officers held a degree. Most of the total (62.4%) had their work as their main sources of knowledge about mental health. The main answers given are presented. Discussion: Almost 25% of penitentiary professionals participated in the MEDICS project. Most of them (67%) held a degree. There is a professional concern about mental disorders but not discrimination. Some groups (doctors and, specially, non-health professionals) believe as basic a continuing training and working in multidisciplinary teams