Availability and use of healthcare resources in prisons according to the transference model: a comparative study in Spain.

OBJECTIVE: In most European countries, correctional healthcare provision is under strain or in the process of change regarding its management model and the implications that such modifications may entail for the improvement of inmates' health. This paper compares the functioning and the results of health management in a facility whose healthcare service is integrated within an autonomic health system and others which depend on the department of corrections. MATERIALS AND METHODS: Cross-sectional study where the study unit is the facility itself. From the data collected from the record of Monthly Health Statistics of Penitentiary Institutions we have constructed a series of indicators according to the recommendations of the National Health System. RESULTS: The physician to nurse ratio per inmate is higher in the transferred facility. Only the transferred establishment has telemedicine resources. Attendance to primary health services is higher that in all non-transferred establishments, while the mean attendance to specialized consultation in the transferred facility doubles that of the remaining centers. DISCUSSION: We have observed greater access to specialized care in the correctional facility managed by the community health system when compared to that of the facilities managed by Penitentiary Institutions. This statement is based on a series of effectivity indicators and results that have provided significantly improved outcome in the transferred facility.

Disponibilidad y uso de recursos de asistencia sanitaria en prisión según el modelo de transferencia: estudio comparativo en España / Availability and use of healthcare resources in prisons according to the transference model: a comparative study in Spain

Objetivo: En la mayoría de los países europeos, los servicios sanitarios penitenciarios se encuentran sometidos a tensión o en proceso de cambio en lo que respecta a su modelo de gestión y a las repercusiones que estos cambios puedan tener en la mejora de la salud de los reclusos. Este trabajo compara el funcionamiento y los resultados de la gestión sanitaria en una prisión cuyo servicio sanitario está integrado en un servicio de salud autonómico con otros dependientes de instituciones penitenciarias. Materiales y métodos: Estudio transversal en el que la unidad de estudio es el centro. A partir de datos obtenidos del registro de Estadística Sanitaria Mensual de Instituciones Penitenciarias se han construido una serie de indicadores propuestos por el Sistema Nacional de Salud. Resultados: La ratio de médicos y de enfermeros por interno es mayor en el centro transferido. Solo el centro transferido dispone de recursos de telemedicina. La frecuentación de los servicios de atención primaria es superior en todos los centros no transferidos, mientras que la frecuentación de consultas especializadas del centro transferido duplica la media de las consultas especializadas de los demás centros. Discusión: Se ha evidenciado una mayor accesibilidad de la asistencia especializada en el centro penitenciario gestionado por el servicio comunitario de salud, si lo comparamos con el gestionado por Instituciones Penitenciarias. Esta afirmación se sustenta en unos indicadores de efectividad y resultados que han proporcionado datos significativamene mejores en el centro transferido (AU)

Objective: In most European countries, correctional healthcare provision is under strain or in the process of change regarding its management model and the implications that such modifications may entail for the improvement of inmates’ health. This paper compares the functioning and the results of health management in a facility whose healthcare service is integrated within an autonomic health system and others which depend on the department of corrections. Materials and methods: Cross-sectional study where the study unit is the facility itself. From the data collected from the record of Monthly Health Statistics of Penitentiary Institutions we have constructed a series of indicators according to the recommendations of the National Health System. Results: The physician to nurse ratio per inmate is higher in the transferred facility. Only the transferred establishment has telemedicine resources. Attendance to primary health services is higher that in all non-transferred establishments, while the mean attendance to specialized consultation in the transferred facility doubles that of the remaining centers. Discussion: We have observed greater access to specialized care in the correctional facility managed by the community health system when compared to that of the facilities managed by Penitentiary Institutions. This statement is based on a series of effectivity indicators and results that have provided significantly improved outcome in the transferred facility (AU)

[A new prison health care model: the experience of the Basque Country]. / Un nuevo modelo asistencial penitenciario: la experiencia del País Vasco.

A year after the transfer of prison health care functions and services from the State Administration to the Autonomous Community of the Basque Country, the process up to completion of the transfer, the current status of the transferred services and remaining challenges are described.

Un nuevo modelo asistencial penitenciario: la experiencia del País Vasco / A new prison health care model: the experience of the Basque Country

Un año después del traspaso de las funciones y servicios de la Administración del Estado a la Comunidad Autónoma del País Vasco en materia de sanidad penitenciaria, se describe el proceso que se ha seguido hasta la culminación de la transferencia, la situación actual de los servicios transferidos y los retos pendientes(AU)

A year after the transfer of prison health care functions and services from the State Administration to the Autonomous Community of the Basque Country, the process up to completion of the transfer, the current status of the transferred services and remaining challenges are described(AU)

[Present situation and future perspectives of the epidemic of HIV and AIDS in Spain]. / Situación actual y perspectivas futuras de la epidemia de VIH y sida en España.

