Trastornos del límite, un reto para los equipos técnicos penitenciarios: el derecho a la salud integral de las personas privadas de libertad / Boundary disorders, a challenge for prison technical teams: the right to comprehensive health of persons deprived of liberty

La finalidad de la violencia es doblegar la voluntad de quien la padece, y si es en una cárcel, se representa con intencionalidad de modificar estructuras psíquicas de la persona penada. Desde la inclusión del papel del entorno psicosocial en la definición de salud, se reconsidera a los equipos técnicos penitenciarios, apostando por una acción que vaya más allá de la lógica securitaria. El tratamiento penitenciario es una oportunidad de cambio, más si se basa en derechos -y en el derecho a la salud- para tratar el sufrimiento. En el caso de los trastornos del límite, por más que la persona presa sea sujeto de derecho, se precisa un tratamiento penitenciario sin métodos de control ni dispositivos productores de exclusión, segregación o aislamiento. Se propugna una mirada ética en la que se tenga en cuenta la subjetividad de personas vulnerables y vulneradas, y que se traduzca en prácticas concretas sobre el uso de las medicaciones, el consumo de drogas, el aislamiento, las medidas disciplinarias y el trabajo en red, entre otras posibles. Ahí el trabajo en red, en lo institucional y lo comunitario, es una vía primordial. (AU)

The purpose of violence is to bend the will of the person who suffers it, and, if this occurs in a prison, it is carried out with the intention of modifying the psychic structures of the punished person. With the inclusion of the role of the psychosocial environment in the definition of health, the prison technical teams are reconsidered, committing to an action that goes further than the security logic. Prison treatment is an opportunity for change, especially if it is based on rights –and the right to health– to deal with suffering. When it comes to boundary disorders, even if the prisoner is a subject of law, prison treatment without methods of control or devices that produce exclusion, segregation or isolation is required. An ethical perspective in which the subjectivity of vulnerable and violated people is taken into account and is reflected into concrete practices on the use of medications, drug use, isolation, disciplinary measures and networking, among other possible ones, is advocated. There, networking, institutionally and community-based, is a primary path. (AU)

Género y adicciones en el medio penitenciario / Gender and addictions in prisons

Conocido el patrón de consumo y uso social de sustancias psicoactivas, se revisa el modelo de atención a los problemas de salud mental en los centros penitenciarios que albergan a mujeres presas, que representan un 7,6% de la población reclusa, la más elevada en Europa Occidental. Se perfilan medidas de las políticas penitenciarias dirigidas a la mujer reclusa previas al ingreso en prisión, intervenciones en el propio medio penitenciario, así como medidas de transición a la comunidad. (AU)

Given the pattern of consumption and social use of psychoactive substances, the model of attention to mental health problems in penitentiary centers is reviewed. Female prisoners in these centers represent the 7.6% of prison population, the highest in Western Europe. Measures of penitentiary policies aimed at women prisoners prior to entry into prison and interventions in the penitentiary environment itself are outlined. In addition, community transition measures are presented. (AU)

Suicidios en prisión: algunas tareas pendientes / Suicides in prison: some pending tasks

En la actualidad el suicidio es un auténtico problema de salud pública a nivel mundial y la primera causa de muerte no natural en España. Sin pretender una investigación exhaustiva sobre el tema, que excedería los límites de este artículo, se realiza una revisión general del concepto y un breve análisis crítico del modo en el que se recopilan los datos: se trata de un fenómeno infravalorado y es necesario mejorar la fiabilidad de las cifras manejadas. Tras recopilar la información oficial sobre el suicidio en la población penitenciaria española, con una tasa significativamente superior a la de la población general, se recogen los factores de riesgo y de protección a tener en cuenta para mejorar las políticas preventivas. Se cierra la exposición con un inventario de buenas prácticas que la Institución Penitenciaria no solo debe incorporar al Programa Marco de Prevención de Suicidios, sino también velar por su cumplimiento efectivo; para ello es imprescindible la detección precoz y la coordinación de los profesionales penitenciarios con la Red Sanitaria Pública. (AU)

At present, suicide is a real public health problem worldwide and the leading cause of unnatural death in Spain. With no intention of carrying out an exhaustive investigation on the subject, which would exceed the limits of this article, a general review of the concept and a brief critical analysis of the way in which data are collected are carried out. Suicide is an undervalued phenomenon and it will be necessary to improve the reliability of the statistical figures handled. After compiling official information on suicide in the Spanish prison population, with a rate considerably higher than in the general population, the risk and protection factors to be taken into account to improve preventive policies are collected. The exposition closes with an inventory of good practices that the Penitentiary Institution must not only incorporate into the Framework Program for Suicide Prevention, but also ensure its effective compliance. An early detection and the coordination of professionals with the Public Health Network is needed for this proper compliance. (AU)

Nuevos retos en la consulta ¿Qué hacer ante la Fibromialgia, el Síndrome de la Fatiga Crónica-EM y las Sensibilidades Químicas Múltiples?

Tres enfermedades emergentes, la Fibromialgia (FM), el Síndrome de la Fatiga Crónica/Encefalomielitis Miálgica (SFC-EM) y las Sensibilidades Químicas Múltiples (SQM), de la familia de los Síndromes de Sensibilidad Central (SSC)1, suponen un nuevo reto para los profesionales sociosanitarios no sólo por ser nuevas enfermedades crónicas multisistémicas si no también por no ser conocidas y por la realidad social que eso conlleva.

Diferencias de género en el consumo diario de tabaco e intensivo de alcohol en adolescentes latinoamericanos en tres áreas españolas (Andalucía, Madrid y País Vasco) / Gender differences to daily smoking and binge drinking in the Latinoamerican Adolescents in three Spanish areas

El consumo diario de tabaco e intensivo de alcohol en la adolescencia puede configurarse como hábitos persistentes para la vida adulta. En este trabajo se pretende explorar las diferencias entre chicos y chicas adolescentes de origen latino con consumos intensivos de tabaco y alcohol, dado que son escasos los trabajos en España que introducen la variable cultural o étnica. Se trata de un estudio trasversal mediante encuesta escolar, a 1126 adolescentes de origen latino, escolarizados en la Educación Secundaria en tres zonas españolas, de 12 a 19 años. Entre los resultados destacamos que el 9,4% de los chicos y el 5,6% de las chicas latinas fumaban diariamente y el 24,2% de los chicos y el 19% de las chicas bebió cinco o más bebidas alcohólicas en el último evento. Fumar diariamente se asoció con ser chico, fumar el padre, fumar la pareja, actuando como factor de protección hacer deporte. Ser chico, emborracharse y haber ido de botellón aumenta la probabilidad de consumir alcohol de forma intensiva. Para concluir destacamos que existen diferencias de género en los consumos de tabaco y alcohol en el tipo de consumo intensivo pero no se aprecia cuando se trata del uso de estas sustancias. Se plantea la necesidad de tener en cuenta la variable de origen cultural en las intervenciones educativas sociosanitarias (AU)

The daily smoking and binge drinking in adolescence may produce persistent habit for adulthood. The objective of this research is to explore the differences between Latinoamerican girls and boys adolescents in the tobacco and alcohol consumes. The researches with cultural variable are scant in Spain. This study is transversal via a school survey comprising 1126 Latinoamerican adolescents, in Secondary Education in three areas and ranging from 12 to 19 years of age. The results are the 9,4% of the boys and the 5,6% of the girls smoke daily, and the 24,2% of the boys and the 19% of the girls for binge drinking the last event. The probability of daily smoking was associated to be a boy, to have a smoking father, to have a smoking couple and as protection factor was to do sport. So, to be a boy, to get drunk and have gone to Botellon increase the probability to binge drinking. The most important conclusion is that there were differences of gender in tobacco and alcohol abuse but not in the use. It is necessary to introduce the cultural variable in educative, health and social prevention (AU)

[How does collective violence shape the health status of its victims? Conceptual model and design of the ISAVIC study]. / ¿Cómo influye la violencia colectiva en la salud? Modelo conceptual y diseño del estudio ISAVIC.

OBJECTIVES: Epidemiologic research on collective violence (violence exerted by and within groups in pursuit of political, social or economic goals) is very scarce despite its growing recognition as a major public health issue. This paper describes the conceptual model and design of one of the first research studies conducted in Spain aiming to assess the impact of collective violence in the health status of its victims (study known as ISAVIC, based on its Spanish title Impacto en la SAlud de la VIolencia Colectiva). METHODS: Starting with a comprehensive but non-systematic review of the literature, the authors describe the sequelae likely produced by collective violence and propose a conceptual model to explain the nature of the relationships between collective violence and health status. The conceptual model informed the ISAVIC study design and its measurement instruments. RESULTS: The possible sequelae of collective violence, in the physical, emotional and social dimensions of health, are described. Also, the review distinguishes the likely impact in primary and secondary victims, as well as the interplay with the social environment. The mixed methodological design of the ISAVIC study supports the coherence of the conceptual model described. CONCLUSIONS: The ISAVIC study suggests that collective violence may affect the main dimensions of the health status of its victims, in intimate relation to the societal factors where it operates. It is necessary to validate these results with new studies.

Impacto de la violencia colectiva en la salud. Resultados del estudio ISAVIC en el País Vasco / Sequelae of collective violence: victims’ voices in the ISAVIC study

Objetivo: A pesar de la importancia de la violencia colectiva en la salud, aún quedan muchas lagunas sobre la naturaleza de las lesiones que produce y su relación con el bienestar y la calidad de vida de sus víctimas. Durante los años 2005-2008 se realizó en el País Vasco el estudio ISAVIC para estimar los efectos de este tipo de violencia en la salud. El estudio intentó comprender las características de las secuelas de la violencia colectiva en la salud de las víctimas a partir de sus percepciones. Métodos: Se seleccionó una muestra intencional de 36 víctimas primarias, a través de redes de contactos y mediadores. Se realizaron entrevistas en profundidad semiestructuradas, analizadas en función del modelo conceptual del estudio.Resultados: Los testimonios sugieren que las víctimas han experimentado un proceso traumático de gran intensidad que no han superado en su totalidad y que es causa de una importante pérdida de calidad de vida. Se describen las principales limitaciones funcionales observadas en términos físicos, emocionales ysociales.Conclusiones: Los resultados cualitativos son coherentes con los obtenidos mediante instrumentos estandarizados,a los que dotan de mayor sentido al explicar la naturaleza de las limitaciones de la salud.También permiten intuir algunas de las relaciones entre las diferentes limitaciones funcionales y suimpacto en la calidad de vida. Conviene verificar los resultados con muestras más amplias de víctimas y profundizar en el estudio de la relación entre violencia y salud, incluyendo el impacto del contexto social (AU)

Objective: Despite the significant influence of collective violence on the health status of its victims,there are still many gaps in our understanding of the nature of the functional limitations this violence produces and its impact on victims’ well being and quality of life. The ISAVIC study was carried out in the autonomous region of the Basque Country from 2005-2008 to estimate the effects of collective violence on health. The assessment included victims’ perceptions of these sequelae and their impact on health. Methods: A purposive sample of 36 primary victims was selected through contact networks and mediators.The victims’ perceptions were collected through semi-structured in-depth interviews, which werelater analyzed according to the study’s conceptual framework.Results: The victims’ testimony suggests that they were profoundly traumatized by the collective violence experienced, which was often not yet completely overcome and significantly impaired their quality of life. The main functional, physical, emotional and social limitations described by the victims were identified.Conclusions: The qualitative results of this study are coherent with those obtained through the parametric phase of the ISAVIC study and provide a more complete overview of the nature of the sequelae of collective violence and its impact on quality of life. These results should be verified in larger studies andthe influence of the social context on the relationship between collective violence and health should beanalyzed in greater depth (AU)

Secuelas de la violencia colectiva: hablan las víctimas del estudio ISAVIC / Sequelae of collective violence: victims’ voices in the ISAVIC study

Objetivo: A pesar de la importancia de la violencia colectiva en la salud, aún quedan muchas lagunas sobre la naturaleza de las lesiones que produce y su relación con el bienestar y la calidad de vida de susvíctimas. Durante los años 2005-2008 se realizó en el País Vasco el estudio ISAVIC para estimar los efectosde este tipo de violencia en la salud. El estudio intentó comprender las características de las secuelas dela violencia colectiva en la salud de las víctimas a partir de sus percepciones. Métodos: Se seleccionó una muestra intencional de 36 víctimas primarias, a través de redes de contactosy mediadores. Se realizaron entrevistas en profundidad semiestructuradas, analizadas en función delmodelo conceptual del estudio.Resultados: Los testimonios sugieren que las víctimas han experimentado un proceso traumático de gran intensidad que no han superado en su totalidad y que es causa de una importante pérdida de calidad devida. Se describen las principales limitaciones funcionales observadas en términos físicos, emocionales y sociales.Conclusiones: Los resultados cualitativos son coherentes con los obtenidos mediante instrumentos estandarizados,a los que dotan de mayor sentido al explicar la naturaleza de las limitaciones de la salud.También permiten intuir algunas de las relaciones entre las diferentes limitaciones funcionales y su impacto en la calidad de vida. Conviene verificar los resultados con muestras más amplias de víctimas y profundizar en el estudio de la relación entre violencia y salud, incluyendo el impacto del contexto social (AU)

Objective: Despite the significant influence of collective violence on the health status of its victims,there are still many gaps in our understanding of the nature of the functional limitations this violenceproduces and its impact on victims’ wellbeing and quality of life. The ISAVIC study was carried out in the autonomous region of the Basque Country from 2005-2008 to estimate the effects of collective violenceon health. The assessment included victims’ perceptions of these sequelae and their impact on health. Methods: A purposive sample of 36 primary victims was selected through contact networks and mediators.The victims’ perceptions were collected through semi-structured in-depth interviews, which were later analyzed according to the study’s conceptual framework.Results: The victims’ testimony suggests that they were profoundly traumatized by the collective violence experienced, which was often not yet completely overcome and significantly impaired their qualityof life. The main functional, physical, emotional and social limitations described by the victims were identified.Conclusions: The qualitative results of this study are coherent with those obtained through the parametric phase of the ISAVIC study and provide a more complete overview of the nature of the sequelae of collective violence and its impact on quality of life. These results should be verified in larger studies and the influence of the social context on the relationship between collective violence and health should beanalyzed in greater depth (AU)

[Impact of collective violence on health status. Results of the ISAVIC study in the Basque Region (Spain)]. / Impacto de la violencia colectiva en la salud. Resultados del estudio ISAVIC en el País Vasco.

OBJECTIVES: Despite the ubiquity of violence and its possible impact on individual and collective health, the role and causal pathways of this phenomenon as a health determinant have not been widely studied. The present study was conducted between 2005 and 2008 in the Basque Region of Spain and aimed to estimate the health effects of collective violence on its primary victims. METHODS: A purposive sample of 33 primary victims (direct victims of collective violence and the first degree relatives of murder victims) was matched (1:5 ratio) with a random selection of persons drawn from a representative sample of the population aged more than 16 years old living in the Basque Region. Matching criteria were age, sex, educational level and province of residence. All participants completed a questionnaire that included health status measures (WHO-DAS-II-12, GHQ-12, SF-12, loneliness and stigma scales) and other potentially mediating variables such as social support and emotional climate. The results were assessed by regression analysis conditional to exposure to collective violence. RESULTS: The odds of perceiving worse physical and emotional health were 4 to 7 times higher among primary victims than among the general population and were 8 times higher for experiencing functional disability. Primary victims also perceived more loneliness and stigma and negatively valued their social support and emotional climate. No significant impact was found among the general population with some experience of interpersonal violence. CONCLUSIONS: These results suggest that collective violence is associated with substantial impairment in health status. More specific studies to assess the health effects of collective violence in the general population are warranted.

[Sequelae of collective violence: victims' voices in the ISAVIC study]. / Secuelas de la violencia colectiva: hablan las víctimas del estudio ISAVIC.

OBJECTIVE: Despite the significant influence of collective violence on the health status of its victims, there are still many gaps in our understanding of the nature of the functional limitations this violence produces and its impact on victims' wellbeing and quality of life. The ISAVIC study was carried out in the autonomous region of the Basque Country from 2005-2008 to estimate the effects of collective violence on health. The assessment included victims' perceptions of these sequelae and their impact on health. METHODS: A purposive sample of 36 primary victims was selected through contact networks and mediators. The victims' perceptions were collected through semi-structured in-depth interviews, which were later analyzed according to the study's conceptual framework. RESULTS: The victims' testimony suggests that they were profoundly traumatized by the collective violence experienced, which was often not yet completely overcome and significantly impaired their quality of life. The main functional, physical, emotional and social limitations described by the victims were identified. CONCLUSIONS: The qualitative results of this study are coherent with those obtained through the parametric phase of the ISAVIC study and provide a more complete overview of the nature of the sequelae of collective violence and its impact on quality of life. These results should be verified in larger studies and the influence of the social context on the relationship between collective violence and health should be analyzed in greater depth.

Mujeres y psicofármacos: la investigación en atención primaria / Women and psychotropics: the researching in the field of primary care

En este artículo se revisan algunos resultados obtenidos en investigaciones nacionales e internacionales realizadas sobre el uso de psicofármacos, especialmente de aquellos estudios sobre la prescripción y uso por las mujeres. Los resultados muestran que una parte importante de la producción científica se centra en el estudio de la detección de los trastornos en Atención Primaria o Especializada y en la morbilidad psiquiátrica de manera comparada entre los sexos. La mayor parte de las investigaciones realizadas en este ámbito tiene un carácter clínico y epidemiológico. Constituyen una excepción investigaciones realizadas en Estados Unidos o en el norte de Europa que buscan explicar los motivos y razones para un consumo y prescripción diferencial de psicofármacos, siendo las mujeres las principales afectadas. Se han analizado investigaciones que aportan información para poder responder a la pregunta: ¿Por qué las mujeres reciben los dos tercios de las prescripciones con psicofármacos? Vemos que las mujeres tienen mayor probabilidad que los varones de que les prescriban psicofármacos (AU)

This paper presents some of the results arising from an analysis of the researching performed -at both domestic and international levels- on the usage of psychotropic drugs, specially on their prescription and use by women. These results come to show that a significant part of the scientific production in this area focuses on studies about the detection of disorders in Primary or Specialized Care and about psychiatric morbidity, applying a comparative methodology between sexes. Much of the researching performed in this field has a clinical and epidemiologic nature. An exception to this trend come from some surveys performed in the USA and the North of Europe intended to clarify the causes and reasons that may explain the persisting differences in both prescription and use of such drugs, a situation that adversely impacts women. The surveys analyzed on this paper offer some information that may help us to find an answer to the question: Why are two thirds of the prescriptions involving psychotropics aimed to women? It is clear that women are more prone than men to be prescribed with such drugs (AU)

Violencia doméstica, consumo de sustanciasy otras circunstancias concurrentes. ¿El derecho versus derecho a la salud? / Domestic violence, substances use and other concurrenting circunstances

Tras reflexionar sobre la violencia de género padecida sobre todo en el ámbito doméstico, se aportan algunos datos procedentes de un estudio realizado sobre las sentencias dictadas durante un año en el País Vasco y referidas a tipología delictiva relacionada con la violencia intrafamiliar. Los resultados reflejan que el consumo de alcohol, de otros tipos de drogas, la existencia de trastornos mentales o la precariedad económica no aparecen como factores criminógenos tan determinantes como en otros trabajos anteriormente realizados sobre el tema. Las medidas y actuaciones en muy diversos campos de intervención son una urgente necesidad (AU)