Anticoagulación oral en Atención Primaria / Oral anticoagulation in primary care

El tratamiento anticoagulante oral (TAO) está hoy en día ampliamente difundido en la población y en el caso de nuestro país la atención primaria juega un papel relevante en su control. La población joven, como la de los centros penitenciarios, muchas veces requiere de este tratamiento por motivos diferentes a la fibrilación auricular, muchas veces en relación con valvulopatías o situaciones de hipercoagulabilidad congénitas o adquiridas. La posibilidad de obtener mediante coagulómetros portátiles el INR de los pacientes ha permitido que los médicos de atención primaria asuman la indicación de esta terapia y el control de estos pacientes en coordinación con los servicios de hematología. La aparición de nuevas alternativas terapéuticas (Dabigatran, Rivaroxaban, Apixaban y Edoxaban, los llamados 'ACOD') ha permitido ampliar las opciones de anticoagulación oral en algunos casos, aunque todavía existen restricciones por parte de las autoridades sanitarias para su uso generalizado. No requieren monitorización sistemática de su efecto e interaccionan con muchos menos fármacos que sus predecesores. Este artículo repasa las diferentes indicaciones de la terapia anticoagulante oral de acuerdo con las nuevas recomendaciones, así como los escenarios clínicos en los que se debe utilizar (AU)

Oral anticoagulant therapy is currently widespread in the population and primary care plays an important role in its control in Spain. Younger populations, such as those in prisons, often require this treatment for reasons other than atrial fibrillation, often in relation to valvular or congenital or acquired hypercoagulability situations. The possibility of obtaining the INR by portable coagulometers has allowed primary care physicians to tackle the indication of this therapy and the control of these patients in coordination with haematology services. The emergence of new therapeutic alternatives (Dabigatran, Rivaroxaban, Apixaban and Edoxaban, the so called 'ACOD') has permitted the expansion of options for oral anticoagulation in some cases, since they do not require systematic monitoring of their effect and interact with far fewer drugs than their predecessors, although there are still restrictions by the health authorities on their widespread use. This article reviews the different indications of oral anticoagulant therapy according to the new recommendations as well as the clinical scenarios in which it should be used (AU)

La esquizofrenia en el medio penitenciario / Schizophrenia in prisons

En las cárceles comunes existe un gran número de individuos con trastornos mentales graves cumpliendo condena, aunque esta es una realidad poco conocida para el público fuera de prisión. En este artículo hacemos una revisión de la literatura científica para conocer las cifras de presos con enfermedades psicóticas en centros penitenciarios de diferentes países. Nos encontramos una prevalencia de la enfermedad esquizofrénica en prisión aumentada con respecto a la población general y una relación estrecha entre enfermedad mental grave, consumo de drogas e ingreso en prisión (AU)

There is a large number of individuals with severe mental disorders in prisons, although this is a reality which is not very familiar for the general public. In this article we present a review of scientific literature in order to know the number of prisoners with psychotic disorders in different countries. We found a higher prevalence of schizophrenic illness among imprisoned persons compared to the general population and a close relationship between severe mental illness, drug abuse and detention (AU)

Psychometric prediction of penitentiary recidivism / Predicción psicométrica de la reincidencia penitenciaria

BACKGROUND: Attempts to predict prison recidivism based on the personality have not been very successful. This study aims to provide data on recidivism prediction based on the scores on a personality questionnaire. For this purpose, a predictive model combining the actuarial procedure with a posteriori probability was developed, consisting of the probabilistic calculation of the effective verification of the event once it has already occurred. METHOD: Cuestionario de Personalidad Situacional (CPS; Fernández, Seisdedos, & Mielgo, 1998) was applied to 978 male inmates classified as recidivists or non-recidivists. RESULTS: High predictive power was achieved, with the area under the curve (AUC) of 0.85 (p <.001; Se = 0.012; 95% CI [0.826, 0.873]. The answers to the CPS items made it possible to properly discriminate 77.3% of the participants. CONCLUSIONS: These data indicate the important role of the personality as a key factor in understanding delinquency and predicting recidivism

ANTECEDENTES: los intentos para predecir la reincidencia penitenciaria basándose en la personalidad no han tenido mucho éxito. Este trabajo tiene como objetivo ofrecer datos sobre la predicción de la reincidencia a partir de las puntuaciones en un cuestionario de personalidad. MÉTODO: se aplicó el Cuestionario de Personalidad Situacional (CPS; Fernández, Seisdedos y Mielgo, 1998) a 978 reclusos varones clasificados como reincidentes o no reincidentes y se elaboró un modelo predictivo combinando el procedimiento actuarial con el concepto de probabilidad a posteriori, consistente en realizar cálculo probabilístico a partir de la constatación efectiva del suceso una vez ya se ha producido. RESULTADOS: se logró un elevado poder predictivo, siendo el área bajo la curva (AUC) de 0.85 (p < 0.001; Se = 0.012; 95% IC [0.826, 0.873]. Las respuestas a los ítems del CPS permitieron discriminar adecuadamente al 77,3% de los participantes. CONCLUSIONES: estos datos indican el papel importante de la personalidad como factor clave para entender la delincuencia y predecir la reincidencia

COPD characteristics and socioeconomic burden in Hellenic correctional institutions.

BACKGROUND: The high prevalence of smoking (80%) in Greek correctional institutions is anticipated to result in high prevalence of COPD in such settings. AIM: The aim of the Greek obstructive luNg disease epidemiOlogy and health economics Study In corrective institutionS (GNOSIS) is to determine the prevalence of smoking and COPD among inmates and to assess the health-related quality of life. METHODS: GNOSIS, a cross-sectional epidemiological study, was conducted between March 2011 and December 2011 in seven correctional institutions in Greece. RESULTS: A total of 552 participants, 91.3% male, median age of 43.0 years (interquartile range: 35-53), were enrolled. COPD prevalence was 6.0% and was found to increase with age (18.6% among those ≥60 years), length of prison stay, and length of sentence. Of the participants diagnosed with COPD, 36.4% were diagnosed with Global initiative for chronic Obstructive Lung Disease (GOLD) stage I and 51.5% were diagnosed with stage II. Dyspnea severity was assessed as grades 0-1 on the medical research council dyspnea scale for 88.3%, while 31% reported ≥2 COPD exacerbations in the past year. Seventy-nine percent of the total number of the participants were smokers, with a median smoking of 20.0 cigarettes per day, while 42.9% were assessed as having a strong addiction to nicotine. The median EuroQol visual analog scale score was 70.0 (interquartile range: 60.0-90.0). Problems in the dimension of anxiety/depression were reported by 82.8%. CONCLUSION: The results of the study support the notion that the prevalence of COPD among inmates of Greek correctional institutions may increase in the following years. The findings underscore the importance of taking actions to limit COPD prevalence and its risk factors in the Greek correctional system.

From Punishment to Treatment: The "Clinical Alternative to Punitive Segregation" (CAPS) Program in New York City Jails.

The proliferation of jails and prisons as places of institutionalization for persons with serious mental illness (SMI) has resulted in many of these patients receiving jail-based punishments, including solitary confinement. Starting in 2013, the New York City (NYC) jail system developed a new treatment unit for persons with SMI who were judged to have violated jail rules (and previously would have been punished with solitary confinement) called the Clinical Alternative to Punitive Segregation (CAPS) unit. CAPS is designed to offer a full range of therapeutic activities and interventions for these patients, including individual and group therapy, art therapy, medication counseling and community meetings. Each CAPS unit requires approximately $1.5 million more investment per year, largely in additional staff as compared to existing mental health units, and can house approximately 30 patients. Patients with less serious mental illness who received infractions were housed on units that combined solitary confinement with some clinical programming, called Restrictive Housing Units (RHU). Between 1 December 2013 and 31 March 2015, a total of 195 and 1433 patients passed through the CAPS and RHU units, respectively. A small cohort of patients experienced both CAPS and RHU (n = 90). For these patients, their rates of self-harm and injury were significantly lower while on the CAPS unit than when on the RHU units. Improvements in clinical outcomes are possible for incarcerated patients with mental illness with investment in new alternatives to solitary confinement. We have started to adapt the CAPS approach to existing mental health units as a means to promote better clinical outcomes and also help prevent jail-based infractions. The cost of these programs and the dramatic differences in length of stay for patients who earn these jail-based infractions highlight the need for alternatives to incarceration, some of which have recently been announced in NYC.

Prevalencia de problemas de salud mental en varones que cumplen condena en centros penitenciarios de Andalucía (España) / Prevalence of mental health problems in sentenced men in prisons from Andalucía (Spain)

Objetivos: Estimar la prevalencia de problemas de salud mental en varones que cumplen condena en instituciones penitenciarias en Andalucía. Material y métodos: Estudio descriptivo transversal de una muestra aleatoria de 472 varones penados de dos centros penitenciarios en Andalucía. Se obtuvieron datos sociodemográficos y penales generales y se identificaron problemas de salud mental mediante dos instrumentos validados de investigación epidemiológica: la entrevista SCID-I, para diagnosticar trastornos del Eje 1 de la DSM-IV y el cuestionario autoaplicado IPDE, para estimar Trastornos de personalidad. Se analizaron los datos (proporciones e intervalos de confianza) con el paquete estadístico SPSS-18. Resultados: El 82,6% de la muestra tenía antecedentes de haber padecido algún tipo de problema de salud mental a lo largo de su vida (prevalencia-vida) y el 25,8 de haberlo padecido en el último mes (prevalencia mes). Los trastornos más frecuentes del Eje I fueron los relacionados con el abuso y dependencia a substancias psicoactivas (prevalencia vida de 65,9% y prevalencia mes de 6,6%), seguidos por los trastornos afectivos (31,4%-9,3%), de ansiedad (30,9%-10,4%) y psicóticos (9,5%-3,4%). La prevalencia probable estimada de trastornos de personalidad estaba entre el 56,6% y el 79,9 (puntos de corte del IPDE de '5' y '4' respectivamente). Conclusiones: La población masculina y penada de centros penitenciarios de Andalucía muestra una elevada prevalencia de problemas de salud mental, similar a la encontrada en otras poblaciones penitenciarias españolas e internacionales, pero sus necesidades de atención deben tener en cuenta las diferentes patologías que presentan (AU)

Objectives: To estimate the prevalence of different mental health problems in men serving prison sentences in Andalusia. Methods: Descriptive, cross-sectional study of a random sample of 472 men interned in two prisons located in Andalusia. We collected socio-demographic and general criminal and penitentiary data, and we identified mental health problems with two validated instruments for epidemiological research in mental health: the SCID-I interview to diagnose Axis 1 disorders of the DSM-IV and the self-applied questionnaire IPDE to estimate personality disorders. We analyzed the data (proportions and confidence intervals) with the SPSS-18 statistical package. Results: 82.6% of the sample had a history of having suffered some type of mental health problem throughout their life (prevalence-life) and 25.8 have suffered from them in the past month (month prevalence). The most common disorders of the Axis I (DSM-IV) are related to abuse of and dependence on psychoactive substances (prevalence life of 65.9% and month prevalence of 6.6%), with an important but less frequent presence of affective (31.4%-9.3%), anxiety (30.9%-10, 4%) and psychotic disorders (9.5%-3, 4%). As regards personality disorders, the estimated probable prevalence lies between the 56.6% ('5' cutoff point) and the 79.9 ('4' cut-off point). Conclusions: The male inmate population in prisons in Andalucía shows a high prevalence of mental health problems, similar to that found in other Spanish and international prisons, but their care needs should take into account the different pathologies that they present (AU)

Oportunidades para la práctica de la promoción de la salud: el modelo de activos y las guías NICE / Opportunities for the practice of health promotion: the assets model and NICE guidelines

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Prevalencia de trastorno mental y factores de riesgo asociados en tres prisiones de España / Mental disorder prevalence and associated risk factors in three prison of Spain

Objetivos: Conocer la prevalencia vida y prevalencia mes de personas con trastorno mental y su asociación con factores de riesgo sociodemográficos y penales en tres centros penitenciarios de España (Ocaña I y II y Madrid VI). Material y Método: Estudio epidemiológico descriptivo transversal con una muestra de 184 internos. Los datos sociodemográficos y penales se recogieron mediante una entrevista ad hoc. Los trastornos mentales se evaluaron con la versión clínica de la Structured Clinical Interview for Diagnostic and Statical Manual of Mental Disorders Axis I Disorders (SCID-I). Resultados: La prevalencia vida de trastorno mental fue del 90,2%, siendo los trastornos mentales más frecuentes el abuso o dependencia de sustancias (72,3%), seguidos de los trastornos del estado de ánimo (38,5%) y los trastornos psicóticos (34,2%). La prevalencia de cualquier trastorno mental en el último mes fue del 52,2%, siendo el principal trastorno el psicótico (20,7%) seguido del abuso o dependencia de sustancias (18,5%), y del trastorno del estado de ánimo (13%). Para cada uno de los trastornos se encontró un perfil sociodemográfico como factor de riesgo. Discusión: La prevalencia de las personas con trastorno mental es muy elevada en las prisiones españolas, estando asociada a un perfil sociodemográfico característico. Es esencial continuar investigando esta realidad, traduciendo los resultados en acciones de tipo terapéutico y preventivo, adaptadas al estatus de los internos para reducir las desigualdades sociales en esta situación prioritaria de Salud Pública (AU)

Aims: To determine the lifetime and monthly prevalence of people with mental disorders and its association with socio-demographic factors and criminal risk in three Spanish prisons (Ocaña, Madrid I, II and VI). Method: Cross-sectional epidemiological study of a sample of 184 inmates. Socio-demographic and criminal data were collected by an ad hoc interview. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Axis I Disorders (SCID-I). Results: Life prevalence of mental disorders was 90.2%. The most common mental disorders and substance abuse or dependence was 72.3%, followed by mood disorder (38.5%) and psychotic disorders (34.2%). Moreover, the prevalence of any mental disorder in the last month was 52.2%. The main psychotic disorder (20.7%) was followed by substance abuse or dependence (18.5%), and mood disorder state (13%). A socio-demographic profile as a risk for each disorder was found. Discussion: The prevalence of people with mental disorders is very high in Spanish prisons, and is associated with a distinct demographic profile. It is essential to continue researching this reality, translating the results into therapeutic and preventive action adapted to the status of inmates to reduce social inequalities in this high priority public health situation (AU)

The pivotal role of primary care in meeting the health needs of people recently released from prison.

OBJECTIVE: Australia's prison population is growing at a rate well in excess of population growth. Indigenous Australians are over-represented by a factor of 13. Prisoners are a profoundly marginalised group characterised by complex health and social needs. Despite improvements in health during incarceration, poor health outcomes after release are common, and the net effect of incarceration is usually health depleting. Given the need for effective care coordination, primary care plays a pivotal role in meeting the health needs of this population. In this paper we review what is known about patterns of primary care utilisation in ex-prisoners, identify evidence-based strategies for increasing access to primary care in ex-prisoners, and consider how such contact may shape subsequent health service outcomes. CONCLUSIONS: Primary care is a necessary but not sufficient condition for effective post-release support. Positive outcomes may depend more on the quality than the quantity of care received. Given massive over-representation of Indigenous people in Australia's prisons, and compelling evidence of preventable morbidity and mortality after release from prison, effective models of care for this population are an important component of closing the gap in Indigenous life expectancy.

Learning from peer support schemes--can prison listeners support offenders who self-injure in custody?

PURPOSE: The purpose of this paper is to critically evaluate the current evidence for peer support in prisons, in particular its contribution to working with prisoners who self-injure and the extent to which the success of peer support schemes such as the prison listeners, hinges upon staff's willingness to engage with the initiative. DESIGN/METHODOLOGY/APPROACH: The review was constructed by using primary and secondary terms to search the literature. The studies focused on peer support in custody with reference to mental health and self-injury. Searches identified papers on the prison listener scheme and staff perspectives on prison peer support, as these formed a central focus of the review. Studies were excluded from the review if the participants' behaviours was explicitly linked to suicidal intent, as the review focused on self-injury as a coping strategy. FINDINGS: A total of 24 studies were selected according to specific inclusion criteria (six were grey literature, 18 academic literature). Of the 24 studies ten studies focused on peer support and self-injury. Of the 24 studies the listener scheme was the focus of 16 studies, of these 16 studies self-injury and the listener scheme was a focus of eight studies. ORIGINALITY/VALUE: Evidence from the review suggests that prison peer support could be considered on a continuum depending on the different degrees of peer involvement.

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS.

BACKGROUND: Ukraine is experiencing one of the most volatile HIV epidemics globally, fueled primarily by people who inject drugs (PWIDs), and a parallel incarceration epidemic. Opioid substitution therapy (OST) is internationally recognized as one of the most effective forms of treatment for opioid dependence and is among the most effective HIV prevention strategies available, yet efforts to adopt it in Ukraine's Criminal Justice System (CJS) have been thwarted. METHODS: To understand the reluctance of the Ukrainian CJS to adopt OST despite the overwhelming evidence pointing to its health benefits and improved criminal justice outcomes, we conducted the first survey of Ukrainian prison administrative, medical and custodial staff (N=243) attitudes towards addiction in general, OST, and people living with HIV/AIDS (PLWHA) in representative regions of Ukraine. RESULTS: Results revealed that Ukrainian CJS workers' attitudes toward OST, PLWHA, and drug addiction were universally negative, but differed substantially along geographic and occupational lines. Whereas geographic and cultural proximity to the European Union drove positive attitudes in the west, in the southern region we observed an identifiability effect, as workers who worked directly with prisoners held the most positive attitudes. We also found that knowledge mediated the effect of drug intolerance on OST attitudes. CONCLUSION: In Ukraine, adoption of OST is more influenced by myths, biases and ideological prejudices than by existing scientific evidence. By elucidating existing attitudes among CJS personnel, this study will help to direct subsequent interventions to address the barriers to implementing evidence-based HIV prevention treatments.

[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.

Trastornos de síntomas somáticos y trastornos relacionados / No disponible

En esta mesa se comentan las perspectivas epistemológicas, diagnósticas, explicativas y etiopatogénicas, así como una pauta general de actuación ante los trastornos de síntomas somáticos y trastornos relacionados (AU)

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Detección de Enfermedades importadas. Estrategias y recomendaciones a aplicar en el reconocimiento de ingreso en prisión / No disponible

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Prevención y manejo de la hepatitis B en las cárceles de Ginebra, Suiza: facilidad entre barreras - una síntesis narrativa de la práctica actual / No disponible

La hepatitis B (HBV) constituye un problema sustancial de salud pública y el riesgo de contraer HBV en la cárcel y durante los meses posteriores a la liberación es alto. En la cárcel preventiva de Ginebra la prevalencia de HBV crónica es 20 veces más alta que dentro de la población general de Suiza, afectando principalmente a los inmigrantes encarcelados. Las acciones realizadas en la prisión preventiva de Ginebra para el control de la hepatitis B en los presos y profesionales trabajando con ellos, engloban la prevención, la educación, la vacunación, el despistaje y el tratamiento. Estas acciones se basan en las guías nacionales y son adaptadas a los datos epidemiológicos confirmados en estudios científicos. La prisión representa una oportunidad única para intervenciones de control de la HBV, en una población vulnerable con acceso limitado a la atención médica en la comunidad. Sin embargo, las estrategias deben ser mejoradas para hacer frente a varios desafíos, tales como las barreras del idioma o la continuidad de la atención. La prisión es un paso intermedio para estas personas. Así, la implementación de programas de educación y de prevención dirigidos a los presos protege igualmente a toda la comunidad (AU)

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Dental triage Hydebank Wood Prison and young offenders centre, Belfast.

OBJECTIVE: The aim of this study was to devise and test a triage protocol to prioritise patients' dental needs in a prison environment. Secondary aims were to include in the triage process oral health promotion and information about accessing prison dental services. Also to work collaboratively with the prison staff to improve referrals to the dental services. METHOD: The triage system was devised to have three strands: (1) an oral health assessment conducted by the dental nurse during the induction process for each new prisoner; (2) a simple oral health examination conducted in monthly screening clinics; (3) the prioritisation of referrals from prison landing staff using the prisons computer system PRISM. The triage was evaluated by assessing the first 100 patients' records with regard to the prioritisation of the triage category at the time of the clinical dental examination. RESULTS: Of the 100 patients triaged 95% were prioritised into the correct triage category. Seventy-two percent of patients were seen in the appropriate timeframe. Referral patterns from prison landing staff were improved along with interdisciplinary working in the prison. All new prisoners were seen within 72 hours of committal and received oral health advice and information on accessing dental services. CONCLUSION: This is the first triage system to be introduced into Hydebank Wood Prison, facilitating a targeted approach to dental care. It has improved access to the prison dental services; introduced oral health advice and information into the regular prison healthcare structure; and improved the efficiency of the clinical dental sessions. It is hoped to strategically address problems with waiting times and inequity in service utilisation.