Until 1997 Spain was the European country with the highest incidence of AIDS, due mainly to transmission between users of injected drugs. Since early 1990 there has been a fall in the rate of diagnoses of HIV infection in the Spanish autonomous communities where this information is available, and in 2004 this rate was situated below that of several western European countries. New infections in users of intravenous drugs have declined, and although heterosexual transmission has not undergone significant changes, it has become the prime cause of new HIV infections. The rate of diagnoses of HIV has fallen in both the indigenous population and immigrants; however, demographic changes have meant an increase in the percentage of HIV diagnoses in immigrants. In homosexual men there have been descriptions of a recent increase in the incidence of syphilis and gonococcus, which are a warning of possible increases in the transmission of HIV in this group. The number of people who live with HIV in Spain remains between 100,000 and 150,000 (2.4 to 3.6 per 1,000 inhabitants). In spite of the improvement in prognosis due to antiretroviral treatments, there are annually in Spain over 2,000 cases of AIDS (4.8 per 100,000 inhabitants) and over 1,600 deaths from AIDS (3.8 per 100,000). One third of the people who developed AIDS in 2004 had not until then been diagnosed with HIV, which prevented starting the antiretroviral treatment in time.

Situación actual y perspectivas futuras de la epidemia de VIH y sida en España / Present situation and future perspectives of the epidemic of HIV and AIDS in Spain

España fue hasta 1997 el país europeo con mayor incidencia de sida, debido principalmente a la transmisión entre usuarios de drogas inyectadas. Desde principios de 1990 ha disminuido la tasa de diagnósticos de infección por el VIH en las comunidades autónomas españolas que disponen de esta información, y en 2004 esta tasa se situó por debajo de la de varios países de Europa occidental. Han disminuido las nuevas infecciones en usuarios de drogas por vía parenteral, y aunque la transmisión heterosexual no ha sufrido cambios importantes, ha pasado a ser la primera causa de las nuevas infecciones por VIH. La tasa de diagnósticos de VIH ha disminuido tanto en población autóctona como en inmigrantes; no obstante, los cambios demográficos hacen que crezca el porcentaje de diagnósticos de VIH de inmigrantes. En hombres homosexuales se han descrito aumentos recientes en la incidencia de sífilis y gonococia que alertan sobre posibles ascensos en la transmisión del VIH en este colectivo. El número de personas que viven con el VIH en España se mantiene entre 100.000 y 150.000 (2,4 a 3,6 por 1.000 habitantes). A pesar de la mejora en el pronóstico debida a los tratamientos antirretrovirales, en España se producen todavía más de 2.000 casos de sida (4,8 por 100.000 habitantes) y más de 1.600 muertes por sida anuales (3,8 por 100.000 habitantes). Un tercio de las personas que debutaron con sida en 2004 no habían sido diagnosticadas de VIH hasta entonces, lo que impidió iniciar el tratamiento antirretroviral a tiempo

Until 1997 Spain was the European country with the highest incidence of AIDS, due mainly to transmission between users of injected drugs. Since early 1990 there has been a fall in the rate of diagnoses of HIV infection in the Spanish autonomous communities where this information is available, and in 2004 this rate was situated below that of several western European countries. New infections in users of intravenous drugs have declined, and although heterosexual transmission has not undergone significant changes, it has become the prime cause of new HIV infections. The rate of diagnoses of HIV has fallen in both the indigenous population and immigrants; however, demographic changes have meant an increase in the percentage of HIV diagnoses in immigrants. In homosexual men there have been descriptions of a recent increase in the incidence of syphilis and gonococcus, which are a warning of possible increases in the transmission of HIV in this group. ;;The number of people who live with HIV in Spain remains between 100,000 and 150,000 (2.4 to 3.6 per 1,000 inhabitants). In spite of the improvement in prognosis due to antiretroviral treatments, there are annually in Spain over 2,000 cases of AIDS (4.8 per 100,000 inhabitants) and over 1,600 deaths from AIDS (3.8 per 100,000). One third of the people who developed AIDS in 2004 had not until then been diagnosed with HIV, which prevented starting the antiretroviral treatment in time

The validation of statements by IDUs based on the analysis of blood traces on their used syringes.

The objective of this study was to study the correlation between statements made by injecting drug users (IDUs) and the analytical observation of their used syringes, with regard to needle and syringe non-sharing and HIV serology. A survey was carried out on 137 IDUs participating in different needle exchange programmes (NEPs) throughout the Basque Autonomous Community (BAC). The used syringe they handed over in exchange for a new one was kept to study the 'DNA fingerprint' and the presence of HIV. The DNA fingerprint carried on 123 syringes belonging to different injectors who stated that they had not shared them with other IDUs, confirmed that this was so in 98% of the cases. HIV analysis was applied to the 137 syringes and 63 (46%) had HIV antibodies. The consistency was 89% for the cases who voluntarily declared themselves to be HIV-positive and 76% for the cases who declared themselves to be HIV-negative. For the unknown cases, six (31.6%) syringes were HIV-positive. This study supports the validity and reliability of the surveys, based on statements made by the IDUs themselves, on their behaviour. The prevalence of HIV infection in the IDU population must be based on detection of antibodies against HIV